Hawaii 2022 Regular Session

Hawaii House Bill HB807 Compare Versions

Only one version of the bill is available at this time.

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1	1	HOUSE OF REPRESENTATIVES H.B. NO. 807 THIRTY-FIRST LEGISLATURE, 2021 STATE OF HAWAII A BILL FOR AN ACT relating to NUrses. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	HOUSE OF REPRESENTATIVES H.B. NO. 807
4	4	THIRTY-FIRST LEGISLATURE, 2021
5	5	STATE OF HAWAII
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7	7	HOUSE OF REPRESENTATIVES
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9	9	H.B. NO.
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13	13	THIRTY-FIRST LEGISLATURE, 2021
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	relating to NUrses.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that health care services are becoming complex and it is increasingly difficult for patients to access integrated services. Quality of patient care is jeopardized because of staffing changes implemented in response to managed care. The legislature further finds that, to ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses be accessible and available to meet the needs of patients. The basic principles of staffing in the acute care setting should be based on the patient's care needs, the severity of condition, services needed, and the complexity surrounding those services. The purpose of this Act is to: (1) Prohibit a hospital from assigning unlicensed assistive personnel to perform nursing care tasks, functions, and activities that would otherwise fall under the scope of practice of a registered nurse or permitting a registered nurse to delegate certain tasks, functions, and activities to unlicensed assistive personnel; (2) Prohibit registered nurses from being assigned to a nursing unit or critical care area unless registered nurses receive orientation and demonstrate individual competency; (3) Require the department of health to adopt rules that establish requirements related to registered nurse-to-patient ratios in licensed hospitals; and (4) Require the department of health to submit a report to the legislature. SECTION 2. Chapter 321, part I, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows: "§321- Registered nurses; delegation; staffing levels. (a) A hospital licensed pursuant to this chapter shall not assign unlicensed assistive personnel to perform nursing care tasks, functions, and activities that would otherwise fall under the scope of practice of a registered nurse licensed under chapter 457. A hospital shall not permit a registered nurse to delegate nursing care tasks, functions, and activities to unlicensed assistive personnel that require a substantial amount of scientific knowledge and technical skills, including: (1) Administration of medication; (2) Venipuncture of intravenous therapy; (3) Parenteral or tube feedings; (4) Invasive procedures, including inserting nasogastric tubes, inserting catheters, or tracheal suctioning; (5) Assessment of patient condition; (6) Educating patients and their families concerning the patients' health care problems, including post-discharge care; and (7) Moderate complexity laboratory tests; provided that nothing in this section shall be construed to restrict the practice of another health care provider licensed in the State from practicing within that health care provider's own recognized scope of practice. (b) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that unit or area sufficient to demonstrate individual competency and ability to provide appropriate care to patients in that unit or area. (c) No later than , the department shall adopt rules pursuant to chapter 91 that establish minimum, specific, and numerical registered nurse-to-patient ratios by hospital unit for all hospitals licensed under this chapter. The rules shall include requirements that: (1) Establish the minimum number of registered nurses that shall be allocated within each hospital unit; (2) Establish additional staffing requirements assigned in accordance with a documented patient classification system for determining nursing care requirements, including: (A) Severity of a patient's illness; (B) Need for specialized equipment and technology; (C) Complexity of clinical judgment needed to design, implement, and evaluate a patient care plan and the ability for self-care; and (D) Licensure requirements for health care providers offering care pursuant to the requirements under this paragraph. (3) Provide flexibility for rural health centers, included requests for a waiver from the requirements of this section; provided that any waiver shall not jeopardize the health, safety, and well-being of patients at the rural health center; (4) Distinguish between regularly scheduled registered nurse core staff in an emergency medical services department and additional registered nurses providing critical care services to patients in an emergency medical services department; (5) Consider the unique needs of psychiatric patients receiving care at a licensed hospital; and (6) Consider the unique nurse-to-patient ratios for participants in a board-recognized nurse residency program; provided that the department shall coordinate with the board of nursing to establish requirements pursuant to this paragraph. (d) Rules adopted pursuant to this subsection shall not supersede any existing registered nurse-to-patient ratio requirements that may be in place for: (1) The Hawaii state hospital or any facility operated by the Hawaii health systems corporation; or (2) Intensive care units, neonatal intensive care units, or operating rooms within a licensed hospital. (e) All hospitals shall adopt written policies and procedures for training and mandatory orientation of nursing staff. (f) Except as provided by subsection (a), in the event of a conflict between this section and any provision of chapter 457 or rules adopted by the board of nursing pursuant to this section, chapter 457 and any rules adopted pursuant to that chapter shall prevail. (g) The department shall submit a report to the legislature no later than twenty days prior to the convening of the regular session of 2026, on its efforts to comply with this section, including any proposed changes to the rules adopted pursuant to this section. (h) For purposes of this section: "Critical care unit" means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by registered nurses. "Hospital unit" means a critical care unit, burn unit, labor and delivery room, post-anesthesia service area, emergency medical services department, operating room, pediatric unit, stepdown or intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit." SECTION 3. Section 457-7.5, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) [A] Except as provided in section 321- (a), a registered nurse may delegate nursing care tasks, functions, and activities to unlicensed assistive personnel in a manner that is appropriate to the level of knowledge and skill of the unlicensed assistive personnel; provided that the delegation of tasks, functions, and activities complies with applicable federal and state laws; and provided further that the practice-pervasive functions of assessment, evaluation, and nursing judgment shall not be delegated." SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 5. This Act shall take effect upon its approval. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature finds that health care services are becoming complex and it is increasingly difficult for patients to access integrated services. Quality of patient care is jeopardized because of staffing changes implemented in response to managed care.
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51	51	The legislature further finds that, to ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses be accessible and available to meet the needs of patients. The basic principles of staffing in the acute care setting should be based on the patient's care needs, the severity of condition, services needed, and the complexity surrounding those services.
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53	53	The purpose of this Act is to:
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55	55	(1) Prohibit a hospital from assigning unlicensed assistive personnel to perform nursing care tasks, functions, and activities that would otherwise fall under the scope of practice of a registered nurse or permitting a registered nurse to delegate certain tasks, functions, and activities to unlicensed assistive personnel;
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57	57	(2) Prohibit registered nurses from being assigned to a nursing unit or critical care area unless registered nurses receive orientation and demonstrate individual competency;
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59	59	(3) Require the department of health to adopt rules that establish requirements related to registered nurse-to-patient ratios in licensed hospitals; and
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61	61	(4) Require the department of health to submit a report to the legislature.
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63	63	SECTION 2. Chapter 321, part I, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
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65	65	"§321- Registered nurses; delegation; staffing levels. (a) A hospital licensed pursuant to this chapter shall not assign unlicensed assistive personnel to perform nursing care tasks, functions, and activities that would otherwise fall under the scope of practice of a registered nurse licensed under chapter 457. A hospital shall not permit a registered nurse to delegate nursing care tasks, functions, and activities to unlicensed assistive personnel that require a substantial amount of scientific knowledge and technical skills, including:
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67	67	(1) Administration of medication;
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69	69	(2) Venipuncture of intravenous therapy;
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71	71	(3) Parenteral or tube feedings;
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73	73	(4) Invasive procedures, including inserting nasogastric tubes, inserting catheters, or tracheal suctioning;
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75	75	(5) Assessment of patient condition;
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77	77	(6) Educating patients and their families concerning the patients' health care problems, including post-discharge care; and
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79	79	(7) Moderate complexity laboratory tests;
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81	81	provided that nothing in this section shall be construed to restrict the practice of another health care provider licensed in the State from practicing within that health care provider's own recognized scope of practice.
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83	83	(b) No registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has first received orientation in that unit or area sufficient to demonstrate individual competency and ability to provide appropriate care to patients in that unit or area.
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85	85	(c) No later than , the department shall adopt rules pursuant to chapter 91 that establish minimum, specific, and numerical registered nurse-to-patient ratios by hospital unit for all hospitals licensed under this chapter. The rules shall include requirements that:
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87	87	(1) Establish the minimum number of registered nurses that shall be allocated within each hospital unit;
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89	89	(2) Establish additional staffing requirements assigned in accordance with a documented patient classification system for determining nursing care requirements, including:
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91	91	(A) Severity of a patient's illness;
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93	93	(B) Need for specialized equipment and technology;
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95	95	(C) Complexity of clinical judgment needed to design, implement, and evaluate a patient care plan and the ability for self-care; and
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97	97	(D) Licensure requirements for health care providers offering care pursuant to the requirements under this paragraph.
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99	99	(3) Provide flexibility for rural health centers, included requests for a waiver from the requirements of this section; provided that any waiver shall not jeopardize the health, safety, and well-being of patients at the rural health center;
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101	101	(4) Distinguish between regularly scheduled registered nurse core staff in an emergency medical services department and additional registered nurses providing critical care services to patients in an emergency medical services department;
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103	103	(5) Consider the unique needs of psychiatric patients receiving care at a licensed hospital; and
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105	105	(6) Consider the unique nurse-to-patient ratios for participants in a board-recognized nurse residency program; provided that the department shall coordinate with the board of nursing to establish requirements pursuant to this paragraph.
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107	107	(d) Rules adopted pursuant to this subsection shall not supersede any existing registered nurse-to-patient ratio requirements that may be in place for:
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109	109	(1) The Hawaii state hospital or any facility operated by the Hawaii health systems corporation; or
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111	111	(2) Intensive care units, neonatal intensive care units, or operating rooms within a licensed hospital.
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113	113	(e) All hospitals shall adopt written policies and procedures for training and mandatory orientation of nursing staff.
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115	115	(f) Except as provided by subsection (a), in the event of a conflict between this section and any provision of chapter 457 or rules adopted by the board of nursing pursuant to this section, chapter 457 and any rules adopted pursuant to that chapter shall prevail.
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117	117	(g) The department shall submit a report to the legislature no later than twenty days prior to the convening of the regular session of 2026, on its efforts to comply with this section, including any proposed changes to the rules adopted pursuant to this section.
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119	119	(h) For purposes of this section:
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121	121	"Critical care unit" means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by registered nurses.
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123	123	"Hospital unit" means a critical care unit, burn unit, labor and delivery room, post-anesthesia service area, emergency medical services department, operating room, pediatric unit, stepdown or intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit, and transitional inpatient care unit."
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125	125	SECTION 3. Section 457-7.5, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
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127	127	"(a) [A] Except as provided in section 321- (a), a registered nurse may delegate nursing care tasks, functions, and activities to unlicensed assistive personnel in a manner that is appropriate to the level of knowledge and skill of the unlicensed assistive personnel; provided that the delegation of tasks, functions, and activities complies with applicable federal and state laws; and provided further that the practice-pervasive functions of assessment, evaluation, and nursing judgment shall not be delegated."
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129	129	SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
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131	131	SECTION 5. This Act shall take effect upon its approval.
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135	135	INTRODUCED BY: _____________________________
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137	137	INTRODUCED BY:
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139	139	_____________________________
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145	145	Report Title: Nurses; Registered Nurses; Hospitals; Registered Nurse to Patient Ratios; Rules; Department of Health Description: Prohibits a hospital from assigning unlicensed assistive personnel to perform nursing care tasks, functions, and activities that would otherwise fall under the scope of practice of a registered nurse or permitting a registered nurse to delegate certain tasks, functions, and activities to unlicensed assistive personnel. Prohibits registered nurses from being assigned to a nursing unit or critical care area unless registered nurses receive orientation and demonstrate individual competency. Requires the department of health to adopt rules that establish requirements related to registered nurse-to-patient ratios in licensed hospitals. Requires a report to the legislature. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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151	151	Report Title:
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153	153	Nurses; Registered Nurses; Hospitals; Registered Nurse to Patient Ratios; Rules; Department of Health
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157	157	Description:
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159	159	Prohibits a hospital from assigning unlicensed assistive personnel to perform nursing care tasks, functions, and activities that would otherwise fall under the scope of practice of a registered nurse or permitting a registered nurse to delegate certain tasks, functions, and activities to unlicensed assistive personnel. Prohibits registered nurses from being assigned to a nursing unit or critical care area unless registered nurses receive orientation and demonstrate individual competency. Requires the department of health to adopt rules that establish requirements related to registered nurse-to-patient ratios in licensed hospitals. Requires a report to the legislature.
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167	167	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.