75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 2564
Senate Bill 564
Sponsored by COMMITTEE ON HEALTH CARE AND VETERANS' AFFAIRS (at
the request of Oregon Federation of Nurses and Health
Professionals (AFT, Local 5017) and AFT-Oregon)
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Requires certain health care facilities to implement
acuity-based classification systems, maintain certain
nurse-to-patient staffing ratios, submit staffing plans to
Department of Human Services and implement work assignment
policies. Imposes penalties for violations. Punishes
falsification of required documents by maximum of one year's
imprisonment, $6,250 fine, or both.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to nurses; creating new provisions; amending ORS
441.030, 441.166 and 441.180; repealing ORS 441.162, 441.164
and 441.170; and declaring an emergency.
Whereas the purpose of this 2009 Act is to ensure that the
delivery of health care services to patients in health care
facilities is adequate and safe, and that health care facilities
retain sufficient registered nursing staff to promote optimal
health care outcomes; and
Whereas inadequate hospital staffing results in dangerous
medical errors and patient infections; and
Whereas registered nurses constitute the highest percentage of
direct health care staff in acute care facilities and have a
central role in health care delivery; and
Whereas in order to ensure the adequate protection and care for
patients in health care facilities it is essential that qualified
registered nurses be accessible and available to meet the nursing
needs of patients; and
Whereas the basic principles of staffing in health care
facilities should be focused on patient health care needs and be
based on consideration of patient acuity levels and services that
ensure optimal outcomes; and
Whereas the high-stress workplace environment caused by an
increase in the number and acuity of patients assigned to nurses
results in a decrease in the amount of time nurses have to
participate in direct patient care and severely and negatively
impacts the quality of nursing care patients receive; and
Whereas establishing staffing standards for registered nurses
in health care facilities ensures that the facilities provide
safe workplace environments and improves public safety and the
quality of health care services; now, therefore,
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + As used in sections 1 to 5 of this 2009 Act:
(1) 'Acuity-based patient classification system' means a
standard set of criteria, based on scientific data, that:
(a) Predicts registered nursing care requirements for
individual patients based on severity of patient illness, need
for specialized equipment and technology, intensity of nursing
interventions required and the complexity of clinical judgment
needed to design, implement and evaluate a patient's nursing care
plan consistent with professional standards of care;
(b) Details the amount of registered nursing care needed, both
in number of direct care registered nurses and skill mix of
nursing personnel required on a daily basis for each patient in a
nursing department or unit;
(c) Is stated in terms that can be readily used and understood
by direct care registered nurses; and
(d) Takes into consideration the patient care services provided
by registered nurses, licensed practical nurses and other health
care personnel.
(2) 'Assessment tool' means a system that compares the
registered nurse staffing level in a nursing department or unit
against actual patient nursing care requirements to measure the
accuracy of an acuity-based patient classification system.
(3) 'Direct care registered nurse' means a registered nurse who
is directly responsible for carrying out medical regimens,
nursing care or other bedside care for patients.
(4) 'Facility' means a hospital licensed in Oregon, any
licensed private or state owned and operated general acute care
program hospital, psychiatric facility or specialty hospital or
an acute care program within a state operated facility.
(5) 'Nursing care' means care that falls within the scope of
the practice of nursing defined in ORS 678.010 to 678.410 or
within recognized professional standards of nursing. + }
SECTION 2. { + (1) Each facility shall implement and maintain
the following minimum direct care registered nurse-to-patient
staffing ratios:
(a) Acute rehabilitation unit, 1:3;
(b) Burn unit, 1:2;
(c) Cardiac care unit, 1:2;
(d) Critical care unit, 1:2;
(e) Emergency critical care, 1:2;
(f) Emergency department, 1:3;
(g) Emergency trauma, 1:1;
(h) Intensive care unit, 1:2;
(i) Medical and surgical, 1:4;
(j) Neonatal intensive care, 1:2;
(k) Observational and outpatient treatment, 1:4;
(L) Operating room:
(A) Under anesthesia, 1:1; and
(B) Post-anesthesia, 1:2;
(m) Pediatrics, 1:3;
(n) Perinatal care:
(A) Antepartum, 1:3;
(B) Active labor, 1:1;
(C) Immediate postpartum, 1:2;
(D) Postpartum, 1:6;
(E) Intermediate care nursery, 1:4; and
(F) Well baby nursery, 1:6;
(o) Post-anesthesia care unit:
(A) Under anesthesia, 1:1; and
(B) Post-anesthesia, 1:2;
(p) Psychiatric, 1:4;
(q) Rehabilitation unit, 1:5;
(r) Specialty care unit, 1:4;
(s) Step-down/intermediate care, 1:3;
(t) Telemetry, 1:3; and
(u) Transitional care, 1:5.
(2)(a) Any unit not otherwise listed in subsection (1) of this
section shall be considered a specialty care unit.
(b) A triage or other specialty registered nurse is not counted
as a nurse for the minimum direct care registered
nurse-to-patient staffing ratio established by subsection (1) of
this section.
(3) Nothing in this section:
(a) Precludes a facility from increasing the number of direct
care registered nurses in any unit above the minimum staffing
ratios established by this section; or
(b) Supersedes any requirements otherwise mandated by law, rule
or a collective bargaining agreement if compliance with those
requirements allows the facility to meet the minimum staffing
ratios established by this section.
(4) The minimum direct care registered nurse-to-patient
staffing ratios established by this section do not authorize the
understaffing of other critical health care workers, including
but not limited to licensed practical nurses and certified
nursing assistants, required to enable direct care registered
nurses to focus on the nursing care functions that only direct
care registered nurses are authorized by law to perform. + }
SECTION 3. { + (1) In order to obtain a license from the
Department of Human Services, a facility shall submit annually to
the department a prospective staffing plan, together with a
statement that the staffing plan is sufficient to provide
adequate and appropriate delivery of health care services to
patients for the ensuing year. The prospective staffing plan
must:
(a) Meet the minimum direct care registered nurse-to-patient
staffing ratios established by section 2 of this 2009 Act;
(b) Meet any other requirements for a facility established by
any other applicable law or regulation;
(c) Employ an acuity-based patient classification system for
addressing fluctuations in patient acuity levels by increasing
direct care registered nurse staffing levels above the minimum
staffing ratios established by section 2 of this 2009 Act;
(d) Provide for training of direct care registered nursing
staff in assigned clinical practice areas, including temporary
assignments, sufficient to provide competent nursing care;
(e) Include staffing requirements for other nursing department
or unit activity such as discharges, transfers, admissions and
administrative and support tasks that are done by direct care
registered nurses in addition to direct nursing care;
(f) Describe the assessment tool used to measure and document,
on a daily basis, direct care registered nurse staffing in each
nursing department or unit of the facility for each shift;
(g) Be produced in consultation with a majority of the direct
care registered nurses in each nursing department or unit or, if
applicable, with the recognized or certified collective
bargaining representative of direct care registered nurses at the
facility; and
(h) Include an audit of the preceding year's staffing plan
submitted in compliance with this section. The audit must compare
the requirements of the staffing plan with the actual staffing
for the period covered by the audit and include measurements of
actual acuity for all units within the facility.
(2) A facility required to have a staffing plan under this
section shall:
(a) Prominently post within each unit of the facility the daily
written nursing staffing plan reflecting the minimum direct care
registered nurse-to-patient staffing ratios established by
section 2 of this 2009 Act;
(b) Make copies of the staffing plan filed with the department
available to the public upon request; and
(c) Provide patients with a toll-free hotline number for the
department that may be used to report inadequate direct care
registered nurse staffing.
(3) A facility may not assign any person who is not a direct
care registered nurse to perform functions that must be provided
by a licensed direct care registered nurse, including functions
that require the clinical assessment, judgment and skill of a
direct care registered nurse. These functions include, but are
not limited to:
(a) Physical, psychological and social assessments that require
nursing judgment, intervention, referral or follow-up;
(b) Formulation of the plan of nursing care and evaluation of
the patient's response to the care provided;
(c) Administration of medications; and
(d) Health teaching and health counseling.
(4) A facility shall employ a full-time direct care registered
nurse executive leader to be responsible for:
(a) Management of resources to ensure sufficient direct care
registered nurse staffing is provided by the facility;
(b) Quality assurance of nursing care provided by the facility;
and
(c) Occupational health and safety of nursing staff employed by
the facility.
(5) For the purpose of compliance with the minimum direct care
registered nurse-to-patient staffing ratios established by
section 2 of this 2009 Act, a direct care registered nurse may
not be assigned to or be included in the count of assigned direct
care registered nurse staff in a nursing department or unit or a
clinical practice area within the facility unless the direct care
registered nurse has had training in that clinical practice area
sufficient to provide competent nursing care to the patients in
that area, and has demonstrated current competence in providing
care in that area.
(6) A facility shall adopt, distribute to direct care
registered nurses and comply with a written policy that
establishes the circumstances under which a direct care
registered nurse may refuse a work assignment. The work
assignment policy must include:
(a) A provision that permits a direct care registered nurse to
refuse any assignment that:
(A) The nurse is not prepared by education, training or
experience to fulfill without compromising or jeopardizing
patient safety, the nurse's ability to meet foreseeable patient
needs or the nurse's license; or
(B) Would violate requirements established by sections 2 and 3
of this 2009 Act;
(b) Reasonable requirements and methods for providing prior
notice and supporting reasons to the direct care registered
nurse's supervisor regarding the nurse's refusal of a work
assignment;
(c) A provision that allows, when feasible, an opportunity for
the supervisor to review the specific conditions supporting the
direct care registered nurse's refusal of a work assignment, and
to decide whether to remedy the conditions, to relieve the nurse
of the assignment or to deny the nurse's request to be relieved
of the assignment; and
(d) A process that permits the direct care registered nurse to
exercise the right to refuse the assignment when the supervisor
denies the request to be relieved if:
(A) The supervisor rejects the request without proposing a
remedy or the proposed remedy would be inadequate or untimely;
(B) The complaint and investigation process with a regulatory
agency would be untimely to address the concern; and
(C) The nurse refusing the work assignment believes in good
faith that the assignment meets conditions justifying refusal.
(7) A nurse who refuses an assignment pursuant to a work
assignment policy established pursuant to this section is not,
because of the refusal, considered to have engaged in negligent
or incompetent action or patient abandonment, or otherwise to
have violated applicable legal standards of nursing. + }
SECTION 4. { + The Department of Human Services shall:
(1) Adopt rules necessary to implement the provisions of
sections 1 to 5 of this 2009 Act, including, but not limited to
developing:
(a) An acuity-based patient classification system to be used by
all facilities to predict the number of direct care registered
nurses necessary to meet patient needs; and
(b) An easily accessible, confidential method by which a person
can:
(A) Report any failure to comply with the requirements of
sections 2 and 3 of this 2009 Act; and
(B) Access information about reports of inspections of
facilities, failure by a facility to comply with the requirements
of sections 1 to 5 of this 2009 Act and corrective action taken
by facilities to correct any deficiencies identified; and
(2) Investigate a report that a facility has failed to comply
with the requirements of sections 2 and 3 of this 2009 Act within
24 hours after receiving the report. + }
SECTION 5. { + (1) If a facility violates any provision of
section 2 or 3 of this 2009 Act or rules adopted under section 4
of this 2009 Act, the Department of Human Services may:
(a) Revoke or suspend the facility's license or registration;
and
(b) Impose a civil penalty of not more than $25,000 for each
violation.
(2) Each day a facility is in violation of a provision of
section 2 or 3 of this 2009 Act or rules adopted under section 4
of this 2009 Act is a separate violation.
(3) Civil penalties imposed under this section are in addition
to any other penalties that may be prescribed by law.
(4) Civil penalties may be assessed in any court of competent
jurisdiction in any action brought on behalf of a patient or
resident aggrieved by a violation of a provision of section 2 or
3 of this 2009 Act or rules adopted under section 4 of this 2009
Act.
(5) Civil penalties assessed under this section shall be
deposited in the State Treasury and credited to the Nursing
Education Grant Fund established under ORS 353.612.
(6) Falsification of any documents required to be filed with
the department by section 2 or 3 of this 2009 Act or rules
adopted under section 4 of this 2009 Act is a Class A
misdemeanor. + }
SECTION 6. { + ORS 441.162, 441.164 and 441.170 are
repealed. + }
SECTION 7. ORS 441.030 is amended to read:
441.030. (1) The Department of Human Services, pursuant to ORS
479.215, shall deny, suspend or revoke a license in any case
where the State Fire Marshal, or the representative of the State
Fire Marshal, certifies that there is a failure to comply with
all applicable laws, lawful ordinances and rules relating to
safety from fire.
(2) The department may deny, suspend or revoke a license in any
case where it finds that there has been a substantial failure to
comply with ORS 441.015 to 441.063, 441.085 or 441.087 or the
rules or minimum standards adopted under ORS 441.015 to 441.063,
441.085 or 441.087.
(3) The department may suspend or revoke a license issued under
ORS 441.025 for failure to comply with a department order arising
from a health care facility's substantial lack of compliance with
the provisions of ORS 441.015 to 441.063, 441.084 to 441.087
{ - , 441.162 - } or 441.166 or the rules adopted under ORS
441.015 to 441.063, 441.084 to 441.087 { - , 441.162 - } or
441.166, or for failure to pay a civil penalty imposed under ORS
{ - 441.170 or - } 441.710.
(4) The department may order a long term care facility licensed
under ORS 441.025 to restrict the admission of patients when the
department finds an immediate threat to patient health and safety
arising from failure of the long term care facility to be in
compliance with ORS 441.015 to 441.063 or 441.084 to 441.087 and
the rules adopted under ORS 441.015 to 441.063 or 441.084 to
441.087.
(5) Any long term care facility that has been ordered to
restrict the admission of patients pursuant to subsection (4) of
this section shall post a notice of the restriction, provided by
the department, on all doors providing ingress to and egress from
the facility, for the duration of the restriction.
SECTION 8. ORS 441.166 is amended to read:
441.166. (1) When a hospital learns about the need for
replacement staff, the hospital shall make every reasonable
effort to obtain registered nurses, licensed practical nurses or
certified nursing assistants for unfilled hours or shifts before
requiring a registered nurse, licensed practical nurse or
certified nursing assistant to work overtime.
(2) A hospital may not require a registered nurse, licensed
practical nurse or certified nursing assistant to work:
(a) Beyond the agreed-upon shift;
(b) More than 48 hours in any hospital-defined work week; or
(c) More than 12 consecutive hours in a 24-hour time period,
except that a hospital may require an additional hour of work
beyond the 12 hours if:
(A) A staff vacancy for the next shift becomes known at the end
of the current shift; or
(B) There is a potential harm to an assigned patient if the
registered nurse, licensed practical nurse or certified nursing
assistant leaves the assignment or transfers care to another.
(3)(a) Time spent in required meetings or receiving education
or training shall be included as hours worked for purposes of
subsection (2) of this section.
(b) Time spent on call but away from the premises of the
employer may not be included as hours worked for purposes of
subsection (2) of this section.
(c) Time spent on call or on standby when the registered nurse,
licensed practical nurse or certified nursing assistant is
required to be at the premises of the employer shall be included
as hours worked for purposes of subsection (2) of this section.
(4) The provisions of this section do not apply to nursing
staff needs:
(a) In the event of a national or state emergency or
circumstances requiring the implementation of a facility disaster
plan;
(b) In emergency circumstances identified by the Department of
Human Services by rule; or
(c) If a hospital has made reasonable efforts to contact
{ - all of the - } on-call nursing staff or staffing agencies
{ - on the list described in ORS 441.162 - } and is unable to
obtain replacement staff in a timely manner.
SECTION 9. ORS 441.180 is amended to read:
441.180. (1) A hospital shall post a notice summarizing the
provisions of ORS { - 441.162, - } 441.166, 441.168, 441.174,
441.176, 441.178 and 441.192 in a conspicuous place on the
premises of the hospital. The notice must be posted where notices
to employees and applicants for employment are customarily
displayed.
(2) Any hospital that willfully violates this section is
subject to a civil penalty not to exceed $500. Civil penalties
under this section shall be imposed by the Department of Human
Services in the manner provided by ORS 183.745.
SECTION 10. { + (1) Sections 1, 2, 3 and 5 of this 2009 Act,
the repeal of ORS 441.162, 441.164 and 441.170 by section 6 of
this 2009 Act and the amendments to ORS 441.030, 441.166 and
441.180 by sections 7 to 9 of this 2009 Act become operative on
January 1, 2011.
(2) The Department of Human Services may take any action before
the operative date specified in subsection (1) of this section
that is necessary to enable the department to exercise, on and
after the operative date specified in subsection (1) of this
section, all the duties, functions and powers conferred on the
department by section 3 to 5 of this 2009 Act.
(3) The department shall adopt the rules required by section 4
of this 2009 Act by July 1, 2010. + }
SECTION 11. { + This 2009 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2009 Act takes effect on
its passage. + }
----------