Hospitals would set staffing committees and patient-care staffing rules

Covered hospitals would create technical and service staffing committees, or use committees formed through collective bargaining, and those committees would work with the nursing committee on a written staffing plan. This applies to hospitals in counties with at least 100,000 people that are licensed for more than 70 beds. Technical and service staff would elect at least half of each committee’s members, while hospital management would appoint at least half. Each committee would meet at least quarterly. The staffing plan would address nursing, technical staff, and service staff, and committee members could record objections to the plan. Hospitals would submit reports about the committees’ formation, work, progress, and effectiveness every year by December 31, alternating between the Legislature and an interim legislative committee. A collective bargaining committee could serve in place of a committee formed under these provisions. The provisions would apply for most purposes on October 1, 2025, if enacted; preparatory rulemaking and administrative work could begin upon passage and approval.

Covered hospitals would follow maximum patient assignments for direct-care nurses and, when applicable, certified nursing assistants, and would keep daily staffing and patient-safety records. The proposed nurse ratios vary by hospital unit, including one nurse per patient in operating and critical care rooms, one per three patients in some units, and one per four patients in several general units. Certified nursing assistant plans would use one assistant per seven patients during the day and one per 11 overnight. Hospitals would have to assign a separate nurse for emergency triage and could not count that nurse toward other ratios. Only properly licensed, oriented, and competent nurses could count toward a unit’s staffing ratio. Hospitals would also assign scrub assistants in operating rooms and direct-observation or safety staff for patients. Hospitals would keep records for at least seven years and make them available to the state health division or Labor Commissioner. The proposed ratios and recordkeeping duties would apply for most purposes on October 1, 2025, if enacted.

Hospitals could temporarily depart from the staffing plan during a defined emergency, while state officials could investigate violations, impose licensing penalties, and protect workers who report suspected violations. The emergency option would cover large hospitals in counties with at least 100,000 people during state or federal emergencies, public health emergencies, disasters, or similar events requiring crisis standards of care. Reporting and enforcement provisions would cover the health care facilities and workers addressed by the staffing rules. A hospital deviating from the plan or ratios would report its staffing needs within 30 days to the nursing staffing committee. The nursing staffing committee would create a crisis staffing plan if the emergency continued. A hospital could not continue the deviation for more than 90 days without committee approval. The Division could conduct random visits, receive confidential reports, investigate violations, assign facility star ratings, and use licensing actions or administrative penalties to correct violations. Facilities could appeal inspection findings and would have to post final ratings. The proposed provisions would apply for most purposes on October 1, 2025, if enacted. A deviation report would be due within 30 days, and a deviation lasting beyond 90 days would require committee approval.