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General Assembly Raised Bill No. 1067
January Session, 2023
LCO No. 4107
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING ADEQUATE AND SAFE HEALTH CARE
STAFFING.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-89e of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2023): 2
(a) For purposes of this section: 3
(1) "Department" means the Department of Public Health; [and] 4
(2) "Hospital" means an establishment for the lodging, care and 5
treatment of persons suffering from disease or other abnormal physical 6
or mental conditions and includes inpatient psychiatric services in 7
general hospitals; 8
(3) "Assistive personnel" means personnel who are not licensed by 9
the Department of Public Health, but who work under the direct 10
supervision of a registered nurse to implement specifically delegated 11
patient care activities; and 12
(4) "Professional judgment" means the application of knowledge, 13 Raised Bill No. 1067
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expertise and experience, in accordance with the provisions of the 14
general statutes and regulations of Connecticut state agencies 15
concerning the practice of nursing, in conducting a comprehensive 16
nursing assessment of each patient and making independent decisions 17
about patient care, including, but not limited to, the need for additional 18
staff providing patient care. 19
(b) Each hospital licensed by the department pursuant to chapter 20
368v shall report, annually, to the department on a prospective nurse 21
staffing plan with a written certification that the nurse staffing plan is 22
sufficient to provide adequate and appropriate delivery of health care 23
services to patients in the ensuing period of licensure. Such plan shall 24
promote a collaborative practice in the hospital that enhances patient 25
care and the level of services provided by nurses and other members of 26
the hospital's patient care team. Nurse staffing plans developed and 27
implemented on or after January 1, 2028, shall require the following 28
ratios of (1) patients to registered nurses providing direct patient care 29
per corresponding patient care unit: (A) Four to one for the emergency 30
department; (B) two to one for patients requiring intensive care in the 31
emergency department; (C) one to one for trauma patients in the 32
emergency department; (D) two to one for the intensive care unit; (E) 33
three to one for the progressive care unit; (F) four to one for the 34
telemetry unit; (G) five to one for the medical-surgical unit; (H) four to 35
one for the pediatric unit; (I) one to one for the operating room; (J) two 36
to one in the post-anesthesia recovery unit; (K) five to one for the 37
oncology unit; (L) five to one for the orthopedics unit; (M) six to one for 38
the psychiatry unit; (N) two to one in the labor and delivery unit; (O) 39
four to one in the postpartum unit; (P) four to one in the nursery unit; 40
and (Q) two to one in the neonatal intensive care unit; and (2) patients 41
to assistive personnel providing patient care per corresponding patient 42
care unit: (A) Eight to one in the emergency department; (B) eight to one 43
in the intensive care unit; (C) six to one in the progressive care unit; (D) 44
eight to one in the telemetry unit; (E) eight to one in the medical-surgical 45
unit; (F) eight to one in the pediatric unit; (G) eight to one in the 46
oncology unit; (H) six to one in the orthopedics unit; (I) eight to one in 47 Raised Bill No. 1067
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the psychiatric unit; and (J) twelve to one in the obstetrics unit. 48
(c) Each hospital shall establish a hospital staffing committee to assist 49
in the preparation of the nurse staffing plan required pursuant to 50
subsection (b) of this section. Registered nurses employed by the 51
hospital whose primary responsibility is to provide direct patient care 52
shall account for not less than fifty per cent of the membership of each 53
hospital's staffing committee. In order to comply with the requirement 54
that a hospital establish a hospital staffing committee, a hospital may 55
utilize an existing committee or committees to assist in the preparation 56
of the nurse staffing plan, provided not less than fifty per cent of the 57
members of such existing committee or committees are registered 58
nurses employed by the hospital whose primary responsibility is to 59
provide direct patient care. When registered nurses employed by the 60
hospital are members of a collective bargaining unit, a representative of 61
the collective bargaining unit shall select the registered nurses who shall 62
be members of the hospital staffing committee, provided such selection 63
shall not be construed to permit conduct prohibited under the National 64
Labor Relations Act, 29 USC 151 et seq., as amended from time to time, 65
or 5 USC Chapter 71, as amended from time to time. Each hospital, in 66
collaboration with its staffing committee, shall develop and implement 67
to the best of its ability the prospective nurse staffing plan. Such plan 68
shall: (1) Include the minimum professional skill mix for each patient 69
care unit in the hospital, including, but not limited to, inpatient services, 70
critical care and the emergency department; (2) identify the hospital's 71
employment practices concerning the use of temporary and traveling 72
nurses; (3) set forth the level of administrative staffing in each patient 73
care unit of the hospital that ensures direct care staff are not utilized for 74
administrative functions; (4) set forth the hospital's process for internal 75
review of the nurse staffing plan; and (5) include the hospital's 76
mechanism of obtaining input from direct care staff, including nurses 77
and other members of the hospital's patient care team, in the 78
development of the nurse staffing plan. In addition to the information 79
described in subdivisions (1) to (5), inclusive, of this subsection, nurse 80
staffing plans developed and implemented after January 1, 2016, shall 81 Raised Bill No. 1067
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include: (A) The number of registered nurses providing direct patient 82
care and the ratio of patients to such registered nurses by patient care 83
unit; (B) the number of licensed practical nurses providing direct patient 84
care and the ratio of patients to such licensed practical nurses, by patient 85
care unit; (C) the number of assistive personnel providing direct patient 86
care and the ratio of patients to such assistive personnel, by patient care 87
unit; (D) the method used by the hospital to determine and adjust direct 88
patient care staffing levels; and (E) a description of supporting 89
personnel assisting on each patient care unit. In addition to the 90
information described in subdivisions (1) to (5), inclusive, of this 91
subsection and subparagraphs (A) to (E), inclusive, of this subdivision, 92
nurse staffing plans developed and implemented after January 1, 2017, 93
shall include: (i) A description of any differences between the staffing 94
levels described in the staffing plan and actual staffing levels for each 95
patient care unit; and (ii) any actions the hospital intends to take to 96
address such differences or adjust staffing levels in future staffing plans. 97
(d) Each hospital shall post the nurse staffing plan developed 98
pursuant to subsections (b) and (c) of this section on each patient care 99
unit in a conspicuous location visible and accessible to staff, patients and 100
members of the public. Each hospital shall maintain accurate records, 101
for at least the preceding three years, of the ratios of patients to 102
registered nurses providing direct patient care and patients to assistive 103
personnel providing patient care in each direct care unit for each shift. 104
Such records shall include the number of (1) patients in each unit on 105
each shift; (2) registered nurses providing direct patient care assigned to 106
each patient in each unit on each shift; and (3) assistive personnel 107
providing patient care assigned to each patient in each unit on each shift. 108
Each hospital shall make such records available, upon request, to the 109
Department of Public Health, the staff of the hospital, any collective 110
bargaining unit representing such staff, the patients of the hospital and 111
members of the general public. 112
(e) A registered nurse may object to or refuse to participate in any 113
activity, policy, practice or task assigned by a hospital, provided the 114
registered nurse acts in good faith and, in the registered nurse's 115 Raised Bill No. 1067
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professional judgment, the registered nurse (1) reasonably believes 116
participation in the activity, policy, practice or task would violate a 117
provision of this section, or (2) is not prepared by education, training or 118
experience to participate in the activity, policy, practice or task without 119
compromising the safety of a patient or jeopardizing the registered 120
nurse's license. No hospital shall discharge, retaliate against, 121
discriminate against or take any other adverse action against a 122
registered nurse or any aspect of the registered nurse's employment, 123
including, but not limited to, discharge, promotion, reduction in 124
compensation or revisions to terms, conditions or privileges of 125
employment, as a result of such objection or refusal by the registered 126
nurse. No hospital shall file a complaint or report against a registered 127
nurse with the Department of Public Health as a result of such objection 128
or refusal. Any registered nurse or collective bargaining representative 129
or legal representative of a registered nurse who has been discharged, 130
discriminated against or retaliated against in violation of the provisions 131
of this subsection, or against whom a complaint or report has been filed 132
in violation of such provisions, may bring a cause of action against the 133
hospital. A registered nurse who prevails in such cause of action shall 134
be entitled to one or more of the following: (A) Reinstatement of 135
employment, (B) reimbursement of lost wages, compensation and 136
benefits, (C) attorneys' fees, (D) court costs, and (E) any other relevant 137
damages. 138
[(d)] (f) On or before January 1, 2016, and annually thereafter, the 139
Commissioner of Public Health shall report, in accordance with the 140
provisions of section 11-4a, to the joint standing committee of the 141
General Assembly having cognizance of matters relating to public 142
health concerning hospital compliance with reporting requirements 143
under this section and recommendations concerning any additional 144
reporting requirements. 145
Sec. 2. Section 19a-490l of the general statutes is repealed and the 146
following is substituted in lieu thereof (Effective October 1, 2023): 147
(a) As used in this section: 148 Raised Bill No. 1067
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(1) "Nurse" means a registered nurse or a practical nurse licensed 149
pursuant to chapter 378, or a nurse's aide registered pursuant to chapter 150
378a; [and] 151
(2) "Hospital" has the same meaning as set forth in section 19a-490; 152
and 153
(3) "Overtime" means working (A) in excess of a predetermined 154
scheduled work shift, regardless of the length of such scheduled work 155
shift, provided such scheduled work shift is determined and 156
communicated not less than forty-eight hours prior to the 157
commencement of such scheduled work shift, (B) more than twelve 158
hours in a twenty-four-hour period, (C) during the ten-hour period 159
immediately following the end of the previous work shift of eight hours 160
or more, or (D) more than forty-eight hours in any hospital-defined 161
work week. 162
(b) [No] Except as provided in this section, no hospital [may] shall 163
require a nurse to work [in excess of a predetermined scheduled work 164
shift, provided such scheduled work shift is determined and 165
promulgated not less than forty-eight hours prior to the commencement 166
of such scheduled work shift] overtime. No hospital shall discriminate 167
against, discharge, discipline, threaten to discharge or discipline or 168
otherwise retaliate against a nurse for refusing to work overtime. 169
(c) Any nurse may volunteer or agree to work [hours in addition to 170
such scheduled work shift but the refusal by a nurse to accept such 171
additional hours shall not be grounds for discrimination, dismissal, 172
discharge or any other penalty or employment decision adverse to the 173
nurse] overtime. 174
[(c) The] (d) When the safety of a patient requires and when there is 175
no reasonable alternative, the provisions of subsection (b) of this section 176
shall not apply: (1) To any nurse participating in [a] an ongoing surgical 177
procedure until such procedure is completed; (2) to any nurse working 178
in a critical care unit until such nurse is relieved by another nurse who 179
is commencing a scheduled work shift; (3) in the case of a public health 180 Raised Bill No. 1067
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emergency; or (4) in the case of an institutional emergency, including, 181
but not limited to, adverse weather conditions, catastrophe or 182
widespread illness, that in the opinion of the hospital administrator will 183
significantly reduce the number of nurses available for a scheduled 184
work shift, provided the hospital administrator has made a good faith 185
effort to mitigate the impact of such institutional emergency on the 186
availability of nurses. [; or (5) to any nurse who is covered by a collective 187
bargaining agreement that contains provisions addressing the issue of 188
mandatory overtime.] 189
(e) Before requiring a nurse to work overtime in accordance with the 190
provisions of subsection (d) of this section, a hospital shall make a good 191
faith effort to have such overtime hours covered on a voluntary basis. 192
Mandatory overtime shall not be required as a regular practice for 193
providing appropriate staffing for the necessary level of patient care or 194
in any situation that is the result of routine staffing needs caused by 195
typical staffing patterns, expected levels of absenteeism or time off 196
typically approved by the hospital for vacation, holidays, sick leave and 197
personal leave. 198
(f) (1) The provisions of this section shall not be construed to alter or 199
impair the terms of any bona fide collective bargaining agreement that 200
places additional restrictions or limitations on the use of mandatory 201
overtime. 202
(2) The provisions of this section shall not prohibit mandatory 203
overtime with respect to any nurse who is covered by a bona fide 204
collective bargaining agreement in effect prior to July 1, 2022, containing 205
provisions addressing the issue of mandatory overtime, until the 206
expiration date of the collective bargaining agreement. 207
(3) The provisions of this section shall not prohibit mandatory 208
overtime with respect to any nurse who is covered by a bona fide 209
collective bargaining agreement under chapter 68 to the extent such 210
collective bargaining agreement permits mandatory overtime, provided 211
mandatory overtime for reasons set forth in subsection (d) of this section 212 Raised Bill No. 1067
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shall be a mandatory subject of bargaining, and mandatory overtime for 213
reasons other than those set forth in subsection (d) of this section shall 214
be a permissible subject of bargaining. 215
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 19a-89e
Sec. 2 October 1, 2023 19a-490l
Statement of Purpose:
To ensure adequate and safe health care staffing.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]