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| To enact sections 3727.50 to 3727.57 of the Revised | 1 |
| Code regarding hospital staffing guidelines for | 2 |
| registered nurses and licensed practical nurses. | 3 |
| Section 1. That sections 3727.50, 3727.51, 3727.52, 3727.53, | 4 |
| 3727.54, 3727.55, 3727.56, and 3727.57 of the Revised Code be | 5 |
| enacted to read as follows: | 6 |
| Sec. 3727.50. (A) As used in this section and sections | 7 |
| 3727.51 to 3727.57 of the Revised Code: | 8 |
| "Direct patient care" means care provided by a nurse with | 9 |
| direct responsibility to carry out medical regimens or nursing | 10 |
| care for one or more patients. | 11 |
| "Inpatient care unit" means a hospital unit, including an | 12 |
| operating room or other inpatient care area, in which nursing care | 13 |
| is provided to patients who have been admitted to the hospital. | 14 |
| "Nurse" means a person who is licensed to practice as a | 15 |
| registered nurse under Chapter 4723. of the Revised Code or, if | 16 |
| the hospital employs licensed practical nurses, a person who is | 17 |
| licensed to practice as a licensed practical nurse under that | 18 |
| chapter. | 19 |
| (B) Each hospital shall convene a hospital-wide nursing care | 20 |
| committee not later than ninety days after the effective date of | 21 |
| this section or, if the hospital is not treating patients on the | 22 |
| effective date of this section, ninety days after the hospital | 23 |
| begins to treat patients. The hospital's chief nursing officer | 24 |
| must be a member and the committee's remaining membership must | 25 |
| include, but not be limited to, registered nurses who provide | 26 |
| direct patient care in a number sufficient to adequately | 27 |
| represent on the committee all types of nursing care services in | 28 |
| the hospital. | 29 |
| Sec. 3727.51. The chief nursing officer of each hospital | 30 |
| shall establish a mechanism for obtaining input from nurses in all | 31 |
| inpatient care units who provide direct patient care regarding | 32 |
| what the nursing services staffing plan recommendations described | 33 |
| in division (B) of section 3727.52 of the Revised Code should | 34 |
| include. | 35 |
| Sec. 3727.52. A hospital-wide nursing care committee convened | 36 |
| pursuant to section 3727.50 of the Revised Code shall do all of | 37 |
| the following: | 38 |
| (A) If one exists, evaluate the hospital's current nursing | 39 |
| services staffing plan; | 40 |
| (B) Recommend a nursing services staffing plan that is, at a | 41 |
| minimum, consistent with current standards established by private | 42 |
| accreditation organizations or governmental entities and addresses | 43 |
| all of the following: | 44 |
| (1) The selection, implementation, and evaluation of minimum | 45 |
| staffing levels for all inpatient care units that ensure that the | 46 |
| hospital has a staff of competent nurses with the specialized | 47 |
| skills needed to meet patient needs in accordance with | 48 |
| evidence-based safe nurse staffing standards; | 49 |
| (2) The complexity of complete care, assessment on patient | 50 |
| admission, volume of patient admissions, discharges and transfers, | 51 |
| evaluation of the progress of a patient's problems, the amount of | 52 |
| time needed for patient education, ongoing physical assessments, | 53 |
| planning for a patient's discharge, assessment after a change in | 54 |
| patient condition, and assessment of the need for patient | 55 |
| referrals; | 56 |
| (3) Patient acuity and the number of patients for whom care | 57 |
| is being provided; | 58 |
| (4) The need for ongoing assessments of a unit's patients and | 59 |
| its nursing staff levels; | 60 |
| (5) The hospital's policy for identifying additional nurses | 61 |
| who can provide direct patient care when patients' unexpected | 62 |
| needs exceed the planned workload for direct care staff. | 63 |
| Sec. 3727.53. Each hospital shall create an evidence-based | 64 |
| written nursing care services staffing plan guiding the | 65 |
| assignment of nurses hospital-wide. The staffing plan must, at a | 66 |
| minimum, reflect current standards established by private | 67 |
| accreditation organizations or governmental entities and be | 68 |
| implemented not later than ninety days after the hospital-wide | 69 |
| nursing care committee is convened pursuant to section 3727.50 of | 70 |
| the Revised Code, except that if the hospital's next fiscal year | 71 |
| starts not later than one hundred eighty days after the date on | 72 |
| which the committee convenes, implementation may be delayed until | 73 |
| the first day of that fiscal year. | 74 |
| The plan shall be based on multiple nurse and patient | 75 |
| considerations that yield minimum staffing levels for inpatient | 76 |
| care units that ensure that the hospital has a staff of competent | 77 |
| nurses with specialized skills needed to meet patient needs. | 78 |
| These considerations shall include both of the following: | 79 |
| (A) The recommendations of the hospital-wide nursing care | 80 |
| committee made under section 3727.52 of the Revised Code, which | 81 |
| shall be given significant consideration; | 82 |
| (B) All of the matters listed in divisions (B)(1) to (5) of | 83 |
| section 3727.52 of the Revised Code. | 84 |
| Sec. 3727.54. At least once a year, the hospital-wide nursing | 85 |
| care committee convened pursuant to section 3727.50 of the Revised | 86 |
| Code shall do both of the following: | 87 |
| (A) Review how the most current nursing services staffing | 88 |
| plan does all of the following: | 89 |
| (1) Affects inpatient care outcomes; | 90 |
| (2) Affects clinical management; | 91 |
| (3) Facilitates a delivery system that provides, on a | 92 |
| cost-effective basis, quality nursing care consistent with | 93 |
| acceptable and prevailing standards of safe nursing care and | 94 |
| evidenced-based guidelines established by national nursing | 95 |
| organizations. | 96 |
| (B) Make recommendations, based on the most recent review | 97 |
| conducted under division (A) of this section, regarding how the | 98 |
| most current nursing services staffing plan should be revised, if | 99 |
| at all. | 100 |
| Sec. 3727.55. To provide staffing flexibility to meet patient | 101 |
| needs, every hospital shall identify a model for adjusting the | 102 |
| staffing plan created under section 3727.53 of the Revised Code | 103 |
| for each inpatient care unit. | 104 |
| Sec. 3727.56. A copy of the nursing care services staffing | 105 |
| plan created under section 3727.53 of the Revised Code, and | 106 |
| subsequent changes to it, shall be provided, free of charge, to | 107 |
| the hospital's nursing staff and, at a cost not to exceed the cost | 108 |
| for copying the plan, to any other peson who requests it. | 109 |
| Sec. 3727.57. Nothing in sections 3727.50 to 3727.56 of the | 110 |
| Revised Code shall be construed to limit, alter, or modify any of | 111 |
| the terms, conditions, or provisions of a collective bargaining | 112 |
| agreement entered into by a hospital. | 113 |