Enacts the "safe staffing for quality care act" to require acute care facilities and nursing homes to implement certain direct-care nurse to patient ratios in all nursing units; sets minimum staffing requirements; requires every such facility to submit a documented staffing plan to the department on an annual basis and upon application for an operating certificate; requires acute care facilities to maintain staffing records during all shifts; authorizes nurses to refuse work assignments if the assignment exceeds the nurse's abilities or if minimum staffing is not present; requires public access to documented staffing plans; imposes civil penalties for violations of such provisions; establishes private right of action for nurses discriminated against for refusing any illegal work assignment.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1548
SPONSOR: Gottfried (MS) TITLE OF BILL: An act to amend the public health law, in relation to
enacting the "safe staffing for quality care act"
PURPOSE OR GENERAL IDEA OF BILL: To require all acute care facilities
and nursing homes to meet standards for appropriate staffing ratios of
nursing and unlicensed direct care staff.
SUMMARY OF SPECIFIC PROVISIONS: Section 1 is the short title.
Section 2 amends Public Health Law § 2805 to require that application
for operating certificates for a hospital include a direct care staffing
plan.
Section 3 adds nine new sections, 2823 through 2831, which require
hospitals to maintain and comply with a staffing plan; establish the
Acute Care Facility Council to be appointed by the Commissioner of
Health, enumerate the elements of a satisfactory staffing plan; set
forth minimum nurse to patient ratios; require clinical competency;
provide for emergency situations; require public disclosure of facility
staffing requirements; and allows for private right of action by employ-
ees.
Section 4 amends § 2801-a directing the Public Health and Health Plan-
ning Council to consider staffing violations when reviewing "character,
competence and standing in the community" for applications and renewals
of certificates of incorporation or establishment of a hospital.
Section 5 amends § 2805 requiring the Commissioner to consider staffing
violations when reviewing applications and renewals operating certif-
icates for acute care facilities.
Section 6 amends § 2895-b to establish a Residential Health Care Facili-
ty Council to be appointed by the Commissioner; requires minimum staff-
hours of care per resident per day; allows for private right of action
by employees; and requires public disclosure of information about direct
care staffing.
JUSTIFICATION: The hospital nurse-to-patient ratios specified in this
bill are based on peer-reviewed academic research and evidence-based
recommendations. The minimum care hours specified for residential health
care facilities are also based on research evidence and on the recommen-
dations of the Institute of Medicine's report, "Keeping Patients Safe:
Transforming the Work Environment of Nurses" (2004).
The number of patients assigned to a nurse has a direct impact on the
quality of care that nurse can provide. Research published in the Jour-
nal of the American Medical Association, estimates five additional
deaths per 1,000 patients in hospitals which routinely staff with only
1:8 nurse-to-patient ratios compared to those staffing with 1:4 nurse-
to-patient ratios. This same study determined the odds of patient death
increased by 7% for each additional patient the nurse must care for at
one time.
Safe nurse staffing also reduces avoidable, adverse patient outcomes.
Research funded by the federal Agency for Healthcare Research and Quali-
ty (AHRQ) has demonstrated that hospitals with lower nurse staffing
levels have higher rates of pneumonia, shock, cardiac arrest, urinary
tract infections and upper gastrointestinal bleeds; all leading to high-
er costs and mortality from hospital-acquired complications.
In nursing homes, research has demonstrated that safe nurse staffing
levels have a positive impact on facility processes and on resident
outcomes. Research has demonstrated that as nurse turnover increases in
nursing homes, the quality of resident care declines, resulting in more
frequent use of restraints, urinary catheterization, and psychoactive
drugs; increased risk of contractures, pressure ulcers and more survey
deficiencies.
A broad range of research demonstrates that increased staffing levels do
not diminish the profitability of facilities. Nursing workforce costs
may rise, but that increase is mitigated by overall savings from
improved patient outcomes and avoided adverse events. The improved
outcomes reduce medical malpractice and other penalties resulting from
avoidable occurrences and poor patient satisfaction.
In 2004, California became the first state to mandate nurse staffing
ratios in hospitals. New statistical analysis reveals that the Califor-
nia mandates are significantly associated with fewer negative outcomes
for patients and staff. The study, published in Health Services Research
and conducted by the Center for Health Outcomes and Policy Research,
University of Pennsylvania, concluded that "Improved nurse staffing,
however it is achieved, is associated with better outcomes for nurses
and patients."
Establishing staffing standards for nursing and unlicensed direct care
staff in acute care facilities and residential health care facilities
will help ensure that these facilities operate in a manner that guaran-
tees the public safety and the delivery of quality health care services.
PRIOR LEGISLATIVE HISTORY: 2009-2010: A.11015- referred to Health
committee. 2011-2012: A.921- reported to Ways and Means committee
2013-2014: A6571- reported to Ways and Means committee
FISCAL IMPLICATIONS: Some staff time in the Department of Health;
possible increased Medicaid spending to cover the cost of increased
staffing balanced by reduced Medicaid spending as reduced bad outcomes
and reduced staff turnover reduce health care costs.
EFFECTIVE DATE: Takes effect 180 days after it becomes law.
