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PONL Legislation Synopsis

Pennsylvania Legislative Issues

Violence in the Workplace 

Support SB 351

An Act amending Title 18 (Crimes and Offenses) of the Pennsylvania Consolidated Statutes, the current Title 18 would be amended by adding “health care practitioners” to a protected class in the event of assault. This bill would raise the penalty for an assault on a healthcare practitioner, while in the performance of duty where there is bodily injury, from a misdemeanor of the second degree to a felony of the second degree.

Support HB 39

This bill originated from PA ACT 110 which requires organizations to include last names on healthcare workers identification badges with the exception of Emergency departments and Behavioral health. This bill aims to remove last names from identification badges yet still require photo, first name, credentials and the organization to be displayed.

It is felt that in doing so, we can provide for increased safety for healthcare workers to prevent predatory invasion utilizing social media to contact employees, thereby providing an increase in safety for all healthcare workers.

“Section 809.2. Photo identification tag regulations.

(a) Regulations. -Except as provided under subsection (c), the department shall promulgate regulations under subsection (b) to require employees to wear a photo identification tag when the employee is working. The following shall apply:

(1) The photo identification tag shall include a recent photograph of the employee, the employee's first name, the employee's title and the name of the health care facility or employment agency.
(4) A notation, marker or indicator included on an identification badge that differentiates employees with the same first name is considered acceptable in lieu of displaying an employee's last name."

Staffing

Do not support SB 63 AKA the Health Care Facilities Act

This bill would provide professional nurse staffing standards and establishing the Safe Staffing Penalty Account. Requires that a specific staffing committee be instituted in addition to the developing, implementing and monitoring of a professional nurse staffing plan for each hospital unit. Duties and responsibilities of staffing committees are:

    • Develop a staffing plan
    • Elect a chairperson from within the staffing committee who is a professional nurse that provides direct patient car
    • Take into consideration variables that can influence the staffing plan for that hospital unit, competencies required by the nursing staff in that hospital unit to provide care to the hospital unit's patient population to ensure the delivery of quality care and quality outcomes.
    • Be inclusive of Staffing standards recommended by nationally recognized professional nursing organizations, particularly those that address professional standards of care for the selected patient population
    • Incorporate staff skill mix, specialty certification and years of experience
    • Include the numbers and types of other professional, paraprofessional or support staff that professional nurses must collaborate with or supervise to ensure the delivery of quality care and quality outcomes.
    • Monitor quality measures, patient volume, patient acuity, nursing care intensity and patient turnover issues that can affect the numbers and types of staff required for the patient population in a hospital unit.
    • The time needed to complete various key nursing tasks, including, but not limited to, surveillance, patient assessment, patient education and discharge planning.
    • The physical environment in which care is provided, including, but not limited to, the physical architecture of each hospital unit, patient location and available technology of the health care facility.
    • Routine fluctuations, such as admissions, discharges (Ensure that the plan contains information informing professional nurses how to report concerns about noncompliance with the staffing plan to a person designated by the staffing committee.)
    • Review the plan at least twice annually and adjust the plan as determined by the staffing committee in accordance with the provisions of this section and review information received from the hospital under section 806-A.

A hospital shall have the following duties and responsibilities:

    • Establish the staffing committee
    • Provide the education and parameters necessary for the committee to create a staffing plan given the available resources of the hospital so that the committee can responsibly develop the staffing plan
    • Adopt the staffing plan in a timeline that is consistent with the hospital budgetary planning process.
    • Make accessible to all professional nursing staff the final and approved staffing plan for the units in the hospital.
    • Evaluate the staffing plan and report to the staffing committee no less than twice annually, pertaining to implementation, barriers to implementation and other concerns relating to staffing plans.
    • Develop and implement a plan of action with the assistance of professional nurses providing direct patient care and other appropriate staff, if there is evidence of noncompliance with the staffing plan and the noncompliance with the staffing plan negatively impacts patients and professional nurses.
    • Establish a process by which immediate concerns about nurse staffing can be reported and addressed within nursing and inform the professional nurse staff of the process.
    • Develop mechanisms by which professional nursing staff can raise concerns and make recommendations about the staffing plans either through the existing staffing committee or nursing administration, or both.
    • Ensure that the chief nursing officer receives periodic reports from the staffing committee in a format developed by the hospital to ensure that consistent information is captured.
    • Receive reports from other hospital committees that may be related to nurse staffing.
    • Provide an annual report, for internal purposes, to the chief executive officer, the staffing committee and the governing board relating to nurse staffing, including, but not limited to, compliance with the approved nurse staffing plans and any actions taken to address nurse staffing issues.
    • Make available to all patient’s information on how to make a request for the staffing plan, including the appropriate person, office or department that may be contacted to review or obtain a copy of the plan.
    • Protections for professional nurses specifically refusal of assignment. --A professional nurse who refuses an assignment that is in conflict with a hospital's staffing plan shall not be deemed to have engaged in negligent action or patient abandonment or to be in violation of professional nursing laws or regulations. 
      • Retaliation prohibited.--A hospital may not retaliate against a professional nurse for serving on a staffing committee or participating in the development, approval or review of a staffing plan.

Duties and responsibilities of department:

    • Form. The department shall develop a form to be completed by an individual designated by the department to inspect a hospital
    • Penalty. The department may impose an administrative penalty of $1,000 per day upon a hospital not in compliance

Do not support HB 867 Staffing Ratio Bill

In part states that current unsafe hospital direct care registered nurse staffing practices have resulted in adverse patient outcome. Mandating adoption of uniform, minimum, numerical and specific registered nurse-to-patient staffing ratios by licensed hospital facilities is necessary for competent, safe, therapeutic and effective professional nursing care and for retention and recruitment of qualified direct care registered nurses.

The minimum staffing ratios for general, acute, critical access and specialty hospitals are established in this subsection for direct care registered nurses as follows:

    • The direct care registered nurse-to-patient ratio in an intensive care unit shall be 1:2 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for a critical care unit shall be 1:2 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for a neonatal intensive care unit shall be 1:2 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for a burn unit shall be 1:2 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for a step-down, intermediate care unit shall be 1:3 or fewer at all times.
    • An operating room shall have at least one direct care registered nurse assigned to the duties of the circulating registered nurse and a minimum of one additional person as a scrub assistant for each patient-occupied operating room.
    • The direct care registered nurse-to-patient ratio in the post anesthesia recovery unit of an anesthesia service shall be 1:2 or fewer at all times, regardless of the type of anesthesia the patient received.
    • The direct care registered nurse-to-patient ratio for patients receiving conscious sedation shall be 1:1 at all times.
    • The direct care registered nurse-to-patient ratio for an emergency department shall be 1:4 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for critical care patients in the emergency department shall be 1:2 or fewer at all times.
    • Only direct care registered nurses shall be assigned to critical trauma patients in the emergency department, and a minimum direct care registered nurse to-critical trauma patient ratio of 1:1 shall be maintained at all times.
    • In an emergency department, triage, radio or specialty/flight, registered nurses do not count in the calculation of direct care registered nurse-to-patient ratio.
    • The direct care registered nurse-to-patient ratio in the labor and delivery suite of prenatal services shall be 1:1 at all times for active labor patients and patients with medical or obstetrical complications.
    • The direct care registered nurse-to-patient ratio shall be 1:1 at all times for initiating epidural anesthesia and circulation for cesarean delivery.
    • The direct care registered nurse-to-patient ratio for patients in immediate postpartum shall be 1:2 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for antepartum patients who are not in active labor shall be 1:3 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for patients in a postpartum area of the prenatal service shall be 1:3 mother-baby couplets or fewer at all times. In the event of cesarean delivery, the total number of mothers plus infants assigned to a single direct care registered nurse shall never exceed four. In the event of multiple births, the total number of mothers plus infants assigned to a single direct care registered nurse shall not exceed six. For postpartum areas in which the direct care registered nurse's assignment consists of mothers only, the direct care registered nurse-to-patient ratio shall be 1:4 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for postpartum women or postsurgical gynecological patients shall be 1:4 or fewer at all times.
    • Well baby nursery direct care registered nurse-to-patient ratio shall be 1:5 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for unstable newborns and those in the resuscitation period as assessed by the direct care registered nurse shall be 1:1 at all times.
    • The direct care registered nurse-to-patient ratio for recently born infants shall be 1:4 or fewer at all times.
    • The direct care registered nurse-to-patient ratio for pediatrics shall be 1:3 or fewer at all times.
    • The direct care registered nurse-to-patient ratio in telemetry shall be 1:3 or fewer at all times.
    • The direct care registered nurse-to-patient ratio in medical/surgical shall be 1:4 or fewer at all times.
    • The direct care registered nurse-to-patient ratios for presurgical and admissions units or ambulatory surgical units shall be 1:4 or fewer at all times.
    • The direct care registered nurse-to-patient ratio in other specialty units shall be 1:4 or fewer at all times.
    • The direct care registered nurse-to-patient ratio in psychiatric units shall be 1:4 or fewer at all times.
    • The direct care registered nurse-to-patient ratio in a rehabilitation unit or a skilled nursing facility shall be 1:5 or fewer at all times.
    • The use of patient acuity-adjustable units or clinical patient care areas is prohibited.
    • (Acuity-based patient classification system: In addition to the direct care registered nurse ratio requirements of subsection a hospital shall assign additional nursing staff, such as licensed practical nurses, certified nursing assistants and ancillary staff, through the implementation of a valid acuity-based patient classification system for determining nursing care needs of individual patients.
    • The ratios specified in subsection shall constitute the minimum number of registered nurses who shall be assigned to direct patient care. Additional registered nursing staff in excess of the prescribed ratios shall be assigned to direct patient care in accordance with the hospital's implementation of a valid system for determining nursing care requirements

Do not Support SB 450 Staffing ratios

Follows same premise of HB 867. Also includes language and guidelines as follows:

    • A hospital shall provide minimum staffing by direct care registered nurses.
    • Staffing for patient care tasks not requiring a direct care registered nurse is not included within these ratios and shall be determined under an acuity-based patient classification system.
    • The requirements are as follows:
      • No hospital may assign a direct care registered nurse to a nursing unit or clinical area unless that hospital and the direct care registered nurse determine that the direct care registered nurse has demonstrated and validated current competence in providing care in that area and has also received orientation to that hospital's clinical area sufficient to provide competent, safe, therapeutic and effective care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.
      • Direct care registered nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one direct care registered nurse at all times.
      • There shall be no averaging of the number of patients and the total number of direct care registered nurses on the unit during any one shift nor over any period of time.
      • Only direct care registered nurses providing direct patient care shall be included in the ratios.
      • Nurse administrators, nurse supervisors, nurse managers, charge nurses and case managers may not be included in the calculation of the direct care registered nurseto-patient ratio.
      • Only direct care registered nurses shall relieve other direct care registered nurses during breaks, meals and other routine, expected absences from the unit.

Other Legislative Action

Do not support Revoking the License of Nursing & Medical Professionals for the Theft of a Controlled Substance

Rep. Renshaw (Pittsburgh area) sent out a memorandum stating, in part:

“In the near future, I plan to introduce legislation that will amend the Professional Nursing Law to require the revocation of a professional nurse’s license for the conviction of an offense related to the theft of a controlled substance. As state representatives, I believe it is our duty to ensure that patients are protected by restricting these individuals from returning to work as a nurse after engaging in certain lawful behaviors. To address this issue, my legislation amends Section 14(a)(8) of the Professional Nursing Law by authorizing the State Board of Nursing to revoke the license of a professional nurse that has been convicted of acquiring, obtaining, or possessing a controlled substance by misrepresentation, fraud, forgery, deception, or subterfuge."

To date there has not been legislation formally introduced, will continue to monitor.

Support SB 25; HB 100 AKA “Full Practice Authority”

This bill would amend Professional Nursing Law, further providing for title, for definitions, for State Board of Nursing, certified registered nurse practitioners to practice within the full scope and intent of their education and expertise. This would revoke the current physician oversight collaborative agreements required for practice.

*This bill passed the PA Senate last year but was stalled in the PA House.

Support PA Entry into the Nurse License Compact: https://www.ncsbn.org/nurse-licensurecompact.htm

Currently 33 states have embraced the compact licensure for nurses - PA is not one of them. No legislation has been brought forth to date regarding this issue, however there has been interest with select House of Representative members. Will continue to monitor.

Other disciplines, such as Physical Therapists have legislation in both the Senate and House regarding compact licensure (SB 640 and HB 862).

Federal Legislative Issues

FY 2020 Appropriation request for Title VII Nursing Workforce Development ($266 Million) and National Institute of Nursing Research ($173 Million)

The Title VIII funding would provide for nursing education and funding to practice in rural areas, provide loan forgiveness for clinical nurses and nursing faculty. Funding for the NINR would provide ongoing funding for nursing research projects inclusive of reduction of chronic illnesses, QOL, and patient centered care.

Support Title VIII Nursing Workforce Reauthorization Act (HR 728)

Recognizes APRN roles and provides federal funding through FY 2024 Title VIII Nursing Workforce programs are currently operating without authorization. In today’s tight fiscal environment, programs without a current authorization run the risk of losing funding. Its critical Congress understands nursing workforce development programs are essential to ensuring there enough nurses to treat the patient population (AONL, 2019)

Support Home Health Care Planning Improvement Act (S 296; HR 2150)

Permit Nurse Practitioners and Physician Assistants to authorize home health care services. This will decrease LOS, increase patient satisfaction and QOL, decrease fragmentation by providing seamless entry for ongoing healthcare.

Support United States Cadet Nurse Corps Service Recognition Act (S 997; HR 2056)

Time Sensitive Issue: Would provide Honorable Discharges, medal privileges and veteran burial benefits to Nurses who served in the U.S. Cadet Nurse Corps during WWII.


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