Georgia 2023-2024 Regular Session

Georgia House Bill HB745 Compare Versions

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1-24 LC 33 9647S
2-The House Committee on Health offers the following substitute to HB 745:
1+23 LC 33 9495
2+H. B. 745
3+- 1 -
4+House Bill 745
5+By: Representatives Kelley of the 16
6+th
7+, Hatchett of the 155
8+th
9+, Pirkle of the 169
10+th
11+, and
12+McCollum of the 30
13+th
14+
315 A BILL TO BE ENTITLED
416 AN ACT
5-To amend Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to1
17+To amend Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to
18+1
619 regulation and construction of hospitals and other health care facilities, so as to provide2
720 requirements for nurse staffing in hospitals; to provide for definitions; to require a written3
821 nurse services staffing plan; to provide for an official nurse services staffing plan; to provide4
922 for the establishment of nurse staffing committees; to provide for annual reporting of staffing5
1023 information to the Department of Community Health; to provide for anonymous reports and6
1124 investigations of unsafe staffing conditions; to establish an advisory commission; to provide7
1225 for related matters; to repeal conflicting laws; and for other purposes.8
1326 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
1427 SECTION 1.10
1528 Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to regulation and11
1629 construction of hospitals and other health care facilities, is amended by revising Article 2,12
17-which is reserved, as follows:13
18-H. B. 745 (SUB)
19-- 1 - 24 LC 33 9647S
20-"ARTICLE 214
21-31-7-24.15
30+which is reserved, as follows:13 23 LC 33 9495
31+H. B. 745
32+- 2 -
33+"ARTICLE 2
34+14
35+31-7-24.
36+15
2237 Reserved.16
2338 31-7-30.17
2439 As used in this article, the term:18
2540 (1) 'Committee' means a nurse staffing committee established pursuant to Code Section19
2641 31-7-32.20
2742 (2) 'Hospital' means a hospital which is permitted to operate by the department pursuant21
28-to Article 1 of this chapter, including a hospital maintained or operated by a hospital22
29-authority; provided, however, that this shall not include a state-owned or operated23
30-hospital.24
31-(3) 'Nurse services staffing plan' means the staffing plan required to be established by a25
32-hospital pursuant to Code Section 31-7-31.26
33-(4) 'Nurse staffing committee' means the standing committee established by a hospital27
34-pursuant to Code Section 31-7-32.28
35-(5) 'Patient care unit' means a unit or area of a hospital in which registered nurses provide29
36-patient care.30
37-31-7-31.31
38-(a) The governing body of a hospital shall adopt and implement a written nurse services32
39-staffing plan to ensure that an adequate number and skill mix of nurses are available to33
40-meet the level of patient care needed. Such plan shall include a process for:34
41-(1) Requiring the hospital to give significant consideration to the nurse services staffing35
42-plan recommended by the hospital's nurse staffing committee and to that committee's36
43-evaluation of any existing plan;37
44-H. B. 745 (SUB)
45-- 2 - 24 LC 33 9647S
46-(2) Adopting and implementing an official nurse services staffing plan that is based on38
47-the needs of each patient care unit and shift and on evidence relating to patient care39
48-needs;40
49-(3) Using the official nurse services staffing plan as a component in setting the nurse41
50-staffing budget;42
51-(4) Encouraging nurses to provide input to the committee relating to nurse staffing43
52-concerns;44
53-(5) Protecting nurses who provide input to the committee from retaliation; and45
54-(6) Monitoring compliance with any rules and regulations adopted by the department46
55-relating to nurse staffing.47
56-(b) The written nurse services staffing plan adopted pursuant to subsection (a) of this Code48
57-section shall:49
58-(1) Reflect current standards established by private accreditation organizations,50
59-governmental entities, national nursing professional associations, or other healthcare51
60-professional organizations;52
61-(2) Set minimum staffing levels for patient care units that are:53
62-(A) Based on multiple nurse and patient considerations; and54
63-(B) Determined by the nursing assessment and in accordance with evidence based safe55
64-nursing standards;56
65-(3) Include a method for adjusting the nurse services staffing plan for each patient care57
66-unit to provide staffing flexibility to meet patient needs; and58
67-(4) Include a contingency plan when patient care needs unexpectedly exceed direct59
68-patient care staff resources.60
69-(c) A hospital shall:61
70-(1) Use the official nurse services staffing plan:62
71-(A) As a component in setting the nurse staffing budget; and63
72-(B) To guide the hospital in assigning nurses hospital wide; and64
73-H. B. 745 (SUB)
74-- 3 - 24 LC 33 9647S
75-(2) Make readily available to nurses on each patient care unit at the beginning of each65
76-shift the official nurse services staffing plan levels and current staffing levels for that unit66
77-and that shift.67
78-31-7-32.68
79-(a) A hospital shall establish a nurse staffing committee as a standing committee of the69
80-hospital.70
81-(b) The committee shall be composed of members who are representative of the types of71
82-nursing services provided in the hospital.72
83-(c) The chief nursing officer of the hospital shall be a voting member of the committee.73
84-(d) At least 50 percent of the members of the committee shall be registered nurses who:74
85-(1) Provide direct patient care during at least 50 percent of their work time; and75
86-(2) Represent different inpatient care units, such as, but not limited to, medical/surgical,76
87-intensive care, and cardiac.77
88-(e) The committee shall meet at least quarterly.78
89-(f) The committee shall:79
90-(1) Develop and recommend to the hospital's governing body a nurse services staffing80
91-plan that meets the requirements of Code Section 31-7-31;81
92-(2) Review, assess, and respond to staffing concerns expressed to the committee;82
93-(3) Identify the nurse-sensitive outcome measures the committee will use to evaluate the83
94-effectiveness of the official nurse services staffing plan;84
95-(4) Evaluate, at least semiannually, the effectiveness of the official nurse services85
96-staffing plan and variations between the plan and the actual staffing; and86
97-(5) Submit to the hospital's governing body, at least semiannually, a report on nurse87
98-staffing and patient care outcomes, including the committee's evaluation of the88
99-effectiveness of the official nurse services staffing plan and aggregate variations between89
100-the nurse services staffing plan and actual staffing.90
101-H. B. 745 (SUB)
102-- 4 - 24 LC 33 9647S
103-(g) In evaluating the effectiveness of the official nurse services staffing plan, the91
104-committee shall consider patient needs, workforce shortages and availability,92
105-nurse-sensitive outcome measures, nurse satisfaction measures collected by the hospital,93
106-and evidence based nurse staffing standards.94
107-31-7-33.95
108-(a) A hospital shall annually report to the department, and the department shall include as96
109-a confidential addendum to the annual hospital questionnaire, the following information:97
110-(1) Whether the hospital's governing body has adopted a nurse services staffing plan as98
111-required by Code Section 31-7-31;99
112-(2) Whether the hospital has established a nurse staffing committee as required by Code100
113-Section 31-7-32 that meets the membership requirements of such Code section;101
114-(3) Whether the nurse staffing committee has evaluated the hospital's official nurse102
115-services staffing plan as required by Code Section 31-7-32 and has reported the results103
116-of the evaluation to the hospital's governing body as provided by such Code section; and104
117-(4) The nurse-sensitive outcome measures the committee adopted for use in evaluating105
118-the hospital's official nurse services staffing plan and an evaluation of the effectiveness106
119-of such measures.107
120-(b) To the extent possible, the department shall collect the data required pursuant to108
121-subsection (a) of this Code section in conjunction with surveys or other data required to be109
122-submitted to the department under other laws or regulations.110
123-(c) Such information shall not be subject to Article 4 of Chapter 18 of Title 50.111
124-31-7-34.112
125-(a) The department shall maintain a secure online portal for the submission by hospital113
126-staff members of anonymous reports of unsafe staffing conditions in any hospital.114
127-H. B. 745 (SUB)
128-- 5 - 24 LC 33 9647S
129-(b) Upon receipt of a report of unsafe staffing conditions, the department shall forward the115
130-report to its Division of Healthcare Facility Regulation for investigation, to the nurse116
131-staffing committee of the hospital that is the subject of the report.117
132-(c) The Division of Healthcare Facility Regulation shall investigate all reports of unsafe118
133-staffing conditions pursuant to Code Section 31-2-8. If the division determines that a119
134-patient care unit identified in a complaint did not deliver nursing services in accordance120
135-with patients' needs and generally accepted standards of practice on the date identified in121
136-the complaint or during an on-site investigation, the division shall take appropriate actions122
137-as authorized in Code Section 31-2-8.123
138-31-7-35.124
139-(a) There is hereby established an advisory commission, composed of nine members as125
140-follows:126
141-(1) The following members appointed by the Governor:127
142-(A) An expert in nursing practice, quality of nursing care, or patient care standards;128
143-(B) A representative of associations representing nurses; and129
144-(C) A representative of a hospital;130
145-(2) The following members appointed by the President of the Senate:131
146-(A) An expert in nursing practice, quality of nursing care, or patient care standards;132
147-(B) A representative of associations representing nurses; and133
148-(C) A representative of a hospital; and134
149-(3) The following members appointed by the Speaker of the House of Representatives:135
150-(A) An expert in nursing practice, quality of nursing care, or patient care standards;136
151-(B) A representative of associations representing nurses; and137
152-(C) A representative of a hospital.138
153-The members of the advisory commission shall serve at the pleasure of the appointing139
154-official. Members of the advisory commission shall keep confidential any information140
155-H. B. 745 (SUB)
156-- 6 - 24 LC 33 9647S
157-received in the course of their duties and shall only use such information in the course of141
158-carrying out their duties on the advisory commission, except those reports required to be142
159-issued by the commission under this Code section, which shall only include de-identified143
160-information.144
161-(b) The advisory commission shall convene annually in order to evaluate the effectiveness145
162-of the nurse staffing committees established pursuant to Code Section 31-7-32. Such146
163-review shall evaluate quantitative and qualitative data, including, but not limited to,147
164-whether staffing levels were improved and maintained, patient satisfaction, employee148
165-satisfaction, patient quality of care metrics, workplace safety, and any other metrics the149
166-advisory commission deems relevant.150
167-(c) The advisory commission may collect and shall be provided all relevant information151
168-necessary to carry out its functions from the department and other appropriate state152
169-agencies. The commission may also invite testimony by experts in the field and from the153
170-public. In making its recommendations pursuant to subsection (d) of this Code section, the154
171-advisory commission shall analyze relevant data, including data and factors contained in155
172-subsection (a) of Code Section 31-7-31 related to nurse services staffing plans. The156
173-advisory commission may also make recommendations for additional or enhanced157
174-enforcement mechanisms or powers to address hospital failure to comply with this article158
175-and recommend the appropriation of funding for the department to enforce this article or159
176-to assist hospitals in hiring additional staff to comply with this article.160
177-(d) The advisory commission shall submit to the Speaker of the House of Representatives,161
178-the President of the Senate, and the chairpersons of the House Committee on Health and162
179-Senate Health and Human Services Committee, and make available to the public, a report163
180-that includes recommendations for further legislative action, if any, in order to improve164
181-working conditions and quality of care in hospitals pursuant to the intent of this article.165
182-(e) Any information collected pursuant to Code Section 31-7-33 and provided to the166
183-advisory commission shall not be subject to Article 4 of Chapter 18 of Title 50."167
184-H. B. 745 (SUB)
185-- 7 - 24 LC 33 9647S
186-SECTION 2.168
187-All laws and parts of laws in conflict with this Act are repealed.169
188-H. B. 745 (SUB)
43+to Article 1 of this chapter, including a hospital maintained or operated by this state or22
44+a hospital authority.23
45+(3) 'Nurse services staffing plan' means the staffing plan required to be established by a24
46+hospital pursuant to Code Section 31-7-31.25
47+(4) 'Nurse staffing committee' means the standing committee established by a hospital26
48+pursuant to Code Section 31-7-32.27
49+(5) 'Patient care unit' means a unit or area of a hospital in which registered nurses provide28
50+patient care.29
51+31-7-31.30
52+(a) The governing body of a hospital shall adopt and implement a written nurse services31
53+staffing plan to ensure that an adequate number and skill mix of nurses are available to32
54+meet the level of patient care needed. Such plan shall include a process for:33
55+(1) Requiring the hospital to give significant consideration to the nurse services staffing34
56+plan recommended by the hospital's nurse staffing committee and to that committee's35
57+evaluation of any existing plan;36 23 LC 33 9495
58+H. B. 745
59+- 3 -
60+(2) Adopting and implementing an official nurse services staffing plan that is based on37
61+the needs of each patient care unit and shift and on evidence relating to patient care38
62+needs;39
63+(3) Using the official nurse services staffing plan as a component in setting the nurse40
64+staffing budget;41
65+(4) Encouraging nurses to provide input to the committee relating to nurse staffing42
66+concerns;43
67+(5) Protecting nurses who provide input to the committee from retaliation; and44
68+(6) Monitoring compliance with any rules and regulations adopted by the department45
69+relating to nurse staffing.46
70+(b) The written nurse services staffing plan adopted pursuant to subsection (a) of this Code47
71+section shall:48
72+(1) Reflect current standards established by private accreditation organizations,49
73+governmental entities, national nursing professional associations, or other healthcare50
74+professional organizations;51
75+(2) Set minimum staffing levels for patient care units that are:52
76+(A) Based on multiple nurse and patient considerations; and53
77+(B) Determined by the nursing assessment and in accordance with evidence based safe54
78+nursing standards;55
79+(3) Include a method for adjusting the nurse services staffing plan for each patient care56
80+unit to provide staffing flexibility to meet patient needs; and57
81+(4) Include a contingency plan when patient care needs unexpectedly exceed direct58
82+patient care staff resources.59
83+(c) A hospital shall:60
84+(1) Use the official nurse services staffing plan:61
85+(A) As a component in setting the nurse staffing budget; and62
86+(B) To guide the hospital in assigning nurses hospital wide; and63 23 LC 33 9495
87+H. B. 745
88+- 4 -
89+(2) Make readily available to nurses on each patient care unit at the beginning of each64
90+shift the official nurse services staffing plan levels and current staffing levels for that unit65
91+and that shift.66
92+31-7-32.67
93+(a) A hospital shall establish a nurse staffing committee as a standing committee of the68
94+hospital.69
95+(b) The committee shall be composed of members who are representative of the types of70
96+nursing services provided in the hospital.71
97+(c) The chief nursing officer of the hospital shall be a voting member of the committee.72
98+(d) At least 50 percent of the members of the committee shall be registered nurses who:73
99+(1) Provide direct patient care during at least 50 percent of their work time; and74
100+(2) Are selected by their peers who provide direct patient care during at least 50 percent75
101+of their work time.76
102+(e) The committee shall meet at least quarterly.77
103+(f) The committee shall:78
104+(1) Develop and recommend to the hospital's governing body a nurse services staffing79
105+plan that meets the requirements of Code Section 31-7-31;80
106+(2) Review, assess, and respond to staffing concerns expressed to the committee;81
107+(3) Identify the nurse-sensitive outcome measures the committee will use to evaluate the82
108+effectiveness of the official nurse services staffing plan;83
109+(4) Evaluate, at least semiannually, the effectiveness of the official nurse services84
110+staffing plan and variations between the plan and the actual staffing; and85
111+(5) Submit to the hospital's governing body, at least semiannually, a report on nurse86
112+staffing and patient care outcomes, including the committee's evaluation of the87
113+effectiveness of the official nurse services staffing plan and aggregate variations between88
114+the nurse services staffing plan and actual staffing.89 23 LC 33 9495
115+H. B. 745
116+- 5 -
117+(g) In evaluating the effectiveness of the official nurse services staffing plan, the90
118+committee shall consider patient needs, workforce shortages and availability,91
119+nurse-sensitive outcome measures, nurse satisfaction measures collected by the hospital,92
120+and evidence based nurse staffing standards.93
121+31-7-33.94
122+(a) A hospital shall annually report to the department, and the department shall include as95
123+a confidential addendum to the annual hospital questionnaire, the following information:96
124+(1) Whether the hospital's governing body has adopted a nurse services staffing plan as97
125+required by Code Section 31-7-31;98
126+(2) Whether the hospital has established a nurse staffing committee as required by Code99
127+Section 31-7-32 that meets the membership requirements of such Code section;100
128+(3) Whether the nurse staffing committee has evaluated the hospital's official nurse101
129+services staffing plan as required by Code Section 31-7-32 and has reported the results102
130+of the evaluation to the hospital's governing body as provided by such Code section; and103
131+(4) The nurse-sensitive outcome measures the committee adopted for use in evaluating104
132+the hospital's official nurse services staffing plan and an evaluation of the effectiveness105
133+of such measures.106
134+(b) To the extent possible, the department shall collect the data required pursuant to107
135+subsection (a) of this Code section in conjunction with surveys or other data required to be108
136+submitted to the department under other laws or regulations.109
137+(c) Such information shall not be subject to Article 4 of Chapter 18 of Title 50.110
138+31-7-34.111
139+(a) The department shall maintain a secure online portal for the submission by hospital112
140+staff members of anonymous reports of unsafe staffing conditions in any hospital.113 23 LC 33 9495
141+H. B. 745
142+- 6 -
143+(b) Upon receipt of a report of unsafe staffing conditions, the department shall forward the114
144+report to its Division of Healthcare Facility Regulation for investigation, to the nurse115
145+staffing committee of the hospital that is the subject of the report.116
146+(c) The Division of Healthcare Facility Regulation shall investigate all reports of unsafe117
147+staffing conditions pursuant to Code Section 31-2-8. If the division determines that a118
148+patient care unit identified in a complaint did not deliver nursing services in accordance119
149+with patients' needs and generally accepted standards of practice on the date identified in120
150+the complaint or during an on-site investigation, the division shall take appropriate actions121
151+as authorized in Code Section 31-2-8.122
152+31-7-35.123
153+(a) There is hereby established an advisory commission, composed of nine members as124
154+follows:125
155+(1) The following members appointed by the Governor:126
156+(A) An expert in nursing practice, quality of nursing care, or patient care standards;127
157+(B) A representative of associations representing nurses; and128
158+(C) A representative of a hospital;129
159+(2) The following members appointed by the President of the Senate:130
160+(A) An expert in nursing practice, quality of nursing care, or patient care standards;131
161+(B) A representative of associations representing nurses; and132
162+(C) A representative of a hospital; and133
163+(3) The following members appointed by the Speaker of the House of Representatives:134
164+(A) An expert in nursing practice, quality of nursing care, or patient care standards;135
165+(B) A representative of associations representing nurses; and136
166+(C) A representative of a hospital.137
167+The members of the advisory commission shall serve at the pleasure of the appointing138
168+official. Members of the advisory commission shall keep confidential any information139 23 LC 33 9495
169+H. B. 745
170+- 7 -
171+received in the course of their duties and shall only use such information in the course of140
172+carrying out their duties on the advisory commission, except those reports required to be141
173+issued by the commission under this Code section, which shall only include de-identified142
174+information.143
175+(b) The advisory commission shall convene annually in order to evaluate the effectiveness144
176+of the nurse staffing committees established pursuant to Code Section 31-7-32. Such145
177+review shall evaluate quantitative and qualitative data, including, but not limited to,146
178+whether staffing levels were improved and maintained, patient satisfaction, employee147
179+satisfaction, patient quality of care metrics, workplace safety, and any other metrics the148
180+advisory commission deems relevant.149
181+(c) The advisory commission may collect and shall be provided all relevant information150
182+necessary to carry out its functions from the department and other appropriate state151
183+agencies. The commission may also invite testimony by experts in the field and from the152
184+public. In making its recommendations pursuant to subsection (d) of this Code section, the153
185+advisory commission shall analyze relevant data, including data and factors contained in154
186+subsection (a) of Code Section 31-7-31 related to nurse services staffing plans. The155
187+advisory commission may also make recommendations for additional or enhanced156
188+enforcement mechanisms or powers to address hospital failure to comply with this article157
189+and recommend the appropriation of funding for the department to enforce this article or158
190+to assist hospitals in hiring additional staff to comply with this article.159
191+(d) The advisory commission shall submit to the Speaker of the House of Representatives,160
192+the President of the Senate, and the chairpersons of the House Committee on Health and161
193+Senate Health and Human Services Committee, and make available to the public, a report162
194+that includes recommendations for further legislative action, if any, in order to improve163
195+working conditions and quality of care in hospitals pursuant to the intent of this article.164
196+(e) Any information collected pursuant to Code Section 31-7-33 and provided to the165
197+advisory commission shall not be subject to Article 4 of Chapter 18 of Title 50."166 23 LC 33 9495
198+H. B. 745
189199 - 8 -
200+SECTION 2.
201+167
202+All laws and parts of laws in conflict with this Act are repealed.168