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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 Section 19a-89e of the general statutes is repealed and the 1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 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 18
additional 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 for 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 38
for the psychiatry unit; (N) two to one for the labor and delivery unit; 39
(O) four to one for the postpartum unit; (P) four to one for the nursery 40
unit; and (Q) two to one for the neonatal intensive care unit; and (2) 41
patients to assistive personnel providing patient care per 42
corresponding patient care unit: (A) Eight to one for the emergency 43
department; (B) eight to one for the intensive care unit; (C) six to one 44
for the progressive care unit; (D) eight to one for the telemetry unit; (E) 45
eight to one for the medical-surgical unit; (F) eight to one for the 46
pediatric unit; (G) eight to one for the oncology unit; (H) six to one for 47 Bill No. 1067
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the orthopedics unit; (I) eight to one for the psychiatric unit; and (J) 48
twelve to one for the obstetrics unit. 49
(c) Each hospital shall establish a hospital staffing committee to 50
assist in the preparation of the nurse staffing plan required pursuant to 51
subsection (b) of this section. Registered nurses employed by the 52
hospital whose primary responsibility is to provide direct patient care 53
shall account for not less than fifty per cent of the membership of each 54
hospital's staffing committee. In order to comply with the requirement 55
that a hospital establish a hospital staffing committee, a hospital may 56
utilize an existing committee or committees to assist in the preparation 57
of the nurse staffing plan, provided not less than fifty per cent of the 58
members of such existing committee or committees are registered 59
nurses employed by the hospital whose primary responsibility is to 60
provide direct patient care. When registered nurses employed by the 61
hospital are members of a collective bargaining unit, a representative 62
of the collective bargaining unit shall select the registered nurses who 63
shall be members of the hospital staffing committee, provided such 64
selection shall not be construed to permit conduct prohibited under the 65
National Labor Relations Act, 29 USC 151 et seq., as amended from 66
time to time, or 5 USC Chapter 71, as amended from time to time. Each 67
hospital, in collaboration with its staffing committee, shall develop and 68
implement to the best of its ability the prospective nurse staffing plan. 69
Such plan shall: (1) Include the minimum professional skill mix for 70
each patient care unit in the hospital, including, but not limited to, 71
inpatient services, critical care and the emergency department; (2) 72
identify the hospital's employment practices concerning the use of 73
temporary and traveling nurses; (3) set forth the level of administrative 74
staffing in each patient care unit of the hospital that ensures direct care 75
staff are not utilized for administrative functions; (4) set forth the 76
hospital's process for internal review of the nurse staffing plan; and (5) 77
include the hospital's mechanism of obtaining input from direct care 78
staff, including nurses and other members of the hospital's patient care 79
team, in the development of the nurse staffing plan. In addition to the 80
information described in subdivisions (1) to (5), inclusive, of this 81 Bill No. 1067
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subsection, nurse staffing plans developed and implemented after 82
January 1, 2016, shall include: (A) The number of registered nurses 83
providing direct patient care and the ratio of patients to such 84
registered nurses by patient care unit; (B) the number of licensed 85
practical nurses providing direct patient care and the ratio of patients 86
to such licensed practical nurses, by patient care unit; (C) the number 87
of assistive personnel providing direct patient care and the ratio of 88
patients to such assistive personnel, by patient care unit; (D) the 89
method used by the hospital to determine and adjust direct patient 90
care staffing levels; and (E) a description of supporting personnel 91
assisting on each patient care unit. In addition to the information 92
described in subdivisions (1) to (5), inclusive, of this subsection and 93
subparagraphs (A) to (E), inclusive, of this subdivision, nurse staffing 94
plans developed and implemented after January 1, 2017, shall include: 95
(i) A description of any differences between the staffing levels 96
described in the staffing plan and actual staffing levels for each patient 97
care unit; and (ii) any actions the hospital intends to take to address 98
such differences or adjust staffing levels in future staffing plans. 99
(d) Each hospital shall post the nurse staffing plan developed 100
pursuant to subsections (b) and (c) of this section on each patient care 101
unit in a conspicuous location visible and accessible to staff, patients 102
and members of the public. Each hospital shall maintain accurate 103
records, for at least the preceding three years, of the ratios of patients 104
to registered nurses providing direct patient care and patients to 105
assistive personnel providing patient care in each direct care unit for 106
each shift. Such records shall include the number of (1) patients in each 107
unit on each shift; (2) registered nurses providing direct patient care 108
assigned to each patient in each unit on each shift; and (3) assistive 109
personnel providing patient care assigned to each patient in each unit 110
on each shift. Each hospital shall make such records available, upon 111
request, to the Department of Public Health, the staff of the hospital, 112
any collective bargaining unit representing such staff, the patients of 113
the hospital and members of the general public. 114 Bill No. 1067
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(e) A registered nurse may object to or refuse to participate in any 115
activity, policy, practice or task assigned by a hospital, provided the 116
registered nurse acts in good faith and, in the registered nurse's 117
professional judgment, the registered nurse (1) reasonably believes 118
participation in the activity, policy, practice or task would violate a 119
provision of this section, or (2) is not prepared by education, training 120
or experience to participate in the activity, policy, practice or task 121
without compromising the safety of a patient or jeopardizing the 122
registered nurse's license. No hospital shall discharge, retaliate against, 123
discriminate against or take any other adverse action against a 124
registered nurse or any aspect of the registered nurse's employment, 125
including, but not limited to, discharge, promotion, reduction in 126
compensation or revisions to terms, conditions or privileges of 127
employment, as a result of such objection or refusal by the registered 128
nurse. No hospital shall file a complaint or report against a registered 129
nurse with the Department of Public Health as a result of such 130
objection or refusal. Any registered nurse or collective bargaining 131
representative or legal representative of a registered nurse who has 132
been discharged, discriminated against or retaliated against in 133
violation of the provisions of this subsection, or against whom a 134
complaint or report has been filed in violation of such provisions, may 135
bring a cause of action against the hospital. A registered nurse who 136
prevails in such cause of action shall be entitled to one or more of the 137
following: (A) Reinstatement of employment, (B) reimbursement of 138
lost wages, compensation and benefits, (C) attorneys' fees, (D) court 139
costs, and (E) any other relevant damages. 140
[(d)] (f) On or before January 1, 2016, and annually thereafter, the 141
Commissioner of Public Health shall report, in accordance with the 142
provisions of section 11-4a, to the joint standing committee of the 143
General Assembly having cognizance of matters relating to public 144
health concerning hospital compliance with reporting requirements 145
under this section and recommendations concerning any additional 146
reporting requirements. 147 Bill No. 1067
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Sec. 2. Section 19a-490l of the general statutes is repealed and the 148
following is substituted in lieu thereof (Effective October 1, 2023): 149
(a) As used in this section: 150
(1) "Nurse" means a registered nurse or a practical nurse licensed 151
pursuant to chapter 378, or a nurse's aide registered pursuant to 152
chapter 378a; [and] 153
(2) "Hospital" has the same meaning as set forth in section 19a-490; 154
and 155
(3) "Overtime" means working (A) in excess of a predetermined 156
scheduled work shift, regardless of the length of such scheduled work 157
shift, provided such scheduled work shift is determined and 158
communicated not less than forty-eight hours prior to the 159
commencement of such scheduled work shift, (B) more than twelve 160
hours in a twenty-four-hour period, (C) during the ten-hour period 161
immediately following the end of the previous work shift of eight 162
hours or more, or (D) more than forty-eight hours in any hospital-163
defined work week. 164
(b) [No] Except as provided in this section, no hospital [may] shall 165
require a nurse to work [in excess of a predetermined scheduled work 166
shift, provided such scheduled work shift is determined and 167
promulgated not less than forty-eight hours prior to the 168
commencement of such scheduled work shift] overtime. No hospital 169
shall discriminate against, discharge, discipline, threaten to discharge 170
or discipline or otherwise retaliate against a nurse for refusing to work 171
overtime. 172
(c) Any nurse may volunteer or agree to work [hours in addition to 173
such scheduled work shift but the refusal by a nurse to accept such 174
additional hours shall not be grounds for discrimination, dismissal, 175
discharge or any other penalty or employment decision adverse to the 176
nurse] overtime. 177 Bill No. 1067
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[(c) The] (d) When the safety of a patient requires and when there is 178
no reasonable alternative, the provisions of subsection (b) of this 179
section shall not apply: (1) To any nurse participating in [a] an ongoing 180
surgical procedure until such procedure is completed; (2) to any nurse 181
working in a critical care unit until such nurse is relieved by another 182
nurse who is commencing a scheduled work shift; (3) in the case of a 183
public health emergency; or (4) in the case of an institutional 184
emergency, including, but not limited to, adverse weather conditions, 185
catastrophe or widespread illness, that in the opinion of the hospital 186
administrator will significantly reduce the number of nurses available 187
for a scheduled work shift, provided the hospital administrator has 188
made a good faith effort to mitigate the impact of such institutional 189
emergency on the availability of nurses. [; or (5) to any nurse who is 190
covered by a collective bargaining agreement that contains provisions 191
addressing the issue of mandatory overtime.] 192
(e) Before requiring a nurse to work overtime in accordance with the 193
provisions of subsection (d) of this section, a hospital shall make a 194
good faith effort to have such overtime hours covered on a voluntary 195
basis. Mandatory overtime shall not be required as a regular practice 196
for providing appropriate staffing for the necessary level of patient 197
care or in any situation that is the result of routine staffing needs 198
caused by typical staffing patterns, expected levels of absenteeism or 199
time off typically approved by the hospital for vacation, holidays, sick 200
leave and personal leave. 201
(f) (1) The provisions of this section shall not be construed to alter or 202
impair the terms of any bona fide collective bargaining agreement that 203
places additional restrictions or limitations on the use of mandatory 204
overtime. 205
(2) The provisions of this section shall not prohibit mandatory 206
overtime with respect to any nurse who is covered by a bona fide 207
collective bargaining agreement in effect prior to July 1, 2022, 208
containing provisions addressing the issue of mandatory overtime, 209
until the expiration date of the collective bargaining agreement. 210 Bill No. 1067
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(3) The provisions of this section shall not prohibit mandatory 211
overtime with respect to any nurse who is covered by a bona fide 212
collective bargaining agreement under chapter 68 to the extent such 213
collective bargaining agreement permits mandatory overtime, 214
provided mandatory overtime for reasons set forth in subsection (d) of 215
this section shall be a mandatory subject of bargaining, and mandatory 216
overtime for reasons other than those set forth in subsection (d) of this 217
section shall be a permissible subject of bargaining. 218
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
PH Joint Favorable