Nurse Staffing Committees. Hospitals are required to establish nurse staffing committees whose membership consists of:
The responsibilities of the nurse staffing committee include:
When developing the annual staffing plan, the committee must consider certain statutory factors, such as patient activity, intensity level, nature of care required, and level of experience of staff.
If the staffing plan is not adopted by the hospital, the chief executive officer must provide reasons why the plan was not adopted and either identify the changes to the plan prior to the hospital's adoption or prepare an alternative staffing plan that the hospital will adopt. Hospitals must submit their nurse staffing plans annually to the Department of Health (DOH).
DOH must investigate complaints related to the failure to establish a staffing committee, submit a nurse staffing plan annually, conduct a semi-annual review of the nurse staffing plan, or follow nursing assignments or shift-to-shift adjustments. There are statutory limitations on when DOH may investigate a complaint of a failure to follow nurse assignments or shift-to-shift adjustments.
After an investigation, if DOH determines there has been a violation, DOH must require the hospital to submit a corrective action plan within 45 days of the presentation of findings from DOH to the hospital. If the hospital fails to submit or follow the corrective action plan, DOH may impose a civil penalty of $100 per day. Various provisions related to the staffing committees, including requirements for DOH to investigate complaints, expire June 1, 2023.
Meal and Rest Breaks. In general, hospitals must provide employees with uninterrupted meal and rest breaks, except for:
In the case of a clinical circumstance, if a rest break is interrupted before ten minutes by the employer, the employee must be given an additional ten minute uninterrupted rest break at the earliest reasonable time during the work period.
An unforeseeable emergent circumstance is:
The meal and rest break provision applies to a health care facility employee who is:
Health Care Facility Overtime. No employee of a health care facility may be required to work overtime and the acceptance by an employee of overtime is strictly voluntary. The overtime restriction does not apply to overtime work that occurs because of:
Health care facilities covered by the overtime restrictions include hospitals, hospices, rural health care facilities, psychiatric hospitals, and facilities owned and operated by the Department of Corrections.
A violation of the overtime provision is a class 1 civil infraction.
Staffing Committees. The staffing committee statutes are recodified under the jurisdiction of the Department of Labor and Industries (L&I), rather than DOH. The expiration date of provisions related to staffing committees and investigations is repealed.
By September 1, 2024, hospitals are required to have hospital staffing committees whose membership consists of:
Additional staffing relief must be provided if necessary for committee members to attend the hospital staffing committee meetings. Beginning, July 1, 2025, each hospital must submit its staffing plan to L&I on an annual basis. Hospitals must implement the staffing plan and assign nursing and patient care staff to each unit in accordance with the plan, except in instances of unforeseeable emergent circumstances. Factors considered by the hospital staffing committee when developing the staffing plan are modified. The chief executive officer must provide feedback to the staffing committee on a semiannual basis prior to the committee's semiannual review and adoption of the staffing plan.
If the staffing plan is not adopted by consensus of the staffing committee, the prior staffing plan remains in effect and the hospital is subject to daily fines of $5,000. The daily fine is $100 for critical access hospitals, hospitals with fewer than 25 acute care beds, and certain sole community hospitals certified by the Centers for Medicare and Medicaid Services.
A registered nurse, patient care staff, collective bargaining representative, patient, or other individual may make a complaint to the staffing committee on variations of personnel assignments. All complaints submitted to the staffing committee must be reviewed, regardless of what format the complainant uses to submit the complaint.
In the event of an unforeseeable emergent circumstance, the hospital incident command must report within 30 days to the hospital staffing committee an assessment of the staffing needs arising from the unforeseeable emergent circumstance and the plan to address those needs. After which, the staffing committee must convene and develop a contingency staffing plan. The hospital's deviation from its original staffing plan may not be in effect for more than 90 days without approval of the staffing committee.
An unforeseeable emergent circumstance is:
The hospital staffing committee must file with L&I a charter that must include:
The Department of Labor and Industries Enforcement. L&I must review hospital staffing plans to ensure they are received by the appropriate deadline and in the correct format. Failure to submit a staffing plan or a staffing committee charter results in a violation and a civil penalty of $25,000. L&I must post staffing plans, charters, and violations on its website.
Additionally, L&I must investigates complaints for failure to:
The provision limiting investigations to complaints with evidence of a continuing pattern of unresolved violations is removed.
A hospital will not be found in violation of the nurse staffing committee and staffing plan requirements if an investigation determines that:
Reasonable efforts cannot be used if the employer has chronic staff shortages that persist longer than three months or has frequently reoccurring staff shortages.
Failure to submit or follow a corrective action plan is increased from $100 per day, to $5,000 per day, except the $100 per day remains for critical access hospitals, hospitals with fewer than 25 acute care beds, and certain sole community hospitals certified by the Centers for Medicare and Medicaid Services. The fines apply until the hospital follows the corrective action plan for 90 days, after which L&I may reduce the accumulated fine.
L&I must investigate complaints alleging violations of the bill and issue a notice of assessment or a closure letter with 90 days of receiving the complaint. The penalty for violations of the bill, unless a different penalty is specified, is $1,000 for each violation up to three violations. The penalty is $2,500 for a fourth violation and $5,000 for each subsequent violation. Citations and notices of assessment may be appealed
Staffing Standards. L&I must adopt rules establishing minimum staffing standards for direct care registered nurses and direct care nursing assistants-certified in patient care units by January 1, 2027. The staffing standards must be numerical and represent the maximum number of patients a direct care registered nurse or nursing assistant may be assigned, barring unforeseeable emergent circumstances. Hospitals must comply with the minimum staffing standards by July 1, 2027.
The staffing standards established by L&I do not decrease any nurse-to-patient staffing levels that are:
A direct care registered nurse or direct care nursing assistant-certified may not be assigned by hospitals 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.
Meal and Rest Breaks. Combining meal and rest breaks is allowed for any work period in which an employee is entitled to one or more meal periods and more than one rest period. Provisions that allowed certain clinical circumstances to exempt hospitals from meal and rest break requirements are amended. The requirement to provide uninterrupted meal and rest breaks does not apply when there is a clinical circumstance, as determined by the employee that may lead to a significant adverse effect on the patient's condition, unless the employer determines that the patient may suffer life-threatening adverse effects.
The definition of employee is broadened, applying the meal and rest break provisions to an employee who is employed by a hospital; is involved in direct patient care activities or clinical services; and receives an hourly wage or is covered by a collective bargaining agreement.
Mandatory Overtime. The definition of employee is modified similarly to the change in the meal and rest breaks statute.
For the purposes of exemptions to the overtime restrictions the prescheduled on-call time must not exceed more than 60 hours per month; and the health care facility's reasonable efforts to obtain staffing are not reasonable if overtime is used to fill vacancies from chronic staff shortages that persist longer than three months or for frequently reoccurring staff shortages. Mandatory prescheduled on-call time may not be used when an employer schedules a nonemergent patient procedure that is expected to exceed the employee's regular scheduled hours or work.
PRO: This bill is just part of the discussion around how we staff health care and providing support for health care workers. Inadequate staffing leads to worse patient outcomes. It also leads to seasoned nurses leaving. The current staffing crisis has lead to many nurses being burned out and leaving and there are not enough new nurses to replace them. There is not a shortage of nurses, there is a shortage of safe work environments. Hospitals are not short on money and some have larger reserves now than they did before the pandemic due to investments and federal aid. Current staffing plans are not adhered to, and the current law has no teeth. Ensuring nurses do not have excessive patient load ensures patients receive the care they need. Hospitals are understaffed by design.
CON: Hospitals are already closing various units and stopped performing certain procedures and the bill will only make that worse. Hospitals will have to close because they cannot find more nurses or pay the fines. L&I does not have the expertise to implement the bill. Unlike other industries hospitals cannot limit demand for their services and they cannot stop treating admitted patients. The cap on prescheduled on- call nurses will cause units to close. Ratios will stifle innovative staffing models. Hospitals cannot fill current staffing plans with enough nurses even with hiring expensive traveling nurses. California has ratios and the highest pay in the country and still has a nursing shortage. It also has the fewest nurses per capita in the country. Instead, we need legislation to train and develop new nurses. EMS and fire departments already have to wait to transfer patients and the bill will make that worse, now is not the time to pass the bill.
OTHER: To implement, L&I will need time to gather expertise and increase staff for the bill. The bill will also require an update to IT systems.