Sophie told us about this! Isn't this what we ALL WANT??! WILL YOU SEND IT TO YOUR STATE LEGISLATORS??!!
---PLEASE READ THIS----AND LEAP FOR JOY!!!---
~Current Session Legislation~
AB 394 Health facilities: nursing staff.
BILL NUMBER: AB 394 INTRODUCED 02/11/99
INTRODUCED BY Assembly Members Kuehl (Coauthors: Assembly Members Dutra, Gallegos, and Villaraigosa) (Coauthors: Senators Burton and Escutia)
FEBRUARY 11, 1999
An act to add Section 2725.3 to the Business and Professions Code, and to add Section 1276.4 to the Health and Safety Code, relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
AB 394, as introduced, Kuehl. Health facilities: nursing staff.
Existing law provides for the licensing, registration, and regulation of nurses, and sets forth the scope of practice.
This bill would prohibit a general acute care hospital, an acute psychiatric hospital, and a special hospital, as defined, from assigning an unlicensed person to perform nursing functions in lieu of a registered nurse, or from allowing unlicensed personnel under the direct clinical supervision of a registered nurse to perform certain functions.
Existing law prohibits operation of a health facility, as defined, without a license issued by the State Department of Health Services and provides for the issuance of licenses and for the regulation of health facilities and sets forth the services to be provided therein. Willful or repeated violation of these provisions is a crime.
This bill would require general acute care hospitals, acute psychiatric hospitals, and special hospitals to provide certain minimum nurse-to-patient ratios, and to adopt written policies and procedures for training and orientation of nursing staff.
By changing the definition of an existing crime this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
SECTION 1. The Legislature finds and declares all of the following:
(a) Health care services are becoming complex and it is increasingly difficult for patients to access integrated services.
(b) Quality of patient care is jeopardized because of staffing changes implemented in response to managed care.
(c) To ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses and other licensed nurses be accessible and available to meet the needs of patients.
(d) The basic principles of staffing in the acute care setting should be based on the patient's care needs, the severity of condition, services needed, and the complexity surrounding those services.
SEC. 2. Section 2725.3 is added to the Business and Professions Code, to read:
2725.3. (a) A health facility licensed pursuant to subdivision (a), (b), or (f), of Section 1250 of the Health and Safety Code shall not assign unlicensed personnel to perform nursing functions in lieu of a registered nurse and may not allow unlicensed personnel to perform functions under the direct clinical supervision of a registered nurse that require a substantial amount of scientific knowledge and technical skills, including, but not limited to, any of the following:
(1) Administration of medication.
(2) Venipuncture or intravenous therapy.
(3) Parenteral or tube feedings.
(4) Invasive procedures including inserting nasogastric tubes, inserting catheters, or tracheal suctioning.
(5) Assessment of patient condition.
(6) Educating patients and their families concerning the patient's health care problems, including postdischarge care.
(7) Moderate complexity laboratory tests.
(b) This section shall not preclude any person from performing any act or function that he or she is authorized to perform pursuant to Division 2 (commencing with Section 500).
SEC. 3. Section 1276.4 is added to the Health and Safety Code, to read:
1276.4. (a) A health facility licensed pursuant to subdivision (a), (b), or (f) of Section 1250 shall allocate sufficient numbers of registered nurses so as to provide a nurse-to-patient ratio as follows:
(1) One registered nurse to two patients to staff critical care units, burn units, labor and delivery, postanesthesia units, and critical patients in emergency departments requiring care in an intensive care or critical care setting. The ratio of one registered nurse to two critical care patients temporarily held in the emergency departments shall be in addition to the regularly scheduled emergency room staff.
(2) There shall be sufficient nursing personnel so that one registered nurse is not serving as circulating assistant for more than one operating room.
(3) One licensed nurse to three patients to staff pediatric and step-down/intermediate care units.
(4) One licensed nurse to four patients to staff specialty care and telemetry.
(5) One licensed nurse to six patients to staff general medical care units that include subacute care and transitional inpatient care units.
(b) These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated. Additional staff shall 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 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.
(c) "Critical care unit" as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by licensed registered nurses.
(d) All health facilities licensed under subdivision (a), (b), or (f) or Section 1250 shall adopt written policies and procedures for training and orientation of nursing staff.
(e) No registered nurse shall be 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.
(f) The written policies and procedures for orientation of nursing staff shall require that all temporary personnel shall receive the same amount and type of orientation as is required for permanent staff.
(g) Requests for waivers to this section that do not jeopardize the health, safety, and well-being of patients affected and that are needed for increased operational efficiency may be granted by the department to rural general acute care hospitals meeting the criteria set forth in paragraph (2) of subdivision (a) of Section 1250.
(h) In case of conflict between this section and any provision or regulation defining the scope of nursing practice, the scope of practice provisions shall control.
SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
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