25 LC 46 1163S
The House Committee on Health offers the following substitute to HB 298:
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 the establishment of nurse staffing committees;4
to provide for annual reports of staffing information to the Department of Community5
Health; to provide for anonymous reports and investigations of unsafe staffing conditions;6
to establish an advisory commission; to provide for related matters; to repeal conflicting7
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) 'Hospital' means a hospital which is permitted to operate by the department pursuant19
to Article 1 of this chapter, including a hospital maintained or operated by a hospital20
authority; provided, however, that this shall not include a state owned or operated21
hospital.22
(2) 'Nurse services staffing plan' means the written staffing plan required to be23
established by a hospital pursuant to Code Section 31-7-31.24
(3) 'Nurse staffing committee' or 'committee' means the standing committee established25
by a hospital pursuant to Code Section 31-7-32.26
(4) 'Patient care unit' means a hospital's emergency department and any unit or27
department of a hospital in which registered nurses provide direct patient care to28
inpatients.29
31-7-31.30
(a) The governing body of a hospital shall adopt and implement a written nurse services31
staffing plan to provide that an adequate number and skill mix of nurses are available to32
meet the level of patient care needed for the hospital's patient care units. Such plan shall33
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 a nurse services staffing plan that is based on an38
assessment of the needs of each patient care unit and shift, including evidence relating39
to patient care needs of each patient care unit at the hospital;40
(3) Considering the 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 nurse services staffing plan adopted pursuant to subsection (a) of this Code section48
shall:49
(1) Consider the nurse staffing standards established by the Joint Commission or other50
nationally recognized accreditation organizations, by the department, or by nationally51
recognized hospital associations;52
(2) Set minimum staffing levels for patient care units: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 periodically adjusting the nurse services staffing plan for each57
patient care unit to address significant changes in utilization or other circumstances that58
impact nurse staffing and require staffing flexibility to meet patient needs; and59
(4) Include a contingency plan when patient care needs unexpectedly exceed direct60
patient care staff resources.61
(c) A hospital shall:62
(1) Consider the nurse services staffing plan:63
(A) As a component in setting the nurse staffing budget; and64
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(B) To guide the hospital in assigning nurses to patient care units; and65
(2) Make readily available to nurses on each patient care unit at the beginning of each66
shift the nurse services staffing plan levels and current staffing levels for that unit and67
that shift.68
31-7-32.69
(a) A hospital shall establish a nurse staffing committee as a standing committee of the70
hospital.71
(b) The committee shall be composed of members who are representative of the types of72
nursing services provided in the hospital's patient care units.73
(c) The chief nursing officer of the hospital shall be a voting member of the committee.74
(d) At least 75 percent of the members of the committee shall be registered nurses who:75
(1) Provide direct patient care during at least 50 percent of their work time; and76
(2) Represent different patient care units provided by the hospital.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 nurse services staffing plan for the patient care units;84
(4) Evaluate, at least semiannually, the effectiveness of the nurse services staffing plan,85
including the reasons for any significant variations between the plan and the actual86
staffing; and87
(5) Submit to the hospital's governing body, at least semiannually, a report on nurse88
staffing and outcomes on the nurse-sensitive outcome measures reviewed by the89
committee, including the committee's evaluation of the effectiveness of the nurse services90
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staffing plan and aggregate variations between the nurse services staffing plan and actual91
staffing.92
(g) In evaluating the effectiveness of the nurse services staffing plan, the committee shall93
consider, but is not limited to considering, patient needs, workforce shortages and94
availability, the nurse-sensitive outcome measures reviewed by the committee, any nurse95
satisfaction measures collected by the hospital for the patient care units, and any nationally96
recognized, written, evidence based nurse staffing benchmarks.97
(h) All proceedings, records, and reports of the committee shall be deemed confidential98
review organization records under Code Section 31-7-133 and shall not be subject to99
Article 4 of Chapter 18 of Title 50. The nurse staffing plan adopted by a hospital shall not100
be subject to discovery or introduction into evidence in any civil action; and no person who101
was in attendance at a meeting of such committee shall be permitted or required to testify102
in any such civil action as to any evidence or other matters produced or presented during103
the proceedings or activities of the committee or as to the findings, recommendations,104
evaluations, opinions, or other actions of such committee or any members thereof.105
31-7-33.106
(a) A hospital shall annually report to the department, and the department shall include as107
a confidential addendum to the annual hospital questionnaire, the following information:108
(1) Whether the hospital's governing body has adopted a nurse services staffing plan as109
required by Code Section 31-7-31;110
(2) Whether the hospital has established a nurse staffing committee as required by Code111
Section 31-7-32 that meets the membership requirements of such Code section;112
(3) Whether the nurse staffing committee has evaluated the hospital's nurse services113
staffing plan as required by Code Section 31-7-32 and has reported the results of the114
evaluation to the hospital's governing body as provided by such Code section; and115
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(4) The nurse-sensitive outcome measures the committee adopted for use in evaluating116
the hospital's nurse services staffing plan.117
(b) To the extent possible, the department shall collect the information required pursuant118
to subsection (a) of this Code section in conjunction with surveys or other data required to119
be submitted to the department under other laws or regulations.120
(c) The reports provided by the hospitals under subsection (a) of this Code section shall121
not be subject to Article 4 of Chapter 18 of Title 50.122
31-7-34.123
(a) The department shall maintain a secure online portal for the submission by hospital124
staff members of anonymous reports of unsafe staffing conditions in any hospital patient125
care unit, provided that the forms for reporting shall require specificity, including the126
patient care unit; the date, time, and description of the conditions deemed unsafe; and any127
supporting information.128
(b) Upon receipt of a report that complies with subsection (a) of this Code section, the129
department shall forward the report to its Healthcare Facility Regulation Division for130
possible investigation and to the nurse staffing committee of the hospital that is the subject131
of the report.132
(c) If the Healthcare Facility Regulation Division determines that a patient care unit133
identified in a report made under subsection (a) of this Code section failed to comply with134
nurse staffing requirements established by the department or violated any rule or regulation135
relating to the licensing of hospitals on the date identified in the complaint or during an136
on-site investigation, the Healthcare Facility Regulation Division is authorized to take137
appropriate actions under the provisions of Code Section 31-2-8.138
(d) The reports provided by hospital staff members under subsection (a) of this Code139
section shall not be subject to Article 4 of Chapter 18 of Title 50.140
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31-7-35.141
(a) There is hereby established an advisory commission, composed of 12 members as142
follows:143
(1) The following members appointed by the Governor:144
(A) An expert in nursing practice, quality of nursing care, or patient care standards;145
(B) A representative of an association representing nurses; and146
(C) Two representatives of an association representing hospitals;147
(2) The following members appointed by the President of the Senate:148
(A) An expert in nursing practice, quality of nursing care, or patient care standards;149
(B) A registered nurse who provides direct patient care at a hospital at least 50 percent150
of the work time; and151
(C) Two representatives of a hospital in a rural county; and152
(3) The following members appointed by the Speaker of the House of Representatives:153
(A) An expert in nursing practice, quality of nursing care, or patient care standards;154
(B) A representative of an association representing nurses; and155
(C) Two representatives of a hospital.156
(b) The members of the advisory commission shall serve at the pleasure of the appointing157
official. Members of the advisory commission shall keep confidential any information158
received in the course of their duties and shall only use such information in the course of159
carrying out their duties on the advisory commission, except those reports required to be160
issued by the commission under this Code section, which shall only include de-identified161
information that cannot reasonably be used to identify any person, hospital, or other entity.162
(c) The advisory commission shall convene annually in order to evaluate the effectiveness163
of the nurse staffing committees established pursuant to Code Section 31-7-32. Such164
review shall evaluate quantitative and qualitative data, including, but not limited to,165
whether staffing levels were improved and maintained, patient satisfaction, employee166
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satisfaction, patient quality of care metrics, workplace safety, and any other metrics the167
advisory commission deems relevant.168
(d) The advisory commission may collect and shall be provided all relevant information169
necessary to carry out its functions from the department and other appropriate state170
agencies. The commission may also invite testimony by experts in the field and from the171
public. In making its recommendations pursuant to subsection (e) of this Code section, the172
advisory commission shall analyze relevant data provided by the department or other state173
agencies, including data and factors contained in subsection (a) of Code Section 31-7-31174
related to nurse services staffing plans. The advisory commission may also make175
recommendations for additional or enhanced enforcement mechanisms or powers to176
address hospital failure to comply with this article and recommend the appropriation of177
funds for the department to enforce this article or to assist hospitals in recruiting or hiring178
additional nursing staff.179
(e) The advisory commission shall submit to the Speaker of the House of Representatives,180
the President of the Senate, and the chairpersons of the House Committee on Health and181
Senate Health and Human Services Committee, and make available to the public, a report182
that may include recommendations for further legislative action, if any, in order to improve183
nurse staffing in hospitals pursuant to the intent of this article.184
(f) Any information collected pursuant to Code Section 31-7-33 and provided to the185
advisory commission shall not be subject to Article 4 of Chapter 18 of Title 50."186
SECTION 2.187
All laws and parts of laws in conflict with this Act are repealed.188
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