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  • NJ A750
  • Establishes minimum registered professional nurse staffing standards for hospitals and ambulatory surgery facilities and certain DHS facilities.
In Committee
Crossed OverPassedSignedDead/Failed/Vetoed
Veto Overridden
2016-2017 Regular Session
This bill establishes staffing standards for registered professional nurses in hospitals, ambulatory surgical facilities, and State developmental centers and psychiatric hospitals. Specifically, the bill provides that, in addition to staffing requirements provided by law or regulation, the Commissioner of Health is to adopt regulations that provide minimum direct care registered professional nurse-to-patient staffing ratios for all patient units in general and special hospitals and ambulatory surgical facilities. The regulations are not to decrease any nurse-to-patient staffing ratios in effect on the effective date of the bill. The minimum nurse-to-patient ratios will vary depending on the type of unit, and will range from one registered professional nurse for every five patients in a behavioral health or psychiatric or a medical/surgical unit, to one registered professional nurse for every patient under anesthesia in an operating room. The bill provides that the Commissioner of Health is to require all general and special hospitals and ambulatory surgical facilities to employ an acuity and staffing system for the purpose of increasing direct care registered professional nurse staffing levels above the minimum levels established in the bill, or as otherwise provided by law or regulation, to ensure adequate staffing of each unit, service, or department. The acuity and staffing system will be based on: patient classification or acuity; professional nurse staffing standards adopted by nurse specialty organizations; skill mix; and the staffing levels of other health care personnel and the use of agency or temporary staff. The system is to be established in the facility by the department of nursing with approval of a majority of the unit staff nurses or their bargaining agent. The bill provides that the acuity and staffing system is to allow forecasting of staffing levels and provide a method to adjust staff to each patient care unit based on objective criteria currently set forth at N.J.A.C.8:43G-17.1(a)3, including, but not limited to: (1) documented skills, training, and competency of staff to plan and provide nursing services in the nursing areas where they function; (2) a patient database incorporating objective factors such as the case mix index, specific or aggregate patient diagnostic classifications or acuity levels, patient profiles, critical pathways or care progression plans, length of stay, and discharge plans; (3) operational factors, such as unit size, design, and capacity, the admission/discharge/transfer index, and support service availability; (4) contingency plans to address critical departures from the staffing plan, including policies and procedures to regulate closure of available beds if staffing levels fall below specified levels; and (5) policies and procedures for the reassignment of staff, including float and agency staff. The system will additionally be required to permit waiver of minimum staffing level requirements in the event of an unforeseen emergent circumstance which causes significant changes in the patient census for a regular shift. Waiver will not be permitted unless the facility has made reasonable efforts to provide sufficient additional staff to meet the required minimum staffing levels, including seeking volunteers and making use of on-call staff, per-diem staff, agency staff, and float pools. The bill defines "unforeseeable emergent circumstance" to mean an unpredictable or unavoidable occurrence requiring immediate action. The bill will provide a system for a registered professional nurse or other staff member or a member of the public who believes that a facility is in violation of the staffing requirements or the staffing and acuity system to file a complaint with the Commissioner of Health. The commissioner will be required to conduct an investigation of the complaint to determine whether or not a hospital or facility is in violation and to take such action as may be necessary to ensure compliance with the requirements of the bill. In addition to investigating complaints, the Department of Health will also be required to monitor and enforce the minimum staffing level requirements though periodic inspections. The Commissioner of Health will be permitted to waive the minimum staffing level requirements for any hospital or facility that the commissioner determines is in financial distress. A waiver may be revoked upon a determination that the facility is no longer in financial distress. The bill requires the Commissioner of Human Services to conduct a review of Department of Human Services regulations concerning registered professional nurse staffing standards in developmental centers and State psychiatric hospitals, and to revise the regulations, as appropriate, to reflect safe staffing practices and assure adequate staffing at the facilities.
Health and Senior Services, Withdrawn from the Files
Withdrawn from Consideration  (on 10/27/2016)
Date Chamber Action Description
10/27/2016 A Withdrawn from Consideration
1/27/2016 A Introduced, Referred to Assembly Health and Senior Services Committee
Date Motion Yea Nay Other
None specified