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AN ACT TO PROMOTE SAFE PATIENT CARE AND Bill Number: Senate 1244 (2007-2008) Committee(s): Public Health Sponsors: Sen. Richard T. Moore, Rep. John Lepper, Rep. John Fernandes, Sen. Sue Fargo, Rep. Martha M. Walz, Sen. Steven C. Panagiotakos, Sen. Karen E. Spilka, Rep. Walter F. Timilty, Sen. Bruce E. Tarr Summary: This bill will provide a process to bolster the supply of nurses and nurse faculty through incentives for students and matching grants for hospitals. It also creates a public accountability process for developing staffing patterns for patient care. The bill further provides a process to evaluate and report on measures to improve the quality of patient care and ensure transparency in hospital nurse staffing. Section 1. Analysis of Workforce and Faculty Resources Directs the Secretary of Administration and Finance to review the efficacy of current workforce development programs and recommend the redesign of state initiatives to ensure a coordinated focus on enhancing the development of the health care workforce. Report is due April 15, 2007. It also directs the Board of Higher Education to analyze the nurse faculty shortage in both publicly funded and private schools of nursing. The Board will compile information necessary to understand the full scope of the shortage and make recommendations to enhance the nurse faculty pipeline. The report is due on April 15, 2007 and will be compiled in collaboration with the Department of Labor and Workforce Development, the Board of Registration in Nursing, and the Massachusetts Center for Nursing, Inc. Section 2: Promoting Health Care Professions Directs the Executive Office of Economic Development to develop a statewide plan to promote health care professions to the general public, including young adults and adult career changers. Section 3. Enhancing the Availability of Nursing Workforce Data Creates a repository for all nursing workforce data collected by the Commonwealth. This section requires all state agencies that collect data, conduct surveys or gather information related to the practice of nursing, the supply of nursing workforce, the supply of nursing faculty or any other nursing workforce issue, to regularly submit such data to the Massachusetts Center for Nursing, Inc. (MCN). MCN is a unique collective of nursing organizations working together to shape a healthy future for the profession of nursing and for the people of Massachusetts through collaboration and innovation. The Center for Nursing is charged with identifying categories of data that are not currently reported to the center that would enhance the ability of the center to identify and analyze nurse-sensitive patient outcome measures. The Center will develop uniform reporting requirements for all agencies that should be required to submit data. The Center will also develop recommendations for legislation or regulation, together with an appropriate budget request for collection and analysis of data, necessary to carry out the intent of this section. Section 4. Establishing the Clara Barton Nursing Excellence Programs Creates the Clara Barton Nursing Excellence Trust Fund and appropriates $30 million to fund the Clara Barton Nursing Excellence Programs. These programs include: a student loan repayment program and a faculty position bonus payment program of $25,000 per year for ten years; an expert nursing corps to provide mentoring services to incoming or novice nurses with stipends of up to $5,000 a year for five years; a grant program for higher education and health care institutions to foster partnerships that promote the recruitment and retention of nurses; a scholarship program to encourage outstanding students to pursue nursing as a profession; and, a matching grant program to provide a dollar-for-dollar match for any hospital that commits resources or personnel to nurse education programs. Section 5. Accountability for Nurse Staffing Requires that all hospitals licensed by the Department of Public Health file and post a nurse staffing plan that addresses patient nursing needs by identifying the appropriate number and mix of staff for each hospital, specific to each shift in the hospital inpatient units, special care units, and emergency departments by day of week. The nurse staffing plan will address patient nursing needs in each hospital and set forth a mechanism to obtain input from all members of the patient care team. Each plan will identify relevant factors, such as: the number of patients in a unit, the intensity of care required; skill and experience of various care givers including registered nurses, licensed practical nurses, ancillary personnel, and other members of the patient care team consistent with the level of authority and responsibility delegated under state licensure; admission, discharge, and transfers; geography of a unit; and the availability of technological support. This section also requires that the nurse staffing plan shall be reviewed and updated when necessary to reflect significant variations in services, approved by the hospital board, describe how it meets applicable JCAHO nurse staffing standards, and be filed with DPH on an annual basis. Hospitals will be subject to $1,000 per day late penalties for failure to submit the plan and are subject to random audits by DPH to ensure that the plan meets the various criteria outlined in the section. A hospital may be required to resubmit a staffing plan if it is deemed inadequate to meet patient care needs. Late fines collected will be deposited in the Clara Barton Nursing Excellence Trust Fund administered by the Board of Higher Education. Section 6. Evaluation of Patient Care Using Nurse-Sensitive Performance Measures Requires hospitals, through their quality improvement programs, to institute a process to collect, monitor, and evaluate patient care through the statewide use of not less than hree evidence-based nurse-sensitive performance measures. The measures will be selected by the Betsy Lehman Center from the National Quality Forum nurse-sensitive performance measures including, but not limited to the National Databank of Nursing Quality Indicators (NDNQI), and will include patient care hours per patient day. Nursing sensitive measures shall include, but not be limited to: patient falls, pressure ulcers, physical/sexual assault, pain management, peripheral IV infiltration, staff mix of Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Nurse Assistants (NAs) and Unlicensed Assistive Personnel (UAP); nursing care hours provided per patient day, RN education/certification, and an RN satisfaction survey. The Center will develop the annual reporting process and will publicly report both hospital-specific performance measure data and aggregated industry trends and best practice developed from the annual reports. Section 7. Limits on Mandatory Overtime and Hours Worked by Nurses Establishes a standard for nursing work hours. A hospital shall not require or permit a nurse to work more than 12 hours in any given shift and not to exceed 16 hours in a 24 hour period. A nurse may not be disciplined, dismissed, or discharged for refusing to work beyond the hours specified in this paragraph. A nurse that works 12 consecutive hours in a shift must be given at least 10 hours off from any work between shifts. Limits hospitals to using mandatory overtime for emergency situations where the safety of a patient requires its use and when there is no reasonable alternative. Whenever a nurse is required to work mandatory overtime, the hospital must document, in an aggregated manner, such use in the annual nurse staffing plan as filed with the department pursuant to Chapter 111, Section 56A. The provisions of this section would not apply to:
Section 8. Requirement for Nursing Homes to Have Registered Nurse on Duty Requires that nursing homes certify that they will, at all times, have at least one registered nurse on duty on all shifts, on all days. Section 9. Limitation on Work Hours of Nurses Nurses are not to work more than 12 hours in any given shift or in excess of 16 hours in a 24 hour period. Nurses that work 12 consecutive hours in a shift must take at least 10 hours off between shifts. During the rest period, nurses are not to work for employment compensation for a health care facility or for any other employer or work for compensation more than 60 hours in any seven day period whether such work is for a health care facility or other employer. Section 10. Commission to Study Limitations of Nursing Hours in Order to Reduce Fatigue and Improve Patient Care Establishes a broad-based commission within the Executive Office of Health and Human Services to study of the limitations of nursing hours in order to reduce fatigue and to improve patient care in hospitals. In particular, the special commission shall review the recommendations of the Institute of Medicine’s report “Keeping Patients Safe: Transforming the Work Environment of Nurses” (issued on November 4, 2003) regarding the limitation of nursing hours. The commission shall study key findings of the report and make recommendations for implementation of the findings based on existing state regulations, workforce shortages, and the current financing of hospital care in Massachusetts. The Commission will be jointly chaired by the Chairmen of the Joint Committee on Health Care Financing and will issue a report within six months of the effective date of the act. Section 11: Effective dates (a) The provision of Sections 6, and 7of this Act shall become effective on April 15, 2009. |
