REPORT TITLE:
Nursing Care


DESCRIPTION:
Establishes a Patient Rights to Nursing Care Task Force to assist
the Insurance Commissioner in developing rules to ensure quality
nursing care is provided to Hawaii's patients.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           573
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                     A BILL FOR AN ACT

RELATING TO PATIENT SAFETY AND THE RIGHT TO NURSING CARE.



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

 1      SECTION 1.  The legislature finds that the President's
 
 2 Advisory Commission on Consumer Protection and Quality in the
 
 3 health care industry was created to make recommendations to the
 
 4 President on how to address compelling data that suggested the
 
 5 quality of health care declined radically with the onset of
 
 6 unregulated managed care.
 
 7      On March 31, 1998, The President's Advisory Commission on
 
 8 Consumer Protection and Quality in the Health Care Industry
 
 9 submitted a Final Report to the President of the United States
 
10 called Quality First:  Better Health Care for All Americans.
 
11      The Commission suggests the following statement in defining
 
12 the purpose of the health care system:  "The purpose of the
 
13 health care system must be to continuously reduce the impact and
 
14 burden of illness, injury and disability, and to improve the
 
15 health and functioning of the people of the United States."
 
16      The Commission also suggests that aitial set of national
 
17 aims should include, but not be limited to, the following:
 
18      (1)  Reducing the underlying causes of illness, injury, and
 
19           disability;
 

 
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 1      (2)  Expanding the research on new treatment and evidence on
 
 2           effectiveness;
 
 3      (3)  Assuring the appropriate use of health care services;
 
 4      (4)  Reducing health care errors;
 
 5      (5)  Addressing oversupply and undersupply of health care
 
 6           resources; and
 
 7      (6)  Increasing patients' participation in their care.
 
 8      Hawaii's health care system is undergoing a dramatic
 
 9 transformation.  Contributing factors to the transformation are
 
10 an increased emphasis on managed care, changes in health care
 
11 financing, deregulation of the industry resulting in
 
12 unprecedented competition and consolidation among providers, and
 
13 the emergence of for-profit health care providers into the Hawaii
 
14 health care arena.  These trends have resulted in an increased
 
15 focus by many Hawaii providers on market competition and
 
16 financial performance, blurring their mission of providing
 
17 accessible, high quality health care.
 
18      The impact of these health care system changes on Hawaii's
 
19 patients has been significant.  As a result of the pressures of
 
20 cost containment in the health care industry since 1992, Hawaii
 
21 nurses have increasingly identified difficulty in providing a
 
22 professional standard of care to patients, which is the patient's
 
23 right and the licensed nurses responsibility.
 

 
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 1      The negative effects of health care system changes on
 
 2 patients and patient care has been documented in literature.
 
 3 Lewin-VHI Inc. a health care consulting firm based in Fairfax,
 
 4 Virginia, prepared a report for the American Nurses'
 
 5 Association's (ANA) that explored the nature and strength of the
 
 6 linkages of nursing care and patient outcomes.  The report
 
 7 entitled "Nursing Report Card for Acute Care" contains, in part,
 
 8 research data that indicates that hospitals who employ fewer
 
 9 registered nurses or who "short staff" their units have longer
 
10 lengths of patient residence than hospitals that employ
 
11 registered nurses to provide all or most patient care or that
 
12 have higher nurse to patient ratios.  These longer lengths of
 
13 stay are associated with poor patient monitoring, omissions, or
 
14 delays in certain treatments, and an increase in medication
 
15 errors and accidents.
 
16      The report additionally indicates that mortality rates are
 
17 indeed related to the quality of nursing care, as measured by the
 
18 ratio of registered nurses to all nursing staff.  This
 
19 relationship appears to stem from both the positive effect of a
 
20 more qualified nursing staff on direct patient care and the
 
21 organizational changes that often correspond to a larger
 
22 proportion of registered nurses (e.g., increased centralization
 
23 of nursing decision making at the ward level and standardization
 

 
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 1 of nursing procedures).  In addition, lower Medicare mortality
 
 2 has been found to occur in hospitals which nurses characterize as
 
 3 "good" places to work.  While this does not imply a causal
 
 4 relationship between mortality and nurse satisfaction (e.g., the
 
 5 importance and status of nurses, increased nurse autonomy, and
 
 6 control over the practice environment) it does appear to have
 
 7 some effect on mortality.
 
 8      As a matter of public policy and as evidenced by the passage
 
 9 of Act 178, Session Laws of Hawaii 1998, the Hawaii Patient Bill
 
10 of Rights and Responsibilities Act, the State of Hawaii, as the
 
11 Health State, is committed to continuously reduce the impact and
 
12 burden of illness, injury, and disability, and to improve the
 
13 health and functioning of the people of Hawaii.  The State must
 
14 also ensure that people who seek care through Hawaii's health
 
15 care system have access to cost-effective and quality health
 
16 care.
 
17      Consequently, the legislature finds that patients in health
 
18 care environments that do not have sufficient nursing care are at
 
19 risk for inadequate assessment of their condition, increased
 
20 infection rates, skin breakdown, medication errors, inadequate
 
21 pain management, falls, and inadequate preparation for discharge.
 
22 These risk factors often contribute to increased lengths of stay,
 
23 readmissions, and increased costs to the patient, family,
 

 
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 1 taxpayer, and the health care system.  The legislature further
 
 2 finds a positive correlation between increased nursing staffing
 
 3 and positive outcomes for patients.  The legislature believes
 
 4 that Hawaii's patients have a right to quality nursing care
 
 5 across the health care continuum and calls upon the health care
 
 6 industry, the nursing profession, and state agencies to adopt
 
 7 rules that codify the right to sufficient nursing care.
 
 8      The purpose of this Act is to assist Hawaii's citizens to
 
 9 receive the highest quality of nursing care, by requiring
 
10 development of rules by the insurance commissioner through a
 
11 patients rights to nursing care task force.
 
12      SECTION 2.  For the purposes of this Act:
 
13      "Commissioner" means the insurance commissioner of the State
 
14 of Hawaii.
 
15      "Board" means the Hawaii state board of nursing.
 
16      "Health care facility" means a health care facility or
 
17 service as defined in chapter 323D, Hawaii Revised Statutes.
 
18      "Nurse" means a person licensed under chapter 457, Hawaii
 
19 Revised Statutes.
 
20      "Patient or resident" means an individual or family
 
21 receiving nursing care within a health care facility.
 
22      SECTION 3.  The commissioner, with the assistance of the
 
23 patient's right to nursing care task force, shall develop, adopt,
 

 
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 1 and enforce rules to ensure that every patient or resident of any
 
 2 health care facility shall be assured upon admission for
 
 3 emergent, ambulatory, inpatient, or resident services to the
 
 4 health care facility, that sufficient nursing care shall be
 
 5 provided for the patient's or resident's safety and that a plan
 
 6 of nursing care based on applicable, professionally recognized
 
 7 standards of nursing practice shall be implemented throughout the
 
 8 patient's or resident's stay at the health care facility.
 
 9      The rules shall include but not be limited to:
 
10      (1)  A requirement that a registered nurse executive/leader
 
11           be designated by the facility to be involved in the
 
12           overall allocation of resources to ensure that a
 
13           patient's rights to nursing care is attained;
 
14      (2)  A requirement that a registered nurse designated by the
 
15           health care facility to be responsible for the overall
 
16           quality assurance for nursing care provided;
 
17      (3)  A requirement that upon a patient's or resident's
 
18           admission into a health care facility, a registered
 
19           nurse be designated by the health care facility to be
 
20           responsible for the direct nursing care of the patient
 
21           or resident at all times during the patient's or
 
22           resident's stay at the facility;
 
23      (4)  The adoption of nursing service staffing standards;
 

 
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 1      (5)  The adoption of professionally recognized standards of
 
 2           nursing practice; and
 
 3      (6)  Penalties and remedies for non-compliance with adopted
 
 4           rules.
 
 5      SECTION 4.  The commissioner shall convene a patient's right
 
 6 to nursing care task force for the purposes of developing rules
 
 7 to implement the purpose and intent of this Act.  The patient's
 
 8 right to nursing care task force shall be comprised of:
 
 9      (1)  Three health care consumer representatives:
 
10           (A)  One health care consumer, or a member of the
 
11                consumer's family, who has received nursing care
 
12                in an acute care setting in the last six months;
 
13           (B)  One health care consumer who represents senior
 
14                citizens who have received nursing care in the
 
15                last six months; and
 
16           (C)  One health care consumer receiving nursing care in
 
17                a long-term/home care setting in the last six
 
18                months;
 
19      (2)  Two representatives from the Hawaii Nurses'
 
20           Association;
 
21      (3)  Two representatives from the Healthcare Association of
 
22           Hawaii;
 
23      (4)  One representative from the Hawaii state board of
 

 
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 1           nursing;
 
 2      (5)  One representative from the Hawaii Long-Term Care
 
 3           Association;
 
 4      (6)  One representative from the Hawaii Association for Home
 
 5           Care; and
 
 6      (7)  One representative from the University of Hawaii,
 
 7           school of nursing.
 
 8      SECTION 5.  The commissioner shall report to the legislature
 
 9 not later than twenty days prior to the convening of the regular
 
10 session of 2000 on the progress in the development, adoption, and
 
11 implementation of rules ensuring Hawaii's patients' rights to
 
12 nursing care.
 
13      The task force shall cease to exist on June 30, 2000.
 
14      SECTION 6.  There is appropriated out of the general
 
15 revenues of the State of Hawaii the sum of $          , or so
 
16 much thereof as may be necessary for fiscal year 1999-2000, for
 
17 the purposes of this Act.
 
18      SECTION 7.  The sum appropriated shall be expended by the
 
19 department of commerce and consumer affairs for the purposes of
 
20 this Act.
 
21      SECTION 8.  This Act shall take effect upon approval;
 
22 provided that section 6 shall take effect on July 1, 1999.
 
23 
 
24                              INTRODUCED BY:______________________