H. B. 2584
(By Delegates Hatfield, Brown, Marshall,
Caputo, Varner and Mahan)
[Introduced February 28, 2001; referred to the
Committee on Government Organization then Finance.]
A BILL to amend chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article thirty-eight,
relating to services provided by nurses in hospitals and
nursing homes; requiring the development of nurse-to-patient
ratios for hospitals and nursing homes; and creating a safe
staffing advisory council.
Be it enacted by the Legislature of West Virginia:
That chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by adding
thereto a new article, designated article thirty-eight, to read as
follows:
ARTICLE 38. NURSING STAFF IN HOSPITALS AND NURSING HOMES.
§16-38-1. Legislative findings.
The Legislature finds the following:
(1) Health care services are becoming complex and it is
increasingly difficult for patients to access integrated services;
(2) Quality of patient care is jeopardized because of staffing
changes implemented in response to managed care;
(3) To ensure the adequate protection of patients in acute
care settings, it is essential that qualified registered nurses and
other licensed nurses be accessible and available to meet the needs
of patients; and
(4) 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.
§16-38-2. Development of nurse-patient ratios.
(a) By the first day of January, two thousand two, the health
care authority, created in article twenty-nine-b of this chapter,
with the concurrence of the safe staffing advisory council, shall
propose rules for legislative approval in accordance with the
provisions of article three, chapter twenty-nine-a of this code
that establish minimum, specific and numerical licensed
nurse-to-patient ratios by licensed nurse classification and by
unit for:
(1) All facilities licensed under the provisions of article
five-b of this chapter, all hospitals operated by the state or any
agency of the state and all hospitals which are staffed, in whole
or in part, by public employees; and
(2) All nursing homes licensed under the provisions of article
five-c of this chapter.
(b) The authority shall consider providing flexibility for
rural primary care hospitals in response to their special needs.
(c) With regards to hospitals, as used in subsection (a) of
this section, "unit" includes, but is not limited to, a critical
care unit, burn unit, labor and delivery room, postanesthesia
service area, emergency department, operating room, pediatric unit,
step-down/intermediate care unit, specialty care unit, telemetry
unit, general medical care unit, subacute care unit and
transitional inpatient care unit.
(d) The rules addressing emergency units shall distinguish
between regularly scheduled core staff licensed nurses and
additional licensed nurses required to care for critical care
patients in an emergency unit.
(e) The ratios shall be the minimum number of registered and
licensed nurses that may be allocated. Additional staff shall be
assigned in accordance with a documented patient classification system for determining nursing care requirements, including the
severity of the illness, the need for specialized equipment and
technology, the complexity of clinical judgment needed to design,
implement, and evaluate the patient care plan and the ability for
self-care and the licensure of the personnel required for care.
(f) "Critical care unit" as used in this section means a unit
that is established to safeguard and protect patients whose
severity of medical conditions requires continuous monitoring, and
complex intervention by licensed nurses.
(g) The health care authority shall take into consideration
the findings of the legislative oversight commission on health and
human resources accountability when establishing licensed
nurse-to-patient ratios.
(h) The health care authority may take into consideration the
unique nature of state sponsored teaching hospitals as educational
institutions when establishing licensed nurse-to-patient ratios.
The authority shall coordinate with the board examiners for
registered professional nurses to ensure that staffing ratios are
consistent with the board's approved nursing education
requirements. This includes nursing clinical experience incidental
to a work-study program rendered in a state-sponsored teaching
hospital if there are sufficient direct care registered professional nurse preceptors available to ensure safe patient
care.
(i) Hospitals operated by a county are subject to a phase-in
process developed in conjunction with the health care authority.
The phase-in process shall be completed within one year of the
adoption of the rules that implement this section.
§16-38-3. Safe staffing advisory council; members, appointment and
expenses; appointment; duties.
(a) The safe staffing advisory council is created within the
health care authority. The council consists of fifteen members.
The governor shall appoint:
(1) One registered nurse who is employed in a school of
nursing in a teaching hospital in this state;
(2) Two individuals who are on the board of examiners for
registered professional nurses;
(3) Four individuals that are employed as registered
professional nurses in a hospital and who work primarily providing
direct patient care;
(4) One registered professional nurse who works as a long-term
care nurse in a nursing home and who works primarily providing
direct patient care;
(5) One administrator of a hospital in this state;
(6) One doctoral prepared nurse educator;
(7) One doctoral prepared nurse researcher;
(8) One nursing home administrator; and
(9) Three representatives of the public not currently or
previously employed in hospital, nursing home or for a related
entity.
(b) Of the members first appointed, the governor shall, at the
time of their appointment, designate five members to serve terms
expiring on the thirtieth day of June, two thousand two, five
members to serve terms expiring on the thirtieth day of June, two
thousand three, and five members to serve terms expiring on the
thirtieth day of June, two thousand four. As the original
appointments expire, each subsequent appointment is for a
three-year term. Any member whose term has expired serves until a
successor has been duly appointed and qualified. Any person
appointed to fill a vacancy serves only for the unexpired term. In
cases of any vacancy in the office of a member, the vacancy shall
be filled by the governor in the same manner as the original
appointment was made.
(c) Members of the council are not entitled to compensation
for services performed as members, but are entitled to
reimbursement for all reasonable and necessary expenses actually
incurred in the performance of their duties. Eight of the appointed members is a quorum for the purpose of conducting
business. The governor shall designate a chair, who is not a
public official, for a term to run concurrently with the term of
office of the member designated as chair. The council shall
conduct all meetings in accordance with the open meeting law
pursuant to article nine-a, chapter six of this code.
(d) The council:
(1) Shall assist the health care authority in developing the
nurse-to-patients ratios required by this article; and
(2) Must approve the final proposed rules prior to submission
to the legislative rule-making review committee.
NOTE: The purpose of this bill is to address the safe
provision of nursing services in hospitals and nursing homes. It
does this by requiring the development of nurse-to-patient ratios
for hospitals and nursing homes. The bill also creates a Safe
Staffing Advisory Council to assist the Health Care Authority in
developing nurse-to-patient ratios for hospitals and nursing homes.
This article is new; therefore, strike-throughs and
underscoring have been omitted.
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