REPORT TITLE:
Health care facilities


DESCRIPTION:
Prohibits health care facilities from assigning unlicensed
personnel to perform nursing functions in lieu of a registered
nurse.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        2921
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH CARE FACILITIES.


BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      Section 1.  The legislature finds that the quality of
 
 2 patient care is jeopardized because of staffing changes
 
 3 implemented in response to managed care.  To ensure the adequate
 
 4 protection of patients in acute care settings, it is essential
 
 5 that qualified registered nurses and other licensed nurses be
 
 6 accessible and available to meet the needs of patients.  The
 
 7 basic principles of staffing in the acute care setting should be
 
 8 based on the patient's needs and the severity of the condition,
 
 9 services needed, and the complexity surrounding those services.
 
10      The legislature further finds that chapter 457, Hawaii
 
11 Revised Statutes, provides for the licensing and regulation of
 
12 nurses, and sets forth the responsibilities of registered nurses,
 
13 including the delegation of nursing tasks to unlicensed personnel
 
14 to provide safe, quality care to consumers.
 
15      In keeping with the mandate to protect the public, the
 
16 purpose of this Act is to prohibit all health care facilities
 
17 from assigning unlicensed personnel to perform nursing functions
 
18 in lieu of a registered nurse.
 
19      SECTION 2.  Chapter 323, Hawaii Revised Statutes, is amended
 
20 by adding two new sections to part I to read as follows:
 

 
Page 2                                                     2921
                                     H.B. NO.           
                                                        
                                                        

 
 1      "§323-    Health care facilities; nursing functions.  (a)  A
 
 2 health care facility as defined in section 323D-2 shall not
 
 3 assign unlicensed personnel to perform nursing functions in lieu
 
 4 of the practice of nursing as a registered nurse pursuant to
 
 5 chapter 457.
 
 6      (b)  A health care facility may not allow unlicensed
 
 7 personnel to perform functions under the direct clinical
 
 8 supervision of a registered nurse that requires a substantial
 
 9 amount of scientific knowledge and technical skills including but
 
10 not limited to any of the following:
 
11      (1)  Administration of medication;
 
12      (2)  Venipuncture or intravenous therapy;
 
13      (3)  Parenteral or tube feedings;
 
14      (4)  Invasive procedures including inserting nasogastric
 
15           tubes, inserting catheters, or tracheal suctioning;
 
16      (5)  Assessment of patient condition;
 
17      (6)  Education of patients and their families concerning the
 
18           patient's health care problems, including post-
 
19           discharge care; or
 
20      (7)  Moderate complexity laboratory tests.
 
21      §323-    Health care facility; nursing ratio.  (a)  A health
 
22 care facility licensed by the department of health shall allocate
 
23 sufficient numbers of registered nurses to provide a nurse-to-
 
24 patient ratio as follows:
 

 
Page 3                                                     2921
                                     H.B. NO.           
                                                        
                                                        

 
 1      (1)  One registered nurse to no more than two patients in
 
 2           critical care units, burn units, labor and delivery
 
 3           units, post-anesthesia units, and critical patients in
 
 4           emergency departments requiring care in an intensive or
 
 5           critical care setting.  The ratio of one registered
 
 6           nurse to two critical care patients temporarily held in
 
 7           the emergency department shall be in addition to the
 
 8           regularly scheduled emergency room staff;
 
 9      (2)  One registered nurse to three patients to staff
 
10           pediatric and step-down units, telemetry units, or
 
11           intermediate care units; and
 
12      (3)  One registered nurse to four patients to staff general
 
13           medical care units that includes subacute care and
 
14           transitional impatient care units.
 
15      There shall be sufficient nursing personnel so that one
 
16 registered nurse is not serving as circulating assistant for more
 
17 than one operating room.
 
18      (b)  These ratios shall constitute a minimum number of
 
19 registered nurses that shall be allocated.  Additional staff
 
20 shall be assigned in accordance with a documented patient
 
21 classification system for determining nursing care requirements,
 
22 including the severity of the illness, the need for specialized
 
23 equipment and technology, the complexity of clinical judgment
 

 
Page 4                                                     2921
                                     H.B. NO.           
                                                        
                                                        

 
 1 needed to design, implement, and evaluate the patient care plan
 
 2 and the patient's ability for self-care, and the licensure of the
 
 3 personnel required for care.
 
 4      (c)  No registered nurse shall be assigned to a nursing unit
 
 5 or clinical area unless that nurse has first received orientation
 
 6 in that clinical area sufficient to provide competent care to
 
 7 patients in that area, and has demonstrated current competence in
 
 8 providing care in that area.  The written policies and procedures
 
 9 for orientation of nursing staff shall require that all temporary
 
10 personnel receive the same amount and type of orientation as is
 
11 required for permanent staff.
 
12      (d)  Exemptions to this section that do not jeopardize the
 
13 health, safety, and well-being of patients affected and that are
 
14 needed for increased operational efficiency may be granted by the
 
15 department to rural general acute care hospitals.
 
16      (e)  This section shall not abrogate nor supersede Chapter
 
17 457."
 
18      SECTION 2.  New statutory material is underscored.
 
19      SECTION 3.  This Act shall take effect upon its approval.
 
20 
 
21                       INTRODUCED BY:  ___________________________