Bill Summary – FastDemocracy

       Florida Senate - 2024                                     SB 376
       
       
        
       By Senator Garcia
       
       
       
       
       
       36-00573-24                                            2024376__
                      A bill to be entitled                      
       An act relating to delivery of patient protection;
       providing a short title; creating s. 395.1013, F.S.;
       providing legislative findings; defining terms;
       requiring health care facilities to implement staffing
       plans that comply with specified minimum staffing
       levels for direct care registered nurses; providing
       construction; prohibiting health care facilities from
       taking specified actions; requiring such facilities to
       ensure that certain staffing is maintained; specifying
       minimum staffing levels for direct care registered
       nurses based on the hospital or clinical unit setting;
       requiring that patients be cared for only in hospital
       or clinical units that meet the specified minimum
       staffing levels; prohibiting health care facilities
       from using video cameras or monitors as a substitute
       for direct observation and assessment by a direct care
       registered nurse; exempting health care facilities
       from the minimum staffing level requirements during a
       declared state of emergency under certain
       circumstances; providing requirements for any acuity
       based patient classification system adopted by a
       health care facility; providing whistle-blower
       protections; creating a cause of action; providing
       remedies; providing for complaints to and
       administrative actions by the Agency for Health Care
       Administration; providing civil penalties; requiring
       the agency to post specified information on its
       website; providing construction with respect to
       collective bargaining agreements; prohibiting
       employers from taking specified actions with respect
       to employment for certain unionized staff; providing
       an effective date.
        
Be It Enacted by the Legislature of the State of Florida:

       Section 1. This act may be cited as the “Florida Patient
Protection Act.”
       Section 2. Section 395.1013, Florida Statutes, is created
to read:
       395.1013 Health Care Facility Patient Care Standards.—
       (1) LEGISLATIVE FINDINGS.—The Legislature finds that:
       (a) The state has a substantial interest in ensuring that,
in the delivery of health care services to patients, health care
facilities retain sufficient nursing staff to promote optimal
health care outcomes.
       (b) The basic principles of staffing in health care
facility settings should be based on the health care needs of
the individual patient, the severity of the patient’s condition,
the services needed, and the complexity of providing those
services.
       (c) Mandating the adoption of uniform, minimum, numerical,
and specific registered nurse-to-patient staffing ratios by
health care facilities is necessary for competent, safe,
therapeutic, and effective professional nursing care and for the
retention and recruitment of qualified direct care registered
nurses.
       (d) Direct care registered nurses must be able to advocate
for their patients without fear of retaliation from their
employers. Whistle-blower protections that encourage registered
nurses and patients to notify governmental and private
accreditation entities of suspected unsafe patient conditions,
including protection against retaliation for refusing unsafe
patient care assignments, will greatly enhance the health,
safety, and welfare of patients.
       (e) Direct care registered nurses have an irrevocable duty
and right to advocate on behalf of their patients’ interests,
and this duty and right may not be encumbered by cost-saving
practices.
       (2) DEFINITIONS.—As used in this section, the term:
       (a) “Acuity-based patient classification system” or
“patient classification system” means an established measurement
tool that:
       1. Predicts registered nursing care requirements for
individual patients based on the severity of a patient’s
illness; the need for specialized equipment and technology; the
intensity of required nursing interventions; the complexity of
clinical nursing judgment required to design, implement, and
evaluate the patient nursing care plan consistent with
professional standards; the ability for self-care, including
motor, sensory, and cognitive deficits; and the need for
advocacy intervention;
       2. Details the amount of nursing care needed and the
additional number of direct care registered nurses and other
licensed and unlicensed nursing staff that a health care
facility must assign, based on the independent professional
judgment of a direct care registered nurse, in order to meet the
needs of individual patients at all times; and
       3. Can be readily understood and used by direct care
nursing staff.
       (b) “Ancillary support staff” means the personnel assigned
to assist in providing nursing services for the delivery of
safe, therapeutic, and effective patient care, including unit or
ward clerks and secretaries, clinical technicians, respiratory
therapists, and radiology, laboratory, housekeeping, and dietary
personnel.
       (c) “Clinical supervision” means the assignment and
direction of a patient care task required in the implementation
of nursing care for a patient to other licensed nursing staff or
to unlicensed staff by a direct care registered nurse in the
exclusive interest of the patient.
       (d) “Competence” means the ability of a direct care
registered nurse to act and integrate the knowledge, skill,
abilities, and independent professional judgment that underpin
safe, therapeutic, and effective patient care.
       (e) “Declared state of emergency” means an officially
designated state of emergency that has been declared by a
federal, state, or local government official who has the
authority to declare the state of emergency. The term does not
include a state of emergency that results from a labor dispute
in the health care industry.
       (f) “Direct care registered nurse” means a licensed
registered nurse whose competence has been documented and who
has accepted a direct, hands-on patient care assignment to
implement medical and nursing regimens and provide related
clinical supervision of patient care while exercising
independent professional judgment at all times in the exclusive
interest of the patient.
       (g) “Health care facility” means an acute care hospital,
including a long-term acute care hospital, a hospital-based off
campus emergency department, an ambulatory surgical center, or a
psychiatric facility licensed under chapter 394.
       (h) “Hospital unit” or “clinical unit” means a critical
care unit or intensive care unit, labor and delivery room,
antepartum and postpartum unit, newborn nursery, postanesthesia
unit, emergency department, operating room, observation unit,
pediatric unit, medical-surgical unit, rehabilitation unit,
skilled nursing unit, specialty care unit, step-down unit or
intermediate intensive care unit, telemetry unit, or psychiatric
unit.
       1. “Critical care unit” or “intensive care unit” means a
nursing unit established to safeguard and protect a patient
whose severity of medical condition requires continuous
monitoring and complex intervention by a direct care registered
nurse and whose restorative measures and level of nursing
intensity require intensive care through direct observation and
complex monitoring, intensive intricate assessment, evaluation,
specialized rapid intervention, and education or teaching of the
patient, the patient’s family, or other representatives by a
direct care registered nurse. The term includes a burn unit, a
coronary care unit, an acute respiratory unit, and other
critical care settings.
       2. “Medical-surgical unit” means a unit established to
safeguard and protect a patient whose severity of illness,
including all co-occurring morbidities, restorative measures,
and level of nursing intensity, requires continuous care through
direct observation by a direct care registered nurse and
monitoring, multiple assessments, specialized interventions,
evaluations, and education or teaching of the patient, the
patient’s family, or other representatives by a competent and
experienced direct care registered nurse. These units may
include patients requiring less than intensive care or step-down
care; patients receiving 24-hour inpatient general medical care,
postsurgical care, or both general medical and postsurgical
care; and mixed populations of patients of diverse diagnoses and
diverse age groups, but excluding pediatric patients.
       3. “Rehabilitation unit” means a functional clinical unit
established to provide rehabilitation services that restore an
ill or injured patient to the highest level of self-sufficiency
or gainful employment of which he or she is capable in the
shortest possible time, compatible with his or her physical,
intellectual, and emotional or psychological capabilities, and
in accordance with planned goals and objectives.
       4. “Skilled nursing unit” means a functional clinical unit
established to provide skilled nursing care and supportive care
to patients whose primary need is for skilled nursing care on a
long-term basis and who are admitted after at least a 48-hour
period of continuous inpatient care. The term includes, but is
not limited to, a unit established to provide medical, nursing,
dietary, and pharmaceutical services and activity programs.
       5. “Specialty care unit” means a unit established to
safeguard and protect a patient whose severity of illness,
including all co-occurring morbidities and restorative measures,
requires direct observation by a direct care registered nurse
and monitoring, multiple assessments, specialized interventions,
evaluations, and education or teaching of the patient, the
patient’s family, or other representatives by a competent and
experienced direct care registered nurse. The term includes, but
is not limited to, a unit, such as a transplant unit,
established to provide the intensity of care required for a
specific medical condition or a specific patient population or
to provide more comprehensive care for a specific condition or
disease than the care required in a medical-surgical unit.
       6. “Step-down unit” or “intermediate intensive care unit”
means a unit established to safeguard and protect a patient
whose severity of illness, including all co-occurring
morbidities, restorative measures, and level of nursing
intensity, requires intermediate intensive care through direct
observation and monitoring, multiple assessments, specialized
interventions, evaluations, and education or teaching of the
patient, the patient’s family, or other representatives by a
direct care registered nurse. The term includes units
established to provide care to patients who have moderate or
potentially severe physiological instability requiring technical
support, which means the use of specialized equipment by a
direct care registered nurse in providing for invasive
monitoring, telemetry, and mechanical ventilation for the
immediate amelioration or remediation of severe pathology for a
patient requiring less care than intensive care but more care
than that provided in a medical-surgical unit.
       7. “Telemetry unit” means a unit established to safeguard
and protect a patient whose severity of illness, including all
co-occurring morbidities, restorative measures, and level of
nursing intensity, requires intermediate intensive care through
direct observation by a direct care registered nurse and
monitoring, multiple assessments, specialized interventions,
evaluations, and education or teaching of the patient, the
patient’s family, or other representatives by a competent and
experienced direct care registered nurse. A telemetry unit
includes the equipment used to provide for the electronic
monitoring, recording, retrieval, and display of cardiac
electrical signals.
       (i) “Long-term acute care hospital” means a hospital or
health care facility that specializes in providing long-term
acute care to medically complex patients. The term includes a
freestanding hospital and a hospital-within-hospital model of a
long-term acute care facility.
       (j) “Overtime” means the hours worked in excess of 40 hours
per week.
       (k) “Patient assessment” means the process of actively and
skillfully interpreting, applying, analyzing, synthesizing, or
evaluating data obtained through direct observation and
communication with others.
       (l) “Professional judgment” means the intellectual,
educated, informed, and experienced process that a direct care
registered nurse exercises in forming an opinion and reaching a
clinical decision that is in the patient’s best interest and is
based upon analysis of data, information, and scientific
evidence.
       (3) MINIMUM DIRECT CARE REGISTERED NURSE STAFFING LEVEL
REQUIREMENTS.—
       (a) Each health care facility shall implement a staffing
plan that provides for minimum direct care registered nurse
staffing levels in accordance with the requirements of this
subsection.
       (b) Staffing levels for patient care tasks that do not
require a direct care registered nurse are not included within
these ratios and must be determined pursuant to an acuity-based
patient classification system defined by agency rule.
       (c) The direct care registered nurse staffing levels
represent the maximum number of patients that may be assigned to
one direct care registered nurse at any one time.
       (d) A health care facility:
       1. May not average the number of patients and the total
number of direct care registered nurses assigned to patients in
a hospital unit or clinical unit during any period of time for
purposes of meeting the requirements under this subsection.
       2. May not impose mandatory overtime in order to meet the
minimum direct care registered nurse staffing levels in a
hospital unit or clinical unit which are required under this
subsection.
       3. May not terminate employment of or refuse to fill
vacancies for licensed practical nurses, licensed psychiatric
technicians, certified nursing assistants, or other ancillary
support staff in order to meet the direct care registered nurse
staffing levels in a hospital unit or clinical unit, as required
under this subsection.
       4. Shall ensure that only a direct care registered nurse
may relieve another direct care registered nurse during breaks,
meals, and routine absences from a hospital unit or clinical
unit.
       (e) Only a direct care registered nurse may be assigned to
an intensive care newborn nursery service unit. Such units must
have a direct care registered nurse staffing level of one nurse
to two or fewer infants at all times.
       (f) Only a direct care registered nurse may be assigned to
a triage patient, and only a direct care registered nurse may be
assigned to a critical care patient in the emergency department.
       1. The direct care registered nurse staffing level for
triage patients or critical care patients in the emergency
department must be one nurse to two or fewer patients at all
times.
       2. At least two direct care registered nurses must be
physically present in the emergency department when a patient is
present.
       3. Registered nurses providing triage, telehealth, private
duty, rapid response, or flight services do not count in the
calculation of direct care registered nurse staffing levels in
the emergency department.
       4. Triage registered nurses may not be assigned the
responsibility of the base radio for the emergency department.
       (g) Only direct care registered nurses may be assigned to a
labor and delivery unit.
       1. The direct care registered nurse staffing level must be
one nurse to one active labor patient or to one patient having
medical or obstetrical complications during the initiation of
epidural anesthesia and during circulation for a