REFERENCE TITLE: nurse-to-patient ratios; DHS rules

State of Arizona Senate Fifty-first Legislature First Regular Session 2013

SB 1398

Introduced by Senators McGuire: Farley, Jackson Jr., Landrum Taylor, Lopez, Tovar

 

AN ACT

 

Prescribing rule making requirements to establish HOSPITAL unit nurse‑t0‑patient ratios.

 

(TEXT OF BILL BEGINS ON NEXT PAGE)

 

Be it enacted by the Legislature of the State of Arizona:

Section 1.  Department of health services; nurse-to-patient ratios; rules; definitions

A.  On or before January 1, 2015, the department of health services shall adopt rules to establish minimum, specific and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit for hospital units regulated pursuant to title 36, chapter 4, Arizona Revised Statutes.  The department shall adopt these rules in accordance with the department's licensing and certification regulations.  The department shall review these rules five years after adoption and shall report to the governor, the speaker of the house of representatives and the president of the senate on any proposed changes to its initial rules. 

B.  Rules adopted pursuant to this section shall:

1.  Establish the minimum number of registered and licensed nurses that are allocated and shall require that additional staff be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment that is needed to design, implement and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care.

2.  Consider flexibility for rural general acute care hospitals in response to the special needs of these hospitals.

3.  Distinguish between regularly scheduled core staff licensed nurses in a hospital emergency department and additional licensed nurses required to care for critical care patients in the emergency department.

4.  Require hospitals to adopt written policies and procedures for the training and orientation of its nursing staff.

5.  Prohibit a registered nurse from being assigned to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area.

6.  Require that the written policies and procedures for orientation of nursing staff require that all temporary personnel receive orientation and be subject to competency validation.

7.  Augment and not replace existing nurse-to-patient ratios for the intensive care units, the neonatal intensive care units or the operating room.

8.  Take into account the special needs of the patients served in the psychiatric units.

9.  Consider the unique nature of the teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios.

C.  The department shall coordinate with the Arizona state board of nursing to ensure that staffing ratios are consistent with the board's approved nursing education requirements.

D.  For the purposes of this section:

1.  "Critical care unit" means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by licensed nurses.

2.  "Hospital unit" means:

(a)  A critical care unit.

(b)  A burn unit.

(c)  A labor and delivery room.

(d)  A postanesthesia service area.

(e)  An emergency department.

(f)  An operating room.

(g)  A pediatric unit.

(h)  A step-down/intermediate care unit.

(i)  A specialty care unit.

(j)  A telemetry unit.

(k)  A general medical care unit.

(l)  A subacute care unit.

(m)  A transitional inpatient care unit.