To: CEOs, CNOs and Governmental Affairs
From: Ian Corbridge, RN, Clinical Policy Director and Jennifer Graves, RN, SVP Patient Safety
Staff Contact: Ian Corbridge, RN, Clinical Policy Director, ianc@wsha.org, 206-216-2514
Subject: 2017 Legislative Changes to Nurse Staffing Committee Requirements
Purpose
The purpose of this bulletin is to inform you about 2017 legislative changes to nurse staffing committee requirements and provide resources to help ensure compliance and success under the new law.
Applicability/Scope
This bulletin is relevant to CEOs, CNOs and members of the nurse staffing committees at all hospitals and health systems.
Hospitals and health systems need to comply with existing and new laws and prepare for implementation of the new law.
Recommendation
- Review this bulletin and contact WSHA staff if you have questions
- Review full text of the current and new law (HB 1714) and work with your staffing committee and legal counsel to begin implementation
- Join us on Wednesday, July 26 at 2:00pm for a Go To Training on Nurse Staffing – Understanding the New Law and Ensuring Successful Compliance. To register for this webinar, go here: https://attendee.gototraining.com/r/4613846942638491649
Overview
The new nurse staffing law incorporates some new components into the development of staffing plans and adds a complaint and investigation process while ensuring a reasonable regulatory environment for hospitals. This bulletin provides a summary of the new law, key dates and an overview of the existing law. Please refer to the background section for more information on how WSHA approached this bill and the political dynamics surrounding this bill.
New Law:
Beginning July 23, 2017. The law adds new requirements to those that were already established by the 2008 nurse staffing law, which first required that all hospitals have nurse staffing committees.
- Additional specific considerations must be taken into account by the committees, including:
- Availability of other personnel supporting services on the unit
- Strategies to enable registered nurses to take breaks.
- Hospital finances. (Note under the previous law taking hospital finances into account was optional.)
- The hospital CEO now has clear authority to modify or develop an alternate nurse staffing plan.
Beginning January 1, 2019. There are also several additional steps added to the process:
- The hospital must submit its plan to DOH annually and when it is updated.
- Hospitals must assign nursing personnel to patient care units in accordance with the plan. Shift-to shift adjustments in nurse staffing levels can be made by hospital personnel overseeing patient care operations. Nurses can report to the committee when the assignment has variations or the nurse objects to the shift-to-shift adjustments.
- Nurse staffing committees must develop a process to examine and respond to complaints and may resolve or dismiss them based on unsubstantiated data.
Department of Health Role: Under the new law, (DOH) has new enforcement responsibilities, but only over the complaint process. While the department can issue penalties, WSHA worked hard to ensure they would be reasonable and only invoked after a fair process.
DOH will investigate complaints if a hospital fails to:
- Form a nurse staffing committee,
- Conduct a semi-annual review of the nurse staffing plan,
- Submit the plan to the department as required,
- Follow the plan in its nurse personnel assignments, or
- Make proper shift-to-shift adjustments as described by the law.
Complaints for failure to follow nursing assignments or adjustments cannot be based on isolated incidents. DOH may only investigate after making an assessment based on evidence that shows a “continuing pattern of unresolved violations” that were submitted to the nurse staffing committee. DOH will not review complaints which were resolved or dismissed by the committee.
In addition, the evidence submitted to DOH with the complaint must show a “continuing pattern of unresolved violations for a minimum sixty-day continuous period leading up to receipt of the complaint by the department.”
Complaints made during emergency circumstances or if there is a staff employment shortage, as these situations are described in the law, are not valid. The law states DOH cannot investigate a complaint in the event of unforeseeable emergency circumstances or if the hospital, after consulting with the nurse staffing committee, documents it has made reasonable efforts to obtain staffing, but has been unable to do so. Unforeseeable emergent circumstance is defined as an unforeseen national, state or municipal emergency when a hospital disaster plan is activated, any unforeseen disaster or other catastrophic event that substantially affects or increases the need for health care services, or when a hospital is on divert or receiving patients from another hospital or hospitals.
If after its investigation DOH determines there has been a violation, it will require the hospital to submit a corrective plan of action within 45 days. If the hospital does not submit a corrective action plan or does not follow a submitted plan, DOH may impose civil penalties of $100 per day.
Expiration Date, Fees, and Report:
It is unclear how costly this law will be for DOH to administer. The hope on all sides is that the number of complaints is small. With the uncertainty on costs, it was difficult to determine how much additional revenue is needed and who should pay for the costs. DOH must submit a report to the legislature on December 31, 2020 regarding complaints, costs to administer the act, and needed statutory changes. It will convene a stakeholder group of hospitals and unions as a part of preparing the report. The law expires on June 1, 2023. No fees will be increased until July 1, 2021.
Next Steps
Please start working with your CNO, hospital leadership, legal counsel and members of your nurse staffing committee to begin implementation work with nurse staffing committees.
On Wednesday, July 26 at 2pm WSHA will host a Go To Training for CNOs and hospital leadership to better understand the existing and new laws, share best practices and address questions. We are also looking to partner with NWOne to support targeted discussions and learning opportunities. We look forward to having your staff participate in these events.
