Bill > S1941

Introduced Session

This bill establishes staffing standards for registered professional nurses in State hospitals, ambulatory surgical facilities, developmental centers, and psychiatric hospitals. Specifically, the bill provides that, in addition to existing 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, in accordance with the minimum staffing requirements that are established by the bill. As specified in the bill, 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 regulations adopted by the Commissioner of Health are not to decrease any nurse-to-patient staffing ratios that are already in effect on the bill's effective date. 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 otherwise provided by law or regulation, in order 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 facility's department of nursing, with the approval of a majority of the unit staff nurses or their bargaining agent. The bill requires the acuity and staffing system to allow for the forecasting of staffing levels, and to provide a method to adjust staffing levels for 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) the 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 the 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 acuity and staffing 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 Commissioner of Health will also 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 Department of Health to enforce minimum staffing ratios by conducting periodic inspections and responding to complaints. The bill provides a system, pursuant to which a registered professional nurse, other staff member, or member of the public, believing that a facility is in violation of the staffing requirements or the staffing and acuity system, may file a complaint with the Commissioner of Health. In responding to a complaint, the commissioner will be required to conduct an investigation to determine whether or not a hospital or facility is in violation, and to take such other action as may be necessary to ensure compliance with the requirements of the bill. Finally, in addition to the above-described requirements applicable to the Commissioner of Health, 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.

AI Summary

Committee Categories

Linda Greenstein (D)*,  Joe Vitale (D)*,  Renee Burgess (D),  Patrick Diegnan (D),  Vin Gopal (D),  Joe Lagana (D),  Nellie Pou (D),  Teresa Ruiz (D),  Brian Stack (D),  Shirley Turner (D),  Andrew Zwicker (D), 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 01/09/2024)

Official Document