REPORT TITLE:
Registered Nurses; Staffing


DESCRIPTION:
Prohibits unlicensed personnel from performing certain acts in
hospitals, even under supervision of registered nurses.  Sets
certain nurse to patient ratios in hospitals.  Sets additional
staffing requirements.  Allows waivers for rural general acute
care hospitals under certain conditions.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           2735
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO PATIENT SAFETY.



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

 1      SECTION 1.  The legislature finds and declares that health
 
 2 care services are becoming complex and it is increasingly
 
 3 difficult for patients to access integrated services.  The
 
 4 quality of patient care is jeopardized because of staffing
 
 5 changes implemented in response to managed care.  To ensure the
 
 6 adequate protection of patients in acute care settings, it is
 
 7 essential that qualified registered nurses and other licensed
 
 8 nurses be accessible and available to meet the needs of patients.
 
 9 The basic principles of staffing in the acute care setting should
 
10 be based upon the patients' care needs and the severity of
 
11 condition, services needed, and the complexity surrounding those
 
12 services.
 
13      Existing law provides for the licensing and regulation of
 
14 nurses, and sets forth the responsibilities of registered nurses,
 
15 including the delegation of nursing tasks to unlicensed
 
16 personnel.  Existing law also prohibits operation of a health
 
17 facility without a license issued by the department of health,
 
18 the regulation of these facilities, and sets forth the services
 
19 to be provided.  Both registered nurses and hospitals are
 

 
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 1 licensed and are accountable to the public for providing safe,
 
 2 quality care to consumers.  In keeping with the mandate to
 
 3 protect the public, this Act prohibits all private and public
 
 4 hospitals from assigning an unlicensed person to perform nursing
 
 5 functions in lieu of a registered nurse, or from allowing
 
 6 unlicensed personnel under the direct clinical supervision of a
 
 7 registered nurse to perform certain functions.
 
 8      SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended
 
 9 by adding a new section to be appropriately designated and to
 
10 read as follows:
 
11      "§321-     Acts by unlicensed personnel in hospitals
 
12 prohibited; nurse to patient ratios; allocation of nursing staff
 
13 within hospitals; waiver.  (a)  No hospital licensed by the
 
14 department may assign unlicensed personnel to perform nursing
 
15 functions in place of a registered nurse or allow unlicensed
 
16 personnel to perform functions under the direct clinical
 
17 supervision of a registered nurse that require a substantial
 
18 amount of scientific knowledge and technical skills, including,
 
19 but not limited to, any of the following:
 
20      (1)  Administration of medication;
 
21      (2)  Venipuncture or intravenous therapy;
 
22      (3)  Parenteral or tube feedings;
 
23      (4)  Invasive procedures including inserting nasogastric
 

 
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 1           tubes, inserting catheters, or tracheal suctioning;
 
 2      (5)  Assessment of a patient's condition;
 
 3      (6)  Educating patients and their families concerning the
 
 4           patient's health care problems, including post-
 
 5           discharge care; and
 
 6      (7)  Laboratory tests of moderate complexity.
 
 7      (b)  Each hospital licensed by the department shall allocate
 
 8 sufficient numbers of registered nurses so as to provide a nurse-
 
 9 to-patient ratio as follows:
 
10      (1)  One registered nurse to no more than two patients in
 
11           critical care units, burn units, labor and delivery,
 
12           postanesthesia units, and critical patients in
 
13           emergency departments requiring care in an intensive or
 
14           critical care setting.  The ratio of one registered
 
15           nurse to two critical care patients temporarily held in
 
16           the emergency department shall be in addition to the
 
17           regularly scheduled emergency room staff;
 
18      (2)  At least one registered nurse, serving as circulating
 
19           assistant, to one operating room;
 
20      (3)  One registered nurse to three patients to staff
 
21           pediatric, step-down, telemetry, or intermediate care
 
22           units; and
 
23      (4)  One registered nurse to four patients to staff general
 

 
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 1           medical care units that include subacute care and
 
 2           transitional inpatient care units.
 
 3      (c)  The ratios in subsection (b) shall constitute a minimum
 
 4 number of registered nurses that shall be allocated.  Additional
 
 5 staff shall be assigned in accordance with a documented patient
 
 6 classification system for determining nursing care requirements,
 
 7 including:
 
 8      (1)  The severity of the illness;
 
 9      (2)  The need for specialized equipment and technology;
 
10      (3)  The complexity of clinical judgement needed to design,
 
11           implement, and evaluate the patient care plan;
 
12      (4)  The ability for self-care; and
 
13      (5)  The licensure of the personnel required for care.
 
14      (d)  No registered nurse shall be assigned to a nursing unit
 
15 or clinical area unless that nurse:
 
16      (1)  Has first received orientation in that clinical area
 
17           sufficient to provide competent care to patients in
 
18           that area; and
 
19      (2)  Has demonstrated current competence in providing care
 
20           in that area.
 
21 The written policies and procedures for orientation of nursing
 
22 staff shall require that all temporary personnel receive the same
 
23 amount and type of orientation that is required for permanent
 

 
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 1 staff.  The department may grant a waiver to the requirements of
 
 2 subsection (c) and this subsection for rural general acute care
 
 3 hospitals if the director determines that the request for a
 
 4 waiver clearly shows that granting the waiver will not jeopardize
 
 5 the health, safety, and well being of patients affected and that
 
 6 the waiver is needed to increase operational efficiency of the
 
 7 requesting hospital.
 
 8      (e)  If conflict arises between this section and any
 
 9 provision or rules under chapter 457, the provisions or rules
 
10 under chapter 457 shall prevail."
 
11      SECTION 3.  New statutory material is underscored.
 
12      SECTION 4.  This Act shall take effect upon its approval.
 
13 
 
14                           INTRODUCED BY:  _______________________