10/25/2015

Bills
 

 

A01548 Summary:
BILL NO

A01548

SAME AS

SAME AS

SPONSOR

Gottfried (MS)

COSPNSR

Gunther, Clark, Peoples-Stokes, Rosenthal, Brindisi, Bronson, Colton,
Benedetto, Jaffee, Magnarelli, Markey, Miller, Weprin, Rivera, Ryan,
Skartados, Sepulveda, Aubry, Otis, Skoufis, Steck, Mayer,
Santabarbara, Zebrowski, Mosley, Ortiz, Titus, Abinanti, Persaud,
Barron, Brabenec, Seawright, Linares, Palumbo, Walker, Bichotte,
Richardson

MLTSPNSR

Abbate, Arroyo, Borelli, Brennan, Butler, Cahill, Ceretto, Cook,
Crespo, Cusick, Cymbrowitz, Davila, DenDekker, Dinowitz, Englebright,
Fahy, Farrell, Glick, Graf, Hooper, Johns, Kearns, Lavine, Lifton,
Lupardo, Lupinacci, Magee, McDonough, McKevitt, Montesano, Paulin,
Perry, Pretlow, Ra, Ramos, Robinson, Russell, Saladino, Schimel,
Simon, Simotas, Solages, Tedisco, Thiele, Titone, Weinstein, Woerner,
Wozniak, Wright

Amd Pub Health L, generally
Enacts the "safe staffing for quality care act" to require acute care
facilities and nursing homes to implement certain direct-care nurse to patient
ratios in all nursing units; sets minimum staffing requirements; requires every
such facility to submit a documented staffing plan to the department on an
annual basis and upon application for an operating certificate; requires acute
care facilities to maintain staffing records during all shifts; authorizes
nurses to refuse work assignments if the assignment exceeds the nurse's
abilities or if minimum staffing is not present; requires public access to
documented staffing plans; imposes civil penalties for violations of such
provisions; establishes private right of action for nurses discriminated
against for refusing any illegal work assignment.

A01548 Actions:
BILL NO

A01548

01/12/2015 referred to health
04/22/2015 reported referred to codes
04/28/2015 reported referred to ways and means

A01548 Votes:
There are no votes for this bill in this legislative session.

A01548 Memo:
BILL NUMBER:A1548
TITLE OF BILL: An act to amend the public health law, in relation to
enacting the "safe staffing for quality care act"
PURPOSE OR GENERAL IDEA OF BILL: To require all acute care facilities
and nursing homes to meet standards for appropriate staffing ratios of
nursing and unlicensed direct care staff.
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SUMMARY OF SPECIFIC PROVISIONS: Section 1 is the short title.
Section 2 amends Public Health Law S 2805 to require that application
for operating certificates for a hospital include a direct care
staffing plan.
Section 3 adds nine new sections, 2823 through 2831, which require
hospitals to maintain and comply with a staffing plan; establish the
Acute Care Facility Council to be appointed by the Commissioner of
Health, enumerate the elements of a satisfactory staffing plan; set
forth minimum nurse to patient ratios; require clinical competency;
provide for emergency situations; require public disclosure
of
facility staffing requirements; and allows for private right of action
by employees.
Section 4 amends S 2801-a directing the Public Health and Health
Planning Council to consider staffing violations when reviewing
"character, competence and standing in the community" for applications
and renewals of certificates of incorporation or establishment of a
hospital.
Section 5 amends S 2805 requiring the Commissioner to consider
staffing violations when reviewing applications and renewals operating
certificates for acute care facilities.
Section 6 amends S 2895-b to establish a Residential Health Care
Facility Council to be appointed by the Commissioner; requires minimum
staff-hours of care per resident per day; allows for private right of
action by employees; and requires public disclosure of information
about direct care staffing.
JUSTIFICATION: The hospital nurse-to-patient ratios specified in this
bill are based on peer-reviewed academic research and evidence-based
recommendations. The minimum care hours specified for residential
health care facilities are also based on research evidence and on the
recommendations of the Institute of Medicine's report, "Keeping
Patients Safe: Transforming the Work Environment of Nurses" (2004).
The number of patients assigned to a nurse has a direct impact on the
quality of care that nurse can provide. Research published in the
Journal of the American Medical Association, estimates five additional
deaths per 1,000 patients in hospitals which routinely staff with only
1:8 nurse-to-patient ratios compared to those staffing with 1:4
nurse-to-patient ratios. This same study determined the odds of
patient death increased by 7% for each additional patient the nurse
must care for at one time.
Safe nurse staffing also reduces avoidable, adverse patient outcomes.
Research funded by the federal Agency for Healthcare Research and
Quality (AHRQ) has demonstrated that hospitals with lower nurse
staffing levels have higher rates of pneumonia, shock, cardiac arrest,
urinary tract infections and upper gastrointestinal bleeds; all
leading to higher costs and
mortality
from
hospital-acquired
complications.
In nursing homes, research has demonstrated that safe nurse staffing
levels have a positive impact on facility processes and on resident
outcomes. Research has demonstrated that as nurse turnover increases
in nursing homes, the quality of resident care declines, resulting in
more
frequent
use of restraints, urinary catheterization, and
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psychoactive drugs; increased risk of
and more survey deficiencies.

contractures,

pressure

ulcers

A broad range of research demonstrates that increased staffing levels
do not diminish the profitability of facilities. Nursing workforce
costs may rise, but that increase is mitigated by overall savings from
improved patient outcomes and avoided adverse events. The improved
outcomes reduce medical malpractice and other penalties resulting from
avoidable occurrences and poor patient satisfaction.
In 2004, California became the first state to mandate nurse staffing
ratios in hospitals. New statistical analysis reveals that the
California mandates are significantly associated with fewer negative
outcomes for patients and staff. The study, published in Health
Services Research and conducted by the Center for Health Outcomes and
Policy Research, University of Pennsylvania, concluded that "Improved
nurse staffing, however it is achieved, is associated with better
outcomes for nurses and patients."
Establishing staffing standards for nursing and unlicensed direct care
staff in acute care facilities and residential health care facilities
will help ensure that these facilities operate in a manner that
guarantees the public safety and the delivery of quality health care
services.
PRIOR LEGISLATIVE HISTORY:
2009-2010: A.11015- referred to Health
committee.
2011-2012: A.921- reported to Ways and Means committee
2013-2014: A6571- reported to Ways and Means committee
FISCAL IMPLICATIONS: Some staff time in the Department of Health;
possible increased Medicaid spending to cover the cost of increased
staffing balanced by reduced Medicaid spending as reduced bad outcomes
and reduced staff turnover reduce health care costs.
EFFECTIVE DATE: Takes effect 180 days after it becomes law.

A01548 Text:
S T A T E
O F
N E W
Y O R K
________________________________________________________________________
1548
2015-2016 Regular Sessions
I N

A S S E M B L Y

January 12, 2015
___________
Introduced by M. of A. GOTTFRIED, GUNTHER, CLARK, PEOPLES-STOKES, ROSENTHAL, BRINDISI, BRONSON, COLTON, BENEDETTO, CAMARA, JAFFEE, MAGNARELLI, MARKEY, MILLER, WEPRIN, RIVERA, ROBERTS, RYAN, SKARTADOS, SEPULVEDA, AUBRY, OTIS, SKOUFIS, STECK, MAYER, SANTABARBARA, ZEBROWSKI,
BROOK-KRASNY, MOSLEY, ORTIZ, TITUS -- Multi-Sponsored by -- M. of A.
ABBATE, ABINANTI, ARROYO, BRENNAN, BUTLER, CAHILL, CERETTO, COOK,
CRESPO, CUSICK, CYMBROWITZ, DAVILA, DINOWITZ, ENGLEBRIGHT, FAHY,
FARRELL, GLICK, GRAF, HEASTIE, HOOPER, JOHNS, KEARNS, LAVINE, LIFTON,
LUPARDO, LUPINACCI, MAGEE, McDONOUGH, McKEVITT, MONTESANO, PAULIN,
PERRY, PRETLOW, RA, RAMOS, ROBINSON, RUSSELL, SALADINO, SCARBOROUGH,
SCHIMEL, SIMOTAS, SOLAGES, TEDISCO, THIELE, TITONE, WEINSTEIN, WRIGHT
-- read once and referred to the Committee on Health
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AN ACT to amend the public health law, in relation to enacting the "safe
staffing for quality care act"
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND
BLY, DO ENACT AS FOLLOWS:
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ASSEM-

Section 1. Short title. This act shall be known and may be cited as
the "safe staffing for quality care act".
S 2. Paragraphs (a) and (b) of subdivision 2 of section 2805 of the
public health law, paragraph (a) as amended by chapter 923 of the laws
of 1973 and paragraph (b) as added by chapter 795 of the laws of 1965,
are amended to read as follows:
(a) Application for an operating certificate for a hospital shall be
made upon forms prescribed by the department. The application shall
[contain] INCLUDE the name of the hospital, the kind or kinds of hospital service to be provided, the location and physical description of the
institution, A DOCUMENTED STAFFING PLAN, AS DEFINED
IN
SECTION
TWENTY-EIGHT HUNDRED TWENTY-EIGHT OF THIS ARTICLE, and such other information as the department may require.
(b) An operating certificate shall not be issued by the department
unless it finds that the premises, equipment, personnel, DOCUMENTED
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02732-01-5
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STAFFING PLAN, rules and by-laws, standards of medical care, and hospital service are fit and adequate and that the hospital will be operated
in the manner required by this article and rules and regulations thereunder.
S 3. The public health law is amended by adding nine new sections
2827, 2828, 2829, 2830, 2831, 2832, 2833, 2834 and 2835 to read as
follows:
S 2827. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL OF
THE FOLLOWING:
1. HEALTH CARE SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY
DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES;
2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE STAFFING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES;
3. TO ENSURE THE ADEQUATE PROTECTION OF PATIENTS IN HEALTH CARE
SETTINGS, IT IS ESSENTIAL THAT QUALIFIED REGISTERED NURSES AND OTHER
LICENSED NURSES BE ACCESSIBLE AND AVAILABLE TO MEET THE NEEDS OF
PATIENTS; AND
4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING SHOULD
BE BASED ON THE PATIENT'S CARE NEEDS, THE SEVERITY OF CONDITION,
SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES.
S 2828. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS AND PHRASES,
AS USED IN THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE
CONTEXT OTHERWISE PLAINLY REQUIRES:
1. "ACUTE CARE FACILITY" SHALL MEAN A HOSPITAL OTHER THAN A RESIDENTIAL HEALTH CARE FACILITY AND SHALL ALSO INCLUDE ANY FACILITY THAT
PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW, ARTICLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACILITY IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE OR
A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION.
2. "ACUITY SYSTEM" SHALL MEAN AN ESTABLISHED MEASUREMENT INSTRUMENT
WHICH (A) PREDICTS NURSING CARE REQUIREMENTS FOR INDIVIDUAL PATIENTS
BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND
TECHNOLOGY,
INTENSITY OF NURSING INTERVENTIONS REQUIRED, AND THE
COMPLEXITY OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND

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EVALUATE THE PATIENT'S NURSING CARE PLAN; (B) DETAILS THE AMOUNT OF
NURSING CARE NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND IN SKILL
MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN
A NURSING DEPARTMENT OR UNIT; AND (C) IS STATED IN TERMS THAT READILY
CAN BE USED AND UNDERSTOOD BY DIRECT-CARE NURSES. THE ACUITY SYSTEM
SHALL TAKE INTO CONSIDERATION THE PATIENT CARE SERVICES PROVIDED NOT
ONLY BY REGISTERED PROFESSIONAL NURSES BUT ALSO BY LICENSED PRACTICAL
NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL.
3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE
STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT
NURSING CARE REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF AN ACUITY
SYSTEM.
4. "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN ANY
NURSE WHO HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY OUT MEDICAL
REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS.
5. "DOCUMENTED STAFFING PLAN" SHALL MEAN A DETAILED WRITTEN PLAN
SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURSES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY
FOR A GIVEN YEAR, BASED ON REASONABLE PROJECTIONS DERIVED FROM THE
PATIENT CENSUS AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT
DURING THE PRIOR YEAR, THE DEPARTMENT OR UNIT SIZE AND GEOGRAPHY, THE
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NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR
UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR.
6. "NURSE" SHALL MEAN A REGISTERED PROFESSIONAL NURSE OR LICENSED
PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF
THE EDUCATION LAW.
7. "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION
OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF
THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE RECOGNIZED STANDARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLANNING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
8. "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF SECTIONS
TWENTY-EIGHT
HUNDRED
TWENTY-SEVEN
THROUGH
TWENTY-EIGHT
HUNDRED
THIRTY-FIVE OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSUANT THERETO.
9. "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY AND
EXPERIENCE AMONG DIRECT-CARE NURSES.
10. "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO PATIENT
RATIO WITHIN A NURSING DEPARTMENT OR UNIT.
11. "UNIT" SHALL MEAN A PATIENT CARE COMPONENT, AS DEFINED BY THE
DEPARTMENT, WITHIN AN ACUTE CARE FACILITY.
12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT
A NURSE OR OTHER PERSON LICENSED, CERTIFIED OR REGISTERED UNDER TITLE
EIGHT OF THE EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY IS TO CARRY
OUT PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT ASSISTANCE
IN THE DELIVERY OF PATIENT CARE.
S 2829. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER
SHALL:
1. APPOINT AN ACUTE CARE FACILITY COUNCIL CONSISTING OF THIRTEEN
MEMBERS. NO LESS THAN SEVEN MEMBERS SHALL BE REGISTERED PROFESSIONAL
NURSES, THREE OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES, THREE OF
WHOM SHALL BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A NURSE ADMINISTRATOR. NO LESS THAN TWO MEMBERS OF THE ACUTE CARE FACILITY COUNCIL
SHALL BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO
REPRESENTATIVES OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A NURSING PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED OR
CERTIFIED BARGAINING AGENT OF NURSES. THE ACUTE CARE FACILITY COUNCIL
SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUDING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS AND

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NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE NOT SPECIFIED
IN THIS ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL
BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVALUATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS
ON APPROVAL OF STAFFING PLANS PRIOR TO THE GRANTING OF AN OPERATING
CERTIFICATE BY THE DEPARTMENT.
2. PROMULGATE, AFTER CONSULTATION WITH THE ACUTE CARE FACILITY COUNCIL, THE RULES AND REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES AND
PROVISIONS OF THE SAFE STAFFING REQUIREMENTS, INCLUDING REGULATIONS
DEFINING TERMS, SETTING FORTH DIRECT-CARE NURSE TO PATIENT RATIOS,
SETTING FORTH NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS AND
PRESCRIBING THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY SYSTEMS;
AND
3. ASSURE THAT THE PROVISIONS OF SAFE STAFFING REQUIREMENTS ARE
ENFORCED, INCLUDING THE ISSUANCE OF REGULATIONS WHICH AT A MINIMUM
PROVIDE FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE
TO COMPLY WITH SUCH REQUIREMENTS AND PUBLIC ACCESS TO INFORMATION
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REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
PURSUANT TO SUCH REQUIREMENTS.
S 2830. STAFFING REQUIREMENTS. 1. STAFFING REQUIREMENTS. EACH ACUTE
CARE FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT PROVIDES
SUFFICIENT, APPROPRIATELY QUALIFIED DIRECT-CARE NURSES IN EACH DEPARTMENT OR UNIT WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED
CARE NEEDS OF THE PATIENTS THEREIN. AT A MINIMUM, EACH SUCH FACILITY
SHALL MEET THE REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS
SECTION.
2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING CERTIFICATE TO ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY ANNUALLY SUBMITS
TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION
THAT THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE ADEQUATE AND
APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING
YEAR. THE DOCUMENTED STAFFING PLAN SHALL:
(A) MEET THE MINIMUM REQUIREMENTS SET FORTH IN SUBDIVISION THREE OF
THIS SECTION;
(B) BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY OTHER
LAWS, RULES OR REGULATIONS;
(C) EMPLOY AND IDENTIFY AN ACUITY SYSTEM FOR ADDRESSING FLUCTUATIONS
IN ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS REQUIRING
INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN;
(D) FACTOR IN OTHER UNIT OR DEPARTMENT ACTIVITY SUCH AS DISCHARGES,
TRANSFERS AND ADMISSIONS, STAFF BREAKS, MEALS, ROUTINE AND EXPECTED
ABSENCES FROM THE UNIT AND ADMINISTRATIVE AND SUPPORT TASKS THAT ARE
EXPECTED TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT NURSING
CARE;
(E) INCLUDE A PLAN TO MEET NECESSARY STAFFING LEVELS AND SERVICES
PROVIDED BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE NEEDS
PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE
STAFFING PLAN SHALL NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNCTIONS REQUIRED BY LAWS, RULES OR REGULATIONS, OR ACCEPTED STANDARDS OF
PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE
PERFORMED BY OTHER PERSONNEL;
(F) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING
ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
(G) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S
STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
(H) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN
TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH
SUCH CLASSIFICATION; AND
(I) BE DEVELOPED IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE
NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES-

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ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER
SUPPORTIVE AND ASSISTIVE STAFF.
3. MINIMUM STAFFING REQUIREMENTS. (A) THE DOCUMENTED STAFFING PLAN
SHALL INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PATIENT RATIOS:
(I) ONE NURSE TO ONE PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY
UNITS AND MATERNAL/CHILD CARE UNITS FOR THE SECOND OR THIRD STAGE OF
LABOR;
(II) ONE NURSE TO TWO PATIENTS:
MATERNAL/CHILD CARE UNITS FOR THE
FIRST STAGE OF LABOR, AND ALL CRITICAL CARE AREAS INCLUDING EMERGENCY
CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS;
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(III) ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIATRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERMEDIATE CARE NURSERY UNITS;
(IV) ONE NURSE TO THREE PATIENTS:
POSTPARTUM MOTHER/BABY COUPLETS
(MAXIMUM SIX PATIENTS PER NURSE);
(V) ONE NURSE TO FOUR PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS,
POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHIATRIC UNITS;
(VI) ONE NURSE TO FIVE PATIENTS: REHABILITATION UNITS AND SUBACUTE
PATIENTS; AND
(VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED
TO, PSYCHIATRIC UNITS, AND ACUTE CARE FACILITIES OPERATED PURSUANT TO
THE MENTAL HYGIENE LAW OR THE CORRECTION LAW, THE DEPARTMENT SHALL
ESTABLISH BY REGULATION THE APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT
RATIO.
(B) THE NURSE-TO-PATIENT RATIOS SET FORTH IN PARAGRAPH (A) OF THIS
SUBDIVISION SHALL REFLECT THE MAXIMUM NUMBER OF PATIENTS THAT MAY BE
ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME.
(C) THERE SHALL BE NO AVERAGING OF THE NUMBER OF PATIENTS AND THE
TOTAL NUMBER OF NURSES ON THE UNIT DURING ANY ONE SHIFT NOR OVER ANY
PERIOD OF TIME.
(D) THE COMMISSIONER, IN CONSULTATION WITH THE ACUTE CARE FACILITY
COUNCIL, SHALL ESTABLISH REGULATIONS PROVIDING FOR THE MAINTENANCE OF
MINIMUM NURSE-TO-PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING
DURING ROUTINE OR EXPECTED ABSENCES FROM THE UNIT, SUCH AS MEALS OR
BREAKS.
4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRACTICAL NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY PATIENTS
ASSIGNED TO THE LICENSED PRACTICAL NURSE SHALL ALSO BE INCLUDED IN
CALCULATING THE NUMBER OF PATIENTS ASSIGNED TO ANY REGISTERED PROFESSIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRACTICE TO SUPERVISE OR OVERSEE THE DIRECT-NURSING CARE PROVIDED BY THE
LICENSED PRACTICAL NURSE.
5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE
EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A
REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED PRACTICAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR
ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A LICENSED PRACTICAL
NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL.
6. ADJUSTMENTS BY FACILITY.
THE MINIMUM STAFFING REQUIREMENT AND
NURSE-TO-PATIENT RATIO SET FORTH IN THIS SECTION SHALL BE ADJUSTED BY
THE ACUTE CARE FACILITY AS NECESSARY TO REFLECT THE NEED FOR ADDITIONAL
DIRECT-CARE NURSES. ADDITIONAL STAFF SHALL BE ASSIGNED IN ACCORDANCE
WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMINING NURSING CARE REQUIREMENTS, INCLUDING THE SEVERITY OF THE ILLNESS,

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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.
7. COMMISSIONER REGULATIONS.
THE COMMISSIONER MAY BY REGULATION
REQUIRE A DOCUMENTED STAFFING PLAN TO HAVE HIGHER NURSE-TO-PATIENT
RATIOS THAN THOSE SET FORTH IN THIS SECTION.
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8.
NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE
TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT PROVIDES FOR STAFFING
RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION.
S 2831. COMPLIANCE WITH STAFFING PLAN AND RECORDKEEPING. 1.
EACH
ACUTE CARE FACILITY SHALL AT ALL TIMES STAFF IN ACCORDANCE WITH ITS
DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION
TWENTY-EIGHT HUNDRED THIRTY OF THIS ARTICLE; PROVIDED, HOWEVER, THAT
NOTHING IN THIS SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY
FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT STAFFING LEVELS,
NOR SHALL THE REQUIREMENTS SET FORTH IN SUCH SECTION TWENTY-EIGHT
HUNDRED THIRTY OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT.
2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM STAFFING REQUIREMENTS
STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY OF THIS ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT
RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN AN ACUTE CARE
FACILITY UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW, HAS RECEIVED PRIOR
ORIENTATION IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURSING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND HAS DEMONSTRATED CURRENT COMPETENCE IN PROVIDING CARE IN THAT UNIT OR CLINICAL
AREA. ACUTE CARE FACILITIES THAT UTILIZE TEMPORARY NURSING AGENCIES
SHALL HAVE AND ADHERE TO A WRITTEN PROCEDURE TO ORIENT AND EVALUATE
PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETENCY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO. IN THE EVENT OF AN
EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD TO
UNSAFE PATIENT CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT
UNIT OR CLINICAL AREA, PROVIDED THAT SUCH NURSES SHALL BE ASSIGNED
PATIENTS APPROPRIATE TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY
SHALL ESTABLISH A CONSISTENT PLAN FOR ADDRESSING EMERGENCY STAFFING
SITUATIONS AND MONITOR OUTCOMES.
EMERGENCIES ARE DEFINED AS NATURAL
DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS
NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT REGULARLY OCCURRING
WITHIN THE FACILITY.
3. EACH ACUTE CARE FACILITY SHALL MAINTAIN ACCURATE DAILY RECORDS
SHOWING:
(A) THE NUMBER OF PATIENTS ADMITTED, RELEASED AND PRESENT IN EACH
NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY;
(B) THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND
(C) THE IDENTITY AND DUTY HOURS OF EACH DIRECT-CARE NURSE IN EACH
NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY.
4. EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURSING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY, INFECTION, ACCIDENT,
INJURY AND MEDICAL ERRORS.
5. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
MAINTAINED FOR A PERIOD OF SEVEN YEARS.
6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
MADE AVAILABLE UPON REQUEST TO THE DEPARTMENT AND TO THE PUBLIC;
PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL COMPLY
WITH THE APPLICABLE PATIENT PRIVACY LAWS, RULES AND REGULATIONS, AND
THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE IDENTITY
AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC.

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S 2832. WORK ASSIGNMENT POLICY. 1. GENERAL. EACH ACUTE CARE FACILITY
SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN
WORK ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS TWO
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AND THREE OF THIS SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A
DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT.
2. MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT:
(A) FOR WHICH THE NURSE IS NOT PREPARED BY EDUCATION, TRAINING OR
EXPERIENCE TO SAFELY FULFILL THE ASSIGNMENT WITHOUT COMPROMISING OR
JEOPARDIZING PATIENT SAFETY, THE NURSE'S ABILITY TO MEET FORESEEABLE
PATIENT NEEDS OR THE NURSE'S LICENSE; OR
(B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS.
3. MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
CONTAIN PROCEDURES FOR THE FOLLOWING:
(A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR
REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING RELIEVED
OF AN ASSIGNMENT OR CONTINUED DUTY;
(B) WHERE FEASIBLE, AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE
SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETHER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT, OR
TO DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTINUED DUTY;
(C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT TO REFUSE
THE ASSIGNMENT OR CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES
THE REQUEST TO BE RELIEVED IF:
(I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A REMEDY OR
THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY,
(II) THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY
WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND
(III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT THE ASSIGNMENT MEETS
CONDITIONS JUSTIFYING REFUSAL; AND
(D) RECOGNITION THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A
WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED,
BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR INCOMPETENT ACTION,
PATIENT ABANDONMENT, OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO
NURSING.
S 2833. PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY ACUTE CARE
FACILITY SHALL:
1. POST IN A CONSPICUOUS PLACE READILY ACCESSIBLE TO THE GENERAL
PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH A SUMMARY OF
THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH
INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFFING PLAN AND ACTUAL STAFFING MAY BE OBTAINED;
2. UPON REQUEST, MAKE COPIES OF THE DOCUMENTED STAFFING PLAN FILED
WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND
3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF WITHIN A
DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION:
(A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT,
(B) DOCUMENTATION OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE
PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED ACUITY SYSTEM,
AND
(C) DOCUMENTATION OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT
DURING THE SHIFT.
S 2834. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELEGATE ITS RESPONSIBILITIES TO ENFORCE THE SAFE STAFFING REQUIREMENTS
PROMULGATED PURSUANT TO THIS ARTICLE.
S 2835. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
HUNDRED THIRTY-TWO OF THIS ARTICLE.
ANY ACUTE CARE FACILITY THAT
VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGNA. 1548
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MENT POLICY UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-TWO OF THIS ARTICLE MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT
OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS MAY BE
APPROPRIATE TO EFFECTUATE THE PURPOSES OF THE SAFE STAFFING REQUIREMENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES
AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING FROM
THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE
COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT AWARDED TO A
PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND COSTS OF
ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO INSTITUTE A
PRIVATE ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY
OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
S 4. Section 2801-a of the public health law is amended by adding a
new subdivision 3-b to read as follows:
3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNITY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH
PLANNING COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL
RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS,
WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING
COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF
THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
S 5. Section 2805 of the public health law is amended by adding a new
subdivision 3 to read as follows:
3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN OPERATING CERTIFICATE
TO AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORDANCE WITH THIS ARTICLE, THE COMMISSIONER SHALL CONSIDER ANY PAST
VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING
TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING
OR ANY OTHER LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE
PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT
TO VIOLATIONS OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF
AND SUPPORTIVE STAFF RATIOS.
S 6. The public health law is amended by adding a new section 2895-b
to read as follows:
S 2895-B. RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS. 1. DEFINITIONS. AS USED IN THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS:
(A) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE RESIDENTIAL HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION TWENTY-EIGHT HUNDRED THREE-J OF THIS CHAPTER.
(B) "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL IN
A PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD IN
A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT
THAT TIME.
2. COMMISSIONER AND RESIDENTIAL HEALTH CARE FACILITY COUNCIL; POWERS
AND DUTIES. THE COMMISSIONER SHALL: APPOINT A RESIDENTIAL HEALTH CARE
FACILITY COUNCIL CONSISTING OF THIRTEEN MEMBERS. NO LESS THAN TWO
MEMBERS SHALL BE DIRECT CARE LICENSED PRACTICAL NURSES, NO LESS THAN
TWO MEMBERS SHALL BE DIRECT CARE CERTIFIED NURSE ASSISTANTS AND NO LESS
THAN ONE MEMBER SHALL BE A DIRECT CARE REGISTERED PROFESSIONAL NURSE.
THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE EACH OF
RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURSES, OF NON-REGISTERED NURSE DIRECT CARE STAFF AND A REPRESENTATIVE OF
NURSING PROFESSIONAL ASSOCIATIONS. THE COUNCIL SHALL ALSO INCLUDE NO
LESS THAN TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY OPERAA. 1548
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TORS, TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY NURSE
ADMINISTRATORS AND ONE REPRESENTATIVE OF CONSUMERS. THE RESIDENTIAL
HEALTH CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVEL-

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OPMENT OF REGULATIONS RELATING TO THE STAFFING STANDARDS UNDER THIS
SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLATURE, THE PUBLIC AND THE COMMISSIONER ANY RECOMMENDATIONS REGARDING
STAFFING LEVELS IN RESIDENTIAL HEALTH CARE FACILITIES.
3. STAFFING STANDARDS. (A) THE COMMISSIONER, IN CONSULTATION WITH THE
COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR RESIDENTIAL HEALTH CARE FACILITY MINIMUM STAFFING LEVELS TO MEET APPLICABLE
STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY. THE COMMISSIONER SHALL ALSO
REQUIRE BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAINTAIN RECORDS ON ITS STAFFING LEVELS, REPORT ON SUCH RECORDS TO THE
DEPARTMENT, AND MAKE SUCH RECORDS AVAILABLE FOR INSPECTION BY THE
DEPARTMENT.
(B) EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL:
(I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND
(II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES
TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND
PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY.
(C) SUBJECT TO SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS
UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS UNDER
SUBDIVISION FOUR OF THIS SECTION.
(D) IN DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS
SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED WHILE PERFORMING SERVICES
THAT ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD
PREPARATION, HOUSEKEEPING, LAUNDRY, MAINTENANCE SERVICES, OR OTHER
ACTIVITIES THAT ARE NOT DIRECT NURSING CARE.
4.
STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE
OF THIS SECTION, EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL MAINTAIN A
STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING:
(A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE;
(B) 1.3 HOURS OF CARE PER RESIDENT PER DAY BY A LICENSED PRACTICAL
NURSE OR A REGISTERED NURSE;
(C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE
MINIMUM OF 0.75 HOURS OF CARE PER RESIDENT PROVIDED BY A REGISTERED
NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN APPROPRIATE LEVEL
OF REGISTERED NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK,
TO MEET RESIDENT NEEDS; AND
(D) RESIDENTIAL HEALTH CARE FACILITIES THAT CARE FOR SUBACUTE PATIENTS
SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PATIENT
RATIO: ONE NURSE TO FIVE PATIENTS.
5.
ANY RESIDENTIAL HEALTH CARE FACILITY THAT VIOLATES THE RIGHTS OF
AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGNMENT POLICY UNDER THIS
SECTION MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A
COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS
MAY BE APPROPRIATE TO EFFECTUATE THE PURPOSES OF THE SAFE STAFFING
REQUIREMENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION,
LOST WAGES AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES
RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
DAMAGES. THE COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT
AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND
COSTS OF ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO
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INSTITUTE A PRIVATE ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE
LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A RESIDENTIAL HEALTH CARE
FACILITY SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACILITY
IS REQUIRED TO MAKE AVAILABLE TO THE PUBLIC UNDER SECTION
TWENTY-EIGHT HUNDRED FIVE-T OF THIS CHAPTER.
INFORMATION UNDER THIS
PARAGRAPH SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE

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POSTED IN A MANNER WHICH IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR
FAMILIES AND THE STAFF, AS REQUIRED BY THE COMMISSIONER.
(B) A RESIDENTIAL HEALTH CARE FACILITY SHALL POST A SUMMARY OF THIS
SECTION, PROVIDED BY THE DEPARTMENT, IN PROXIMITY TO EACH POSTING
REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION.
S 7. If any provision of this act, or any application of any provision
of this act, is held to be invalid, or ruled by any federal agency to
violate or be inconsistent with any applicable federal law or regulation, that shall not affect the validity or effectiveness of any other
provision of this act, or of any other application of any provision of
this act.
S 8. This act shall take effect on the one hundred eightieth day after
it shall have become a law, provided that any rules and regulations, and
any other actions necessary to implement the provisions of this act on
its effective date are authorized and directed to be completed on or
before such date.

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