F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 695 2024
1 A bill to be entitled
2 An act relating to delivery of patient protection;
3 providing a short title; creating s. 395.1013, F.S.;
4 providing legislative findings; defining terms;
5 requiring health care facilities to implement staffing
6 plans that comply with specified minimum staffing
7 levels for direct care registered nurses; providing
8 construction; prohibiting health care facilities from
9 taking specified actions; requiring such facilities to
10 ensure that certain staffing is maintained; specifying
11 minimum staffing levels for direct care registered
12 nurses based on the hospital or clinical unit setting;
13 requiring that patients be cared for only in hospital
14 or clinical units that meet the specified minimum
15 staffing levels; prohibiting health care facilities
16 from using video cameras or monitors as a substitute
17 for direct observation and assessment by a direct care
18 registered nurse; exempting health care facilities
19 from the minimum staffing level requirements during a
20 declared state of emergency under certain
21 circumstances; providing requirements for any acuity-
22 based patient classification system adopted by a
23 health care facility; providing whistle-blower
24 protections; creating a cause of action; providing
25 remedies; providing for complaints to and
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26 administrative actions by the Agency for Health Care
27 Administration; providing civil penalties; requiring
28 the agency to post specified information on its
29 website; providing construction with respect to
30 collective bargaining agreements; prohibiting
31 employers from taking specified actions with respect
32 to employment for certain unionized staff; providing
33 an effective date.
34
35 Be It Enacted by the Legislature of the State of Florida:
36
37 Section 1. This act may be cited as the "Florida Patient
38 Protection Act."
39 Section 2. Section 395.1013, Florida Statutes, is created
40 to read:
41 395.1013 Health Care Facility Patient Care Standards.—
42 (1) LEGISLATIVE FINDINGS.—The Legislature finds that:
43 (a) The state has a substantial interest in ensuring that,
44 in the delivery of health care services to patients, health care
45 facilities retain sufficient nursing staff to promote optimal
46 health care outcomes.
47 (b) The basic principles of staffing in health care
48 facility settings should be based on the health care needs of
49 the individual patient, the severity of the patient's condition,
50 the services needed, and the complexity of providing those
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51 services.
52 (c) Mandating the adoption of uniform, minimum, numerical,
53 and specific registered nurse-to-patient staffing ratios by
54 health care facilities is necessary for competent, safe,
55 therapeutic, and effective professional nursing care and for the
56 retention and recruitment of qualified direct care registered
57 nurses.
58 (d) Direct care registered nurses must be able to advocate
59 for their patients without fear of retaliation from their
60 employers. Whistle-blower protections that encourage registered
61 nurses and patients to notify governmental and private
62 accreditation entities of suspected unsafe patient conditions,
63 including protection against retaliation for refusing unsafe
64 patient care assignments, will greatly enhance the health,
65 safety, and welfare of patients.
66 (e) Direct care registered nurses have an irrevocable duty
67 and right to advocate on behalf of their patients' interests,
68 and this duty and right may not be encumbered by cost-saving
69 practices.
70 (2) DEFINITIONS.—As used in this section, the term:
71 (a) "Acuity-based patient classification system" or
72 "patient classification system" means an established measurement
73 tool that:
74 1. Predicts registered nursing care requirements for
75 individual patients based on the severity of a patient's
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76 illness; the need for specialized equipment and technology; the
77 intensity of required nursing interventions; the complexity of
78 clinical nursing judgment required to design, implement, and
79 evaluate the patient nursing care plan consistent with
80 professional standards; the ability for self-care, including
81 motor, sensory, and cognitive deficits; and the need for
82 advocacy intervention;
83 2. Details the amount of nursing care needed and the
84 additional number of direct care registered nurses and other
85 licensed and unlicensed nursing staff that a health care
86 facility must assign, based on the independent professional
87 judgment of a direct care registered nurse, in order to meet the
88 needs of individual patients at all times; and
89 3. Can be readily understood and used by direct care
90 nursing staff.
91 (b) "Ancillary support staff" means the personnel assigned
92 to assist in providing nursing services for the delivery of
93 safe, therapeutic, and effective patient care, including unit or
94 ward clerks and secretaries, clinical technicians, respiratory
95 therapists, and radiology, laboratory, housekeeping, and dietary
96 personnel.
97 (c) "Clinical supervision" means the assignment and
98 direction of a patient care task required in the implementation
99 of nursing care for a patient to other licensed nursing staff or
100 to unlicensed staff by a direct care registered nurse in the
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101 exclusive interest of the patient.
102 (d) "Competence" means the ability of a direct care
103 registered nurse to act and integrate the knowledge, skill,
104 abilities, and independent professional judgment that underpin
105 safe, therapeutic, and effective patient care.
106 (e) "Declared state of emergency" means an officially
107 designated state of emergency that has been declared by a
108 federal, state, or local government official who has the
109 authority to declare the state of emergency. The term does not
110 include a state of emergency that results from a labor dispute
111 in the health care industry.
112 (f) "Direct care registered nurse" means a licensed
113 registered nurse whose competence has been documented and who
114 has accepted a direct, hands-on patient care assignment to
115 implement medical and nursing regimens and provide related
116 clinical supervision of patient care while exercising
117 independent professional judgment at all times in the exclusive
118 interest of the patient.
119 (g) "Health care facility" means an acute care hospital,
120 including a long-term acute care hospital, a hospital-based off-
121 campus emergency department, an ambulatory surgical center, or a
122 psychiatric facility licensed under chapter 394.
123 (h) "Hospital unit" or "clinical unit" means a critical
124 care unit or intensive care unit, labor and delivery room,
125 antepartum and postpartum unit, newborn nursery, postanesthesia
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126 unit, emergency department, operating room, observation unit,
127 pediatric unit, medical-surgical unit, rehabilitation unit,
128 skilled nursing unit, specialty care unit, step-down unit or
129 intermediate intensive care unit, telemetry unit, or psychiatric
130 unit.
131 1. "Critical care unit" or "intensive care unit" means a
132 nursing unit established to safeguard and protect a patient
133 whose severity of medical condition requires continuous
134 monitoring and complex intervention by a direct care registered
135 nurse and whose restorative measures and level of nursing
136 intensity require intensive care through direct observation and
137 complex monitoring, intensive intricate assessment, evaluation,
138 specialized rapid intervention, and education or teaching of the
139 patient, the patient's family, or other representatives by a
140 direct care registered nurse. The term includes a burn unit, a
141 coronary care unit, an acute respiratory unit, and other
142 critical care settings.
143 2. "Medical-surgical unit" means a unit established to
144 safeguard and protect a patient whose severity of illness,
145 including all co-occurring morbidities, restorative measures,
146 and level of nursing intensity, requires continuous care through
147 direct observation by a direct care registered nurse and
148 monitoring, multiple assessments, specialized interventions,
149 evaluations, and education or teaching of the patient, the
150 patient's family, or other representatives by a competent and
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151 experienced direct care registered nurse. These units may
152 include patients requiring less than intensive care or step-down
153 care; patients receiving 24-hour inpatient general medical care,
154 postsurgical care, or both general medical and postsurgical
155 care; and mixed populations of patients of diverse diagnoses and
156 diverse age groups, but excluding pediatric patients.
157 3. "Rehabilitation unit" means a functional clinical unit
158 established to provide rehabilitation services that restore an
159 ill or injured patient to the highest level of self -sufficiency
160 or gainful employment of which he or she is capable in the
161 shortest possible time, compatible with his or her physical,
162 intellectual, and emotional or psychological capabilities, and
163 in accordance with planned goals and objectives.
164 4. "Skilled nursing unit" means a functional clinical unit
165 established to provide skilled nursing care and supportive care
166 to patients whose primary need is for skilled nursing care on a
167 long-term basis and who are admitted after at least a 48 -hour
168 period of continuous inpatient care. The term includes, but is
169 not limited to, a unit established to provide medical, nursing,
170 dietary, and pharmaceutical services and activity programs.
171 5. "Specialty care unit" means a unit established to
172 safeguard and protect a patient whose severity of illness,
173 including all co-occurring morbidities and restorative measures,
174 requires direct observation by a direct care registered nurse
175 and monitoring, multiple assessments, specialized interventions,
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176 evaluations, and education or teaching of the patient, the
177 patient's family, or other representatives by a competent and
178 experienced direct care registered nurse. The term includes, but
179 is not limited to, a unit, such as a transplant unit,
180 established to provide the intensity of care required for a
181 specific medical condition or a specific patient population or
182 to provide more comprehensive care for a specific condition or
183 disease than the care required in a medical-surgical unit.
184 6. "Step-down unit" or "intermediate intensive care unit"
185 means a unit established to safeguard and protect a patient
186 whose severity of illness, including all co-occurring
187 morbidities, restorative measures, and level of nursing
188 intensity, requires intermediate intensive care through direct
189 observation and monitoring, multiple assessments, specialized
190 interventions, evaluations, and education or teaching of the
191 patient, the patient's family, or other representatives by a
192 direct care registered nurse. The term includes units
193 established to provide care to patients who have moderate or
194 potentially severe physiological instability requirin g technical
195 support, which means the use of specialized equipment by a
196 direct care registered nurse in providing for invasive
197 monitoring, telemetry, and mechanical ventilation for the
198 immediate amelioration or remediation of severe pathology for a
199 patient requiring less care than intensive care but more care
200 than that provided in a medical-surgical unit.
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201 7. "Telemetry unit" means a unit established to safeguard
202 and protect a patient whose severity of illness, including all
203 co-occurring morbidities, restorative measures, and level of
204 nursing intensity, requires intermediate intensive care through
205 direct observation by a direct care registered nurse and
206 monitoring, multiple assessments, specialized interventions,
207 evaluations, and education or teaching of the patient, the
208 patient's family, or other representatives by a competent and
209 experienced direct care registered nurse. A telemetry unit
210 includes the equipment used to provide for the electronic
211 monitoring, recording, retrieval, and display of cardiac
212 electrical signals.
213 (i) "Long-