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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. As used in this section and sections 3727.51 | 7 |
| to 3727.57 of the Revised Code: | 8 |
| (A) "Direct patient care" means care provided by a nurse | 9 |
| with direct responsibility to carry out medical regimens or | 10 |
| nursing care for one or more patients. | 11 |
| (B) "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 |
| (C) "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 |
| Sec. 3727.51. (A) Each hospital shall convene a hospital-wide | 20 |
| nursing care committee not later than ninety days after the | 21 |
| effective date of this section or, if the hospital is not | 22 |
| treating patients on the effective date of this section, ninety | 23 |
| days after the hospital begins to treat patients. The hospital | 24 |
| shall select the members of the committee, subject to all of the | 25 |
| following: | 26 |
| (1) The hospital's chief nursing officer shall be included as | 27 |
| a member of the committee. | 28 |
| (2) At least fifty per cent of the committee's membership | 29 |
| shall consist of registered nurses who provide direct patient care | 30 |
| in the hospital. | 31 |
| (3) The number of registered nurses included as members of | 32 |
| the committee shall be sufficient to provide adequate | 33 |
| representation of all types of nursing care services provided in | 34 |
| the hospital. | 35 |
| (B) The committee member who is the hospital's chief nursing | 36 |
| officer shall establish a mechanism for obtaining input from | 37 |
| nurses in all inpatient care units who provide direct patient | 38 |
| care regarding what the nursing services staffing plan | 39 |
| recommendations described in division (B) of section 3727.52 of | 40 |
| the Revised Code should include. | 41 |
| Sec. 3727.52. A hospital-wide nursing care committee convened | 42 |
| pursuant to section 3727.51 of the Revised Code shall do both of | 43 |
| the following: | 44 |
| (A) If one exists, evaluate the hospital's current nursing | 45 |
| services staffing plan; | 46 |
| (B) Recommend a nursing services staffing plan that is, at a | 47 |
| minimum, consistent with current standards established by private | 48 |
| accreditation organizations or governmental entities and addresses | 49 |
| all of the following: | 50 |
| (1) The selection, implementation, and evaluation of minimum | 51 |
| staffing levels for all inpatient care units that ensure that the | 52 |
| hospital has a staff of competent nurses with the specialized | 53 |
| skills needed to meet patient needs in accordance with | 54 |
| evidence-based safe nurse staffing standards; | 55 |
| (2) The complexity of complete care, assessment on patient | 56 |
| admission, volume of patient admissions, discharges and transfers, | 57 |
| evaluation of the progress of a patient's problems, the amount of | 58 |
| time needed for patient education, ongoing physical assessments, | 59 |
| planning for a patient's discharge, assessment after a change in | 60 |
| patient condition, and assessment of the need for patient | 61 |
| referrals; | 62 |
| (3) Patient acuity and the number of patients for whom care | 63 |
| is being provided; | 64 |
| (4) The need for ongoing assessments of a unit's patients and | 65 |
| its nursing staff levels; | 66 |
| (5) The hospital's policy for identifying additional nurses | 67 |
| who can provide direct patient care when patients' unexpected | 68 |
| needs exceed the planned workload for direct care staff. | 69 |
| Sec. 3727.53. (A) In accordance with division (B) of this | 70 |
| section, each hospital shall create an evidence-based written | 71 |
| nursing services staffing plan guiding the assignment of nurses | 72 |
| hospital-wide. The staffing plan shall be implemented not later | 73 |
| than ninety days after the hospital-wide nursing care committee | 74 |
| is convened pursuant to section 3727.51 of the Revised Code, | 75 |
| except that if the hospital's next fiscal year starts not later | 76 |
| than one hundred eighty days after the date on which the | 77 |
| committee convenes, implementation may be delayed until the first | 78 |
| day of that fiscal year. | 79 |
| (B) The staffing plan created under this section shall, at a | 80 |
| minimum, reflect current standards established by private | 81 |
| accreditation organizations or governmental entities. The plan | 82 |
| shall be based on multiple nurse and patient considerations that | 83 |
| yield minimum staffing levels for inpatient care units that | 84 |
| ensure that the hospital has a staff of competent nurses with | 85 |
| specialized skills needed to meet patient needs. These | 86 |
| considerations shall include both of the following: | 87 |
| (1) The recommendations of the hospital-wide nursing care | 88 |
| committee made under section 3727.52 of the Revised Code, which | 89 |
| shall be given significant consideration; | 90 |
| (2) All of the matters listed in divisions (B)(1) to (5) of | 91 |
| section 3727.52 of the Revised Code. | 92 |
| Sec. 3727.54. At least once a year, the hospital-wide nursing | 93 |
| care committee convened pursuant to section 3727.51 of the Revised | 94 |
| Code shall do both of the following: | 95 |
| (A) Review how the most current nursing services staffing | 96 |
| plan does all of the following: | 97 |
| (1) Affects inpatient care outcomes; | 98 |
| (2) Affects clinical management; | 99 |
| (3) Facilitates a delivery system that provides, on a | 100 |
| cost-effective basis, quality nursing care consistent with | 101 |
| acceptable and prevailing standards of safe nursing care and | 102 |
| evidenced-based guidelines established by national nursing | 103 |
| organizations. | 104 |
| (B) Make recommendations, based on the most recent review | 105 |
| conducted under division (A) of this section, regarding how the | 106 |
| most current nursing services staffing plan should be revised, if | 107 |
| at all. | 108 |
| Sec. 3727.55. To provide staffing flexibility to meet patient | 109 |
| needs, every hospital shall identify a model for adjusting the | 110 |
| nursing services staffing plan created under section 3727.53 of | 111 |
| the Revised Code for each inpatient care unit. | 112 |
| Sec. 3727.56. (A) A hospital shall provide copies of its | 113 |
| nursing services staffing plan created under section 3727.53 of | 114 |
| the Revised Code, in accordance with both of the following: | 115 |
| (1) Free of charge, a copy of the staffing plan and | 116 |
| subsequent changes to the plan shall be provided to each member of | 117 |
| the hospital's nursing staff. | 118 |
| (2) For a fee not to exceed actual copying costs, a copy of | 119 |
| the staffing plan shall be provided to any person who requests it. | 120 |
| (B) In a conspicuous location in the hospital, a notice shall | 121 |
| be posted informing the public of the availability of the staffing | 122 |
| plan. The notice shall specify the appropriate person, office, or | 123 |
| department to be contacted to review or obtain a copy of the | 124 |
| staffing plan. | 125 |
| Sec. 3727.57. Nothing in sections 3727.50 to 3727.56 of the | 126 |
| Revised Code shall be construed to limit, alter, or modify any of | 127 |
| the terms, conditions, or provisions of a collective bargaining | 128 |
| agreement entered into by a hospital. | 129 |