Hospitals would limit nurse assignments and post staffing plans

Hospitals would have to follow maximum patient assignments for registered nurses. Limits vary by care unit and, in some units, by a patient's condition; for example, each mother and baby counts as a separate patient in postpartum, antepartum, and well-baby units. A hospital could assign fewer patients than the maximum. The limit depends on the type of care provided, even if the hospital uses a different name for the unit. Hospitals could not average assignments across a shift or time period, and could not count coordinating nurses, remote nurses, or artificial intelligence as bedside nurses.

Hospitals would have to create staffing plans through a committee and make the plans public. Each hospital's plan would cover staffing in its care units and be prepared by a committee that includes nurses, support workers, and hospital representatives. A majority of the staffing committee would have to approve the plan. At least 51 percent of committee members must be nonsupervisory nurses who provide direct care; the committee must also include a support worker and specified hospital leaders. The plan must include nurse numbers and skill levels, support-worker staffing, a patient-care needs system, and the hospital's practices for temporary and travel nurses. Hospitals could not reduce support-worker staffing below the plan or a labor agreement. Hospitals would have to put their first plan in place by January 1, 2027, and send the department the plan for the next calendar year by October 1 each year.

Hospitals would have to report staffing failures and complaints; the Department of Health could require corrective steps and assess civil penalties. Hospitals would report to the Department of Health; quarterly reports would include staffing failures and complaints made to the staffing committee. The department would issue a corrective plan within 30 days after presenting findings of noncompliance to a hospital; failure to follow that plan could lead to a penalty. Penalty amounts would depend on hospital size and the type of reporting or compliance failure. Quarterly reports would be due by the last business day of the month after each quarter; hospitals would also submit their next year's plan by October 1.

Hospitals could depart from staffing limits or their plans in specified emergencies, and employees could report unsafe staffing without retaliation. Employees, nurses, labor representatives, patients, and others could raise concerns about assignments that depart from a hospital plan. Allowed departures include an unforeseen emergency that could jeopardize patient safety, certain weather-related scheduling problems, and a temporary staffing emergency declared by a rural hospital. After an emergency or weather-related departure, the hospital would have to report it and assess staffing needs to the committee within 30 days. A departure lasting more than 90 days would need majority committee approval. Hospitals could not retaliate against employees for committee participation or raising unsafe-staffing concerns. Hospitals would have to report emergency or weather-related departures within 30 days; committee approval would be required to continue one beyond 90 days.