12153514
BILL 1426:
Hospital Patient
Protection
- Complex healthcare services driven by health care trend and patients' needs
- Negatively impacted quality of care secondary to inconsistent staffing
- Necessity for nurse to meet the need of patients at all times to ensure protection
- Establishment of professional nursing practice standards and professional practice
protections
- Hospital Nursing
Practice Standards
- Professional Obligation and Right
- Nurse has the duty and right to act and care in exclusive interests of a patient
- Nurse is required to advocate for the patient as circumstances require
- Nurse has the duty and right to act and care in exclusive interests of a patient
- Acceptance of Patient Care
Assignment
- Qualified direct care registered nurse is required to provide assigned patients with
nursing care that is:
- Competent
- Safe
- Therapeutic
- Effective
- Competent
- Health care facility is required to adopt, disseminate to direct care nurses and comply with a
written policy that details the circumstances under which a direct care nurse may refuse a
work assignment.
- At the minimum, the policy shall permit a direct care nurse to refuse a
patient assignment with the conditions of:
- Insufficiency
- Knowledge
- Judgement
- Compromising/Jeopardizing patient's safety
- Compromising/Jeopardizing patient's safety
- Skill
- Ability
- Knowledge
- Insufficiency
- At a minimum, the policy shall permit a direct care nurse to assess an order initiated
by a physician or legally authorized health care professional before implementation
to determine if the order is:
- In the best
interests of the
patient;
- initiated by a person legally
authorized to issue the
order;
- In accordance with
applicable law and
regulation governing
nursing care
- In the best
interests of the
patient;
- At a minimum, the work assignment policy shall contain procedures for the
following:
- Reasonable requirements for prior notice to the nurse's supervisor regarding the nurse's request and
supporting reasons for being relieved of the assignment, continued duty or implementation of an
order.
- An opportunity for the supervisor to review the specific conditions supporting the nurse's request and
to decide whether to:
- Remedy the conditions
- Deny the nurse's request to be relieved of the assignment, continued
duty or implementation of an order
- Relieve the nurse of the assignment or order
- Remedy the conditions
- A process that permits the nurse to exercise the right to refuse the assignment, continued on-duty
status or implementation of an order when the supervisor denies the request to be relieved if
- The supervisor rejects the request without proposing a remedy or the proposed remedy would be
inadequate or untimely
- The complaint and investigation process with a regulatory agency would be untimely to address
concern
- The employee, in good faith, believes that the assignment or implementation of an order meets
conditions justifying refusal
- The supervisor rejects the request without proposing a remedy or the proposed remedy would be
inadequate or untimely
- Reasonable requirements for prior notice to the nurse's supervisor regarding the nurse's request and
supporting reasons for being relieved of the assignment, continued duty or implementation of an
order.
- At the minimum, the policy shall permit a direct care nurse to refuse a
patient assignment with the conditions of:
- Qualified direct care registered nurse is required to provide assigned patients with
nursing care that is:
- Professional Duty of Patient Advocacy
- Nurse has the duty to:
- Initiate actions to improve patient's health care
- Change decisions or activities that are against the patient's wishes
- Give the patient the opportunity to make informed decisions
- Initiate actions to improve patient's health care
- Nurse has the duty to:
- Free Speech
- Prohibition against discharge and retaliation for nurses who whistleblow or report unsafe practices/violation of policy,
regulation, rule, or law
- Rights guaranteed as essential to effective patient advocacy:
- Protected free speech of health care professionals
- Essentials to protect health and safety of patients
- Essentials to protect health and safety of patients
- Protected free speech of health care professionals
- DO NOT misinterpret protected free speech as authorization to
disclose private and confidential patient information
- Exception
- Compelled by proper legal process
- Required by law
- Consented to be the patient
- Provided in confidence to regulatory or accreditation agencies or other government entities for
investigatory purposes
- Provided in confidence to regulatory or accreditation agencies or other government entities for
investigatory purposes
- Required by law
- Compelled by proper legal process
- Exception
- Prohibition against discharge and retaliation for nurses who whistleblow or report unsafe practices/violation of policy,
regulation, rule, or law
- Direct Care Registered Nurse-to-Patient Staffing Ratios
- Minimum staffing by direct care registered nurses
in accordance with:
- Demonstration of
competence in specific
clinical area
- Appropriate orientation
- Demonstration of
competence in specific
clinical area
- Staffing for patient care tasks not requiring a direct care registered nurse is not included within these
ratios, including: Nurse administrators, nurse supervisors, nurse managers, charge nurses and case
managers
- No averaging of the number of patients and the total number of direct care registered nurses
- intensive care newborn nursery service units: 1 nurse: 2 or fewer infants
- Emergency department: only direct care nurses can be assigned to triage and critical trauma patients
- (Neonatal)ICU/Critical care unit/Burn unit/Post-anesthesia/Critical care patient in ED/Immediate post-partum: 1:2 or fewer at all times
- Conscious sedation/Epidural anesthesia 1:1
- Step-down/Intermmediate care: 1:3 or fewer
- Step-down/Intermmediate care: 1:3 or fewer
- Conscious sedation/Epidural anesthesia 1:1
- (Neonatal)ICU/Critical care unit/Burn unit/Post-anesthesia/Critical care patient in ED/Immediate post-partum: 1:2 or fewer at all times
- Emergency department: only direct care nurses can be assigned to triage and critical trauma patients
- Minimum staffing by direct care registered nurses
in accordance with:
- Hospital Unit Staffing Plam
- Acuity-base patient classification system
- Development of written staffing plan
- Record keeping
- Review comittee
- Time period for adjustments
- Process for staff input
- Limitation on administrator nursing service
- Minimum requirement for each shift
- Temporary nursing agencies
- Planning for routine fluctuations
- Acuity-base patient classification system
- Professional Obligation and Right
- Hospital Nursing
Practice Standards
- Ethical and legal obligations from nurse to patient's right, advocacy, and protection
- Increase in adverse patient outcomes from unsafe staffing practices
- Mandating adoption of nurse-to-patient ratio based on individual patient's need
for competent, safe, therapeutic and effective professional nursing care
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