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OLR Bill Analysis
SB 1067
AN ACT CONCERNING ADEQUATE AND SAFE HEALTH CARE
STAFFING.
SUMMARY
This bill makes several changes affecting nurse staffing and overtime
policies in hospitals. It modifies requirements for hospital nurse staffing
plans by doing the following:
1. requiring plans developed and implemented after January 1,
2028, to require specified ratios of patients to (a) registered nurses
(RNs) providing direct patient care per patient care unit and (b)
assistive personnel providing patient care per patient care unit;
2. requiring hospitals to post their plans on each patient care unit in
a location visible and accessible to staff, patients, and the public;
3. requiring hospitals to retain staffing records and related
information for at least the prior three years and make the records
available, upon request, to the Department of Public Health
(DPH), hospital staff and patients, staff collective bargaining
units, and the public; and
4. requiring RN members of hospital staffing committees that help
develop the staffing plans to be selected by a representative of
their collective bargaining unit, if they are members of one.
The bill also allows RNs to object to or refuse to participate in any
hospital activity, policy, practice, or task if they reasonably believe that
(1) participating would violate the bill’s requirements or (2) they do not
have the training, education, or experience to do so without
compromising patient safety. It prohibits hospitals from taking adverse
action against an RN for refusing to do so and allows RNs to bring a 2023SB-01067-R000465-BA.DOCX
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lawsuit against hospitals for any adverse action taken against them for
doing so.
Additionally, the bill makes changes to hospital overtime policies for
nursing staff by doing the following:
1. prohibiting hospitals from requiring nurses to work overtime
and taking adverse action against nurses for refusing to do so,
with limited exceptions (e.g., public health emergencies or nurses
working in critical care units);
2. requiring hospitals, under these limited exceptions, to make a
good faith effort to cover overtime hours voluntarily before
mandating nurses to work them;
3. allowing mandatory overtime for nurses covered by collective
bargaining agreements if the agreements allow it; and
4. prohibiting hospitals, as a regular practice, from mandating
overtime in order to provide necessary staffing levels for patient
care or address situations resulting from routine staffing needs
(e.g., absenteeism or vacation, personal, or sick leave).
Lastly, the bill makes technical changes.
EFFECTIVE DATE: October 1, 2023
HOSPITAL NURSE STAFF ING PLANS
Plan Requirements
By law, hospitals must annually report to DPH on their prospective
nurse staffing plans. In addition to the information already required by
law, the bill requires plans developed and implemented after January 1,
2028, to require specific ratios of patients to RNs providing direct patient
care per patient care unit.
It also requires the plans to include specific ratios of patients to
assistive personnel providing patient care per patient care unit. Under
the bill, “assistive personnel” are non-licensed personnel who work
under an RN’s direct supervision to provide specific delegated patient 2023SB-01067-R000465-BA.DOCX
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care activities.
The table below provides the specific hospital patient to staff ratios
required under the bill as of January 1, 2028.
Table: Hospital Patient to Staff Ratios Under the Bill
Ratio of Patients to Direct Care RNs Per Patient Per Unit
Ratio Hospital Unit
One-to-one • Operating room
• Trauma patients in the emergency department (ED)
Two-to-one • Intensive care, post-anesthesia recovery, neonatal
intensive care, and labor and delivery units
• Patients requiring intensive care in the ED
Three-to-one • Progressive care units
Four-to-one • Telemetry, pediatric, postpartum, and nursery units
• The ED
Five-to-one • Medical-surgical, oncology, and orthopedics units
Six-to-one • Psychiatry units
Ratio of Patients to Assistive Personnel Per Patient Per Unit
Six-to-one • Orthopedics and progressive care units
Eight-to-one • Intensive care, medical surgical, oncology, pediatric,
psychiatric, and telemetry units
• The ED
Twelve-to-one • Obstetrics units
Hospital Staffing Committees
By law, hospitals must establish a hospital staffing committee to help
prepare its annual nurse staffing plan. Direct care RNs the hospital
employs must comprise at least 50% of the committee membership.
Under the bill, when RNs are members of a collective bargaining unit,
a representative of the collective bargaining unit must select the RNs
who will participate on the committee. It expressly provides that doing
so cannot be construed to allow conduct prohibited under the National
Labor Relations Act.
Records
The bill requires hospitals to maintain accurate patient to staff ratio 2023SB-01067-R000465-BA.DOCX
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records for at least the prior three years. The records must also include
the number of:
1. patients in each unit on each shift,
2. RNs providing direct patient care assigned to each patient in each
unit on each shift, and
3. assistive personnel providing patient care assigned to each
patient in each unit on each shift.
Under the bill, hospitals must make the records available, upon
request, to DPH, hospital staff and patients, collective bargaining units
representing staff, and the public.
NURSE PARTICIPATION IN HOSPITAL ACTIVITIES
The bill allows an RN to object to or refuse to participate in any
activity, policy, practice, or task the hospital assigns, if the RN acts in
good faith and (1) reasonably believes, in his or her professional
judgement, that participating would violate the bill’s requirements or
(2) does not have the education, training, or experience to participate
without compromising patient safety or jeopardizing his or her license.
It prohibits a hospital from taking any adverse action (e.g.,
discrimination or retaliation) against an RN or any aspect of the RN’s
employment for doing so, including (1) revising the RN’s employment
terms, conditions, or privileges or (2) with regard to discharge,
promotion, or reduction in compensation. It also prohibits a hospital
from filing a complaint or report with DPH against an RN for doing so.
Under the bill, an RN, or his or her legal representative or collective
bargaining representative, may bring a lawsuit against a hospital if the
RN was discharged, discriminated or retaliated against, or had a
complaint or report filed with DPH against them. An RN who prevails
in a lawsuit is entitled to (1) reinstatement of his or her employment; (2)
reimbursement for lost wages, compensation, or benefits; (3) attorneys’
fees and court costs; and (4) any other relevant damages. 2023SB-01067-R000465-BA.DOCX
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NURSE OVERTIME
Definitions
Under the bill, “overtime” means working:
1. in excess of a set scheduled work shift, regardless of the shift’s
length, if the shift is determined and communicated at least 48
hours before it starts;
2. more than 12 hours in a 24-hour period;
3. during the 10-hour period immediately following the end of the
previous work shift of at least eight hours; or
4. more than 48 hours in any hospital-defined work week.
Prohibition
Similar to current law, the bill prohibits hospitals from requiring a
nurse to work overtime and from discriminating or retaliating against
them (e.g., threatened or actual discipline or discharge) for refusing to
do so. Under current law, the prohibition does not apply in the
following situations:
1. nurses participating in an ongoing surgical procedure, until it is
completed;
2. nurses working in critical care units, until they are relieved by
another nurse starting a scheduled work shift;
3. public health emergencies; and
4. institutional emergencies, such as adverse weather conditions or
widespread illness, that the hospital administrator determines
will significantly reduce the number of nurses available to work.
The bill specifies that these exemptions apply only when patient
safety requires it and there is no reasonable alternative.
Collective Bargaining Units
The bill provides that its provisions cannot be construed to alter or 2023SB-01067-R000465-BA.DOCX
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impair a collective bargaining agreement’s terms that place additional
mandatory overtime restrictions or limitations.
The bill does not prohibit mandatory overtime for nurses covered by
collective bargaining agreements under the following conditions:
1. the agreements allow mandatory overtime,
2. mandatory overtime for the reasons described above is a
mandatory subject of bargaining, and
3. mandatory overtime for reasons other than those described
above is a permissible subject of bargaining.
COMMITTEE ACTION
Public Health Committee
Joint Favorable
Yea 25 Nay 12 (03/27/2023)