24 LC 33 9647S
The House Committee on Health offers the following substitute to HB 745:
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to1
regulation and construction of hospitals and other health care facilities, so as to provide2
requirements for nurse staffing in hospitals; to provide for definitions; to require a written3
nurse services staffing plan; to provide for an official nurse services staffing plan; to provide4
for the establishment of nurse staffing committees; to provide for annual reporting of staffing5
information to the Department of Community Health; to provide for anonymous reports and6
investigations of unsafe staffing conditions; to establish an advisory commission; to provide7
for related matters; to repeal conflicting laws; and for other purposes.8
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
SECTION 1.10
Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to regulation and11
construction of hospitals and other health care facilities, is amended by revising Article 2,12
which is reserved, as follows:13
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"ARTICLE 214
31-7-24.15
Reserved.16
31-7-30.17
As used in this article, the term:18
(1) 'Committee' means a nurse staffing committee established pursuant to Code Section19
31-7-32.20
(2) 'Hospital' means a hospital which is permitted to operate by the department pursuant21
to Article 1 of this chapter, including a hospital maintained or operated by a hospital22
authority; provided, however, that this shall not include a state-owned or operated23
hospital.24
(3) 'Nurse services staffing plan' means the staffing plan required to be established by a25
hospital pursuant to Code Section 31-7-31.26
(4) 'Nurse staffing committee' means the standing committee established by a hospital27
pursuant to Code Section 31-7-32.28
(5) 'Patient care unit' means a unit or area of a hospital in which registered nurses provide29
patient care.30
31-7-31.31
(a) The governing body of a hospital shall adopt and implement a written nurse services32
staffing plan to ensure that an adequate number and skill mix of nurses are available to33
meet the level of patient care needed. Such plan shall include a process for:34
(1) Requiring the hospital to give significant consideration to the nurse services staffing35
plan recommended by the hospital's nurse staffing committee and to that committee's36
evaluation of any existing plan;37
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(2) Adopting and implementing an official nurse services staffing plan that is based on38
the needs of each patient care unit and shift and on evidence relating to patient care39
needs;40
(3) Using the official nurse services staffing plan as a component in setting the nurse41
staffing budget;42
(4) Encouraging nurses to provide input to the committee relating to nurse staffing43
concerns;44
(5) Protecting nurses who provide input to the committee from retaliation; and45
(6) Monitoring compliance with any rules and regulations adopted by the department46
relating to nurse staffing.47
(b) The written nurse services staffing plan adopted pursuant to subsection (a) of this Code48
section shall:49
(1) Reflect current standards established by private accreditation organizations,50
governmental entities, national nursing professional associations, or other healthcare51
professional organizations;52
(2) Set minimum staffing levels for patient care units that are:53
(A) Based on multiple nurse and patient considerations; and54
(B) Determined by the nursing assessment and in accordance with evidence based safe55
nursing standards;56
(3) Include a method for adjusting the nurse services staffing plan for each patient care57
unit to provide staffing flexibility to meet patient needs; and58
(4) Include a contingency plan when patient care needs unexpectedly exceed direct59
patient care staff resources.60
(c) A hospital shall:61
(1) Use the official nurse services staffing plan:62
(A) As a component in setting the nurse staffing budget; and63
(B) To guide the hospital in assigning nurses hospital wide; and64
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(2) Make readily available to nurses on each patient care unit at the beginning of each65
shift the official nurse services staffing plan levels and current staffing levels for that unit66
and that shift.67
31-7-32.68
(a) A hospital shall establish a nurse staffing committee as a standing committee of the69
hospital.70
(b) The committee shall be composed of members who are representative of the types of71
nursing services provided in the hospital.72
(c) The chief nursing officer of the hospital shall be a voting member of the committee.73
(d) At least 50 percent of the members of the committee shall be registered nurses who:74
(1) Provide direct patient care during at least 50 percent of their work time; and75
(2) Represent different inpatient care units, such as, but not limited to, medical/surgical,76
intensive care, and cardiac.77
(e) The committee shall meet at least quarterly.78
(f) The committee shall:79
(1) Develop and recommend to the hospital's governing body a nurse services staffing80
plan that meets the requirements of Code Section 31-7-31;81
(2) Review, assess, and respond to staffing concerns expressed to the committee;82
(3) Identify the nurse-sensitive outcome measures the committee will use to evaluate the83
effectiveness of the official nurse services staffing plan;84
(4) Evaluate, at least semiannually, the effectiveness of the official nurse services85
staffing plan and variations between the plan and the actual staffing; and86
(5) Submit to the hospital's governing body, at least semiannually, a report on nurse87
staffing and patient care outcomes, including the committee's evaluation of the88
effectiveness of the official nurse services staffing plan and aggregate variations between89
the nurse services staffing plan and actual staffing.90
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(g) In evaluating the effectiveness of the official nurse services staffing plan, the91
committee shall consider patient needs, workforce shortages and availability,92
nurse-sensitive outcome measures, nurse satisfaction measures collected by the hospital,93
and evidence based nurse staffing standards.94
31-7-33.95
(a) A hospital shall annually report to the department, and the department shall include as96
a confidential addendum to the annual hospital questionnaire, the following information:97
(1) Whether the hospital's governing body has adopted a nurse services staffing plan as98
required by Code Section 31-7-31;99
(2) Whether the hospital has established a nurse staffing committee as required by Code100
Section 31-7-32 that meets the membership requirements of such Code section;101
(3) Whether the nurse staffing committee has evaluated the hospital's official nurse102
services staffing plan as required by Code Section 31-7-32 and has reported the results103
of the evaluation to the hospital's governing body as provided by such Code section; and104
(4) The nurse-sensitive outcome measures the committee adopted for use in evaluating105
the hospital's official nurse services staffing plan and an evaluation of the effectiveness106
of such measures.107
(b) To the extent possible, the department shall collect the data required pursuant to108
subsection (a) of this Code section in conjunction with surveys or other data required to be109
submitted to the department under other laws or regulations.110
(c) Such information shall not be subject to Article 4 of Chapter 18 of Title 50.111
31-7-34.112
(a) The department shall maintain a secure online portal for the submission by hospital113
staff members of anonymous reports of unsafe staffing conditions in any hospital.114
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(b) Upon receipt of a report of unsafe staffing conditions, the department shall forward the115
report to its Division of Healthcare Facility Regulation for investigation, to the nurse116
staffing committee of the hospital that is the subject of the report.117
(c) The Division of Healthcare Facility Regulation shall investigate all reports of unsafe118
staffing conditions pursuant to Code Section 31-2-8. If the division determines that a119
patient care unit identified in a complaint did not deliver nursing services in accordance120
with patients' needs and generally accepted standards of practice on the date identified in121
the complaint or during an on-site investigation, the division shall take appropriate actions122
as authorized in Code Section 31-2-8.123
31-7-35.124
(a) There is hereby established an advisory commission, composed of nine members as125
follows:126
(1) The following members appointed by the Governor:127
(A) An expert in nursing practice, quality of nursing care, or patient care standards;128
(B) A representative of associations representing nurses; and129
(C) A representative of a hospital;130
(2) The following members appointed by the President of the Senate:131
(A) An expert in nursing practice, quality of nursing care, or patient care standards;132
(B) A representative of associations representing nurses; and133
(C) A representative of a hospital; and134
(3) The following members appointed by the Speaker of the House of Representatives:135
(A) An expert in nursing practice, quality of nursing care, or patient care standards;136
(B) A representative of associations representing nurses; and137
(C) A representative of a hospital.138
The members of the advisory commission shall serve at the pleasure of the appointing139
official. Members of the advisory commission shall keep confidential any information140
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received in the course of their duties and shall only use such information in the course of141
carrying out their duties on the advisory commission, except those reports required to be142
issued by the commission under this Code section, which shall only include de-identified143
information.144
(b) The advisory commission shall convene annually in order to evaluate the effectiveness145
of the nurse staffing committees established pursuant to Code Section 31-7-32. Such146
review shall evaluate quantitative and qualitative data, including, but not limited to,147
whether staffing levels were improved and maintained, patient satisfaction, employee148
satisfaction, patient quality of care metrics, workplace safety, and any other metrics the149
advisory commission deems relevant.150
(c) The advisory commission may collect and shall be provided all relevant information151
necessary to carry out its functions from the department and other appropriate state152
agencies. The commission may also invite testimony by experts in the field and from the153
public. In making its recommendations pursuant to subsection (d) of this Code section, the154
advisory commission shall analyze relevant data, including data and factors contained in155
subsection (a) of Code Section 31-7-31 related to nurse services staffing plans. The156
advisory commission may also make recommendations for additional or enhanced157
enforcement mechanisms or powers to address hospital failure to comply with this article158
and recommend the appropriation of funding for the department to enforce this article or159
to assist hospitals in hiring additional staff to comply with this article.160
(d) The advisory commission shall submit to the Speaker of the House of Representatives,161
the President of the Senate, and the chairpersons of the House Committee on Health and162
Senate Health and Human Services Committee, and make available to the public, a report163
that includes recommendations for further legislative action, if any, in order to improve164
working conditions and quality of care in hospitals pursuant to the intent of this article.165
(e) Any information collected pursuant to Code Section 31-7-33 and provided to the166
advisory commission shall not be subject to Article 4 of Chapter 18 of Title 50."167
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SECTION 2.168
All laws and parts of laws in conflict with this Act are repealed.169
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