S. 3691 2
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 STAFF-
ING 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 2824. 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 GENERAL HOSPITAL, AND SHALL ALSO
INCLUDE ANY CHRONIC DISEASE HOSPITAL, MATERNITY HOSPITAL, OUTPATIENT
DEPARTMENT, EMERGENCY CENTER OR SURGICAL CENTER, 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
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 NURS-
ES 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
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 STAND-
S. 3691 3
ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
8. "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF SECTIONS
TWENTY-EIGHT HUNDRED TWENTY-THREE-A THROUGH TWENTY-EIGHT HUNDRED THIR-
TY-ONE 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 2825. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER
SHALL:
1. PROMULGATE, AFTER CONSULTATION WITH THE 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 ACUITY SYSTEMS, WHICH MAY INCLUDE A SYSTEM FOR
CLASS APPROVAL OF ACUITY SYSTEMS; AND
2. 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
REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
PURSUANT TO SUCH REQUIREMENTS.
3. ESTABLISH A COMMITTEE TO ADVISE IN THE DEVELOPMENT OF REGULATIONS,
INCLUDING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS
AND NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE NOT SPECI-
FIED IN THIS ARTICLE. THE COMMITTEE SHALL ADVISE THE COMMISSIONER ON
THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL, AND REVIEW AND
MAKE RECOMMENDATIONS ON APPROVAL OF STAFFING PLANS PRIOR TO THE GRANTING
OF AN OPERATING CERTIFICATE BY THE DEPARTMENT. THE COMMITTEE SHALL HAVE
THIRTEEN MEMBERS. NO LESS THAN SIXTY PERCENT OF THE MEMBERS OF THE
COMMITTEE SHALL BE REGISTERED PROFESSIONAL NURSES. THE COMMITTEE SHALL
INCLUDE REGISTERED PROFESSIONAL NURSE DIRECT CARE PROVIDERS, REPRESEN-
TATIVES OF ACUTE CARE FACILITIES, AND REPRESENTATIVES OF NURSING PROFES-
SIONAL ASSOCIATIONS AND RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
REPRESENTATIVE OF NURSES AND OF NON-NURSING DIRECT-CARE STAFF. THE
GOVERNOR SHALL APPOINT THE CHAIR AND SIX OTHER MEMBERS, TWO MEMBERS
SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY, ONE MEMBER SHALL BE
APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY, TWO MEMBERS SHALL BE
APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE AND ONE MEMBER SHALL
BE APPOINTED BY THE MINORITY LEADER OF THE SENATE.
S 2826. 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 DEPART-
MENT OR UNIT WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED
CARE NEEDS OF THE PATIENTS THEREIN. AT A MINIMUM, EACH SUCH FACILITY
S. 3691 4
SHALL MEET THE REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS
SECTION.
2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING CERTIF-
ICATE 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 APPROVED ACUITY SYSTEM FOR ADDRESSING FLUC-
TUATIONS 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, AND ADMINISTRATIVE AND SUPPORT TASKS THAT IS
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 FUNC-
TIONS 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 ASSESSMENT TOOL USED TO VALIDATE THE ACUITY SYSTEM
RELIED ON IN THE PLAN;
(G) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING
ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
(H) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S
STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
(I) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN
TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH
SUCH CLASSIFICATION; AND
(J) BE DEVELOPED IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE
NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES-
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-PA-
TIENT RATIOS:
(I) ONE NURSE TO ONE PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY
UNITS AND ALL CRITICAL CARE AREAS INCLUDING EMERGENCY CRITICAL CARE AND
ALL INTENSIVE CARE 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 POSTANESTHESIA UNITS;
(III) ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA-
TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME-
DIATE CARE NURSERY UNITS;
(IV) ONE NURSE TO THREE PATIENTS: POSTPARTUM MOTHER/BABY COUPLETS
(MAXIMUM SIX PATIENTS PER NURSE);
S. 3691 5
(V) ONE NURSE TO FOUR PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS, AND
MEDICAL/SURGICAL AND ACUTE CARE PSYCHIATRIC UNITS;
(VI) ONE NURSE TO FIVE PATIENTS: REHABILITATION UNITS; AND
(VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING 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 DURING ONE SHIFT. A NURSE,
INCLUDING A NURSE ADMINISTRATOR OR SUPERVISOR, WHO DOES NOT HAVE PRINCI-
PAL RESPONSIBILITY AS A DIRECT-CARE NURSE FOR A SPECIFIC PATIENT SHALL
NOT BE INCLUDED IN THE CALCULATION OF THE NURSE-TO-PATIENT RATIO.
4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC-
TICAL 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 PROFES-
SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC-
TICE 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 NURS-
ING 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 PRACTI-
CAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNC-
TIONS 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. THE MINIMUM STAFFING REQUIREMENT AND NURSE-TO-PATIENT
RATIO SET FORTH IN THIS SECTION SHALL BE ADJUSTED AS NECESSARY TO
REFLECT THE NEED FOR ADDITIONAL DIRECT-CARE NURSES NECESSARY TO ENSURE
ADEQUATE STAFFING OF EACH NURSING DEPARTMENT OR UNIT, IN ACCORDANCE WITH
AN APPROVED ACUITY SYSTEM.
7. DEPARTMENT REGULATIONS. NOTHING IN THIS SECTION SHALL BE DEEMED TO
PRECLUDE THE DEPARTMENT BY RULE OR REGULATION FROM ESTABLISHING AND
REQUIRING A DOCUMENTED STAFFING PLAN TO HAVE HIGHER NURSE-TO-PATIENT
RATIOS THAN THOSE SET FORTH IN THIS SECTION.
8. NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO ALTER, AFFECT
THE VALIDITY OF, MODIFY THE TERMS OF, OR IMPAIR ANY COLLECTIVE BARGAIN-
ING AGREEMENT.
S 2827. COMPLIANCE WITH STAFFING PLAN AND RECORDKEEPING. 1. AS A
CONDITION FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE, 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 TWENTY-SIX 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 TWENTY-SIX OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, RULE, REGULATION OR
CONTRACT.
2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM STAFFING REQUIREMENTS
STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED TWENTY-SIX 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
S. 3691 6
FACILITY UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI-
CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW, HAS RECEIVED PRIOR
ORIENTATION IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS-
ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND HAS DEMON-
STRATED 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 COMPETEN-
CY 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. AS A CONDITION FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE,
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 NURS-
ING 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. AS A CONDITION FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE,
EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURSING
DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY, INFECTION, ACCIDENT, INJU-
RY 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.
S 2828. WORK ASSIGNMENT POLICY. 1. GENERAL. AS A CONDITION FOR THE
MAINTENANCE OF AN OPERATING CERTIFICATE, 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 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;
S. 3691 7
(B) WHERE FEASIBLE, AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE
SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH-
ER 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 CONTIN-
UED 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 2829. 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 STAFF-
ING 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 2830. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE-
GATE ITS RESPONSIBILITIES TO ENFORCE THE SAFE STAFFING REQUIREMENTS
PROMULGATED PURSUANT TO THIS ARTICLE.
S 2831. ENFORCEMENT AND PENALTIES. 1. CIVIL PENALTY. ANY PERSON,
REGARDLESS OF WHETHER THAT PERSON POSSESSES AN OPERATING CERTIFICATE,
WHO HAS COMMITTED A VIOLATION OF ANY OF THE PROVISIONS OF THE SAFE
STAFFING REQUIREMENTS, INCLUDING FAILURE TO CORRECT A SERIOUS VIOLATION
(AS DEFINED BY REGULATION) WITHIN THE TIME SPECIFIED IN A DEFICIENCY
CITATION, MAY BE ASSESSED A CIVIL PENALTY BY ORDER OF THE DEPARTMENT OF
UP TO FIVE HUNDRED DOLLARS FOR EACH DEFICIENCY FOR EACH DAY THAT EACH
DEFICIENCY CONTINUES; PROVIDED, HOWEVER, THAT AN ACUTE HEALTH CARE
FACILITY THAT FAILS TO COMPLY WITH THE REQUIREMENTS OF SECTION
TWENTY-EIGHT HUNDRED TWENTY-SIX OF THIS ARTICLE MAY BE ASSESSED A CIVIL
PENALTY BY ORDER OF THE DEPARTMENT OF UP TO TEN THOUSAND DOLLARS FOR
EACH DAY OF NON-COMPLIANCE. CIVIL PENALTIES SHALL BE COLLECTED FROM THE
DATE SUCH FACILITY RECEIVES NOTICE OF VIOLATION UNTIL THE DATE SUCH
VIOLATION IS CORRECTED.
2. CIVIL PENALTY FOR INTERFERENCE WITH REPORTING OBLIGATIONS. ANY
PERSON OR ACUTE CARE FACILITY THAT FAILS TO REPORT OR FALSIFIES INFORMA-
TION, OR COERCES, THREATENS, INTIMIDATES OR OTHERWISE INFLUENCES ANOTH-
S. 3691 8
ER PERSON TO FAIL TO REPORT OR TO FALSIFY INFORMATION REQUIRED TO BE
REPORTED UNDER THE SAFE STAFFING REQUIREMENTS, MAY BE ASSESSED A CIVIL
PENALTY OF UP TO TEN THOUSAND DOLLARS FOR EACH SUCH INCIDENT.
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 COMMUNI-
TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH COUNCIL
SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL RULES, REGU-
LATIONS 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 COUN-
CIL 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 ACCORD-
ANCE 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. NURSING HOME STAFFING LEVELS. 1. DEFINITIONS. AS USED IN
THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
(A) "ADVISORY COUNCIL" MEANS THE ADVISORY COUNCIL ON NURSING HOME
STAFFING CREATED IN SUBDIVISION TWO OF THIS SECTION.
(B) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE NURSING
HOME NURSE AIDE REGISTRY PURSUANT TO SECTION TWENTY-EIGHT HUNDRED
THREE-J OF THIS CHAPTER.
(C) "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. ADVISORY COUNCIL ON NURSING HOME STAFFING. THERE IS HEREBY CREATED
IN THE DEPARTMENT AN ADVISORY COUNCIL ON NURSING HOME STAFFING TO STUDY
AND MAKE RECOMMENDATIONS RELATING TO THE STAFFING STANDARDS UNDER THIS
SECTION. THE ADVISORY COUNCIL SHALL BE APPOINTED BY THE COMMISSIONER AND
SHALL BE COMPOSED OF REPRESENTATIVES OF NURSING HOME OPERATORS, CONSUM-
ERS, AND NON-ADMINISTRATIVE NURSING HOME EMPLOYEES AND THE PUBLIC. THE
ADVISORY COUNCIL SHALL, FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE
LEGISLATURE, THE PUBLIC AND THE COMMISSIONER ANY RECOMMENDATIONS REGARD-
ING STAFFING LEVELS IN NURSING HOMES.
3. STAFFING STANDARDS. (A) THE COMMISSIONER, IN CONSULTATION WITH THE
ADVISORY COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR
NURSING HOME MINIMUM STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAINTAIN THE HIGH-
EST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH
RESIDENT OF THE NURSING HOME. THE COMMISSIONER SHALL ALSO REQUIRE BY
REGULATION THAT EVERY NURSING HOME 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 NURSING HOME SHALL:
S. 3691 9
(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 NURSING HOME.
(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 NURSING HOME SHALL MAINTAIN A STAFFING RATIO
EQUAL TO AT LEAST THE FOLLOWING:
(A) FROM 2.4 TO 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED
NURSE AIDE;
(B) FROM 1.15 TO 1.3 HOURS OF CARE PER RESIDENT PER DAY BY A LICENSED
PRACTICAL NURSE OR A REGISTERED NURSE; AND
(C) FROM 0.55 TO 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGIS-
TERED NURSE.
5. PHASE-IN. (A) THE COMMISSIONER SHALL MAKE THE FIRST REGULATIONS
UNDER SUBDIVISION THREE OF THIS SECTION WITHIN ONE YEAR AFTER THIS
SECTION BECOMES A LAW.
(B) IF THE COMMISSIONER DETERMINES THAT COMPLIANCE WITH THE STATUTORY
STANDARD UNDER SUBDIVISION FOUR OF THIS SECTION IS NOT REASONABLY FEASI-
BLE FOR NURSING HOMES BY THE TIME SPECIFIED IN THAT SUBDIVISION, THE
COMMISSIONER MAY DELAY THE IMPLEMENTATION OF THAT STAFFING STANDARD FOR
A PHASE-IN PERIOD NOT TO EXCEED FIVE YEARS AFTER THIS SECTION BECOMES A
LAW. IF THE COMMISSIONER DELAYS IMPLEMENTATION OF THAT STAFFING STAND-
ARD, THE COMMISSIONER SHALL PHASE IN, OVER THE PHASE-IN PERIOD, STAFF-
ING STANDARDS THAT GRADUALLY INCREASE IN EACH OF THE YEARS OF THE
PHASE-IN PERIOD UNTIL THE STAFFING STANDARD MEETS AT LEAST THE STATUTORY
STANDARD UNDER SUBDIVISION FOUR OF THIS SECTION.
6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A NURSING HOME SHALL POST
INFORMATION REGARDING NURSE STAFFING THAT THE NURSING HOME 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 POSTED IN A MANNER
WHICH IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR FAMILIES AND THE
STAFF, AS REQUIRED BY THE COMMISSIONER.
(B) A NURSING HOME SHALL POST A SUMMARY OF THIS SECTION, PROVIDED BY
THE DEPARTMENT, IN CLOSE PROXIMITY TO EACH POSTING REQUIRED BY PARAGRAPH
(A) OF THIS SUBDIVISION.
S 7. Subdivisions 2 and 3 of section 97-iiii of the state finance
law, as added by section 18 of part A of chapter 58 of the laws of 2008,
are amended to read as follows:
2. Such account shall consist of monies received from civil penalties
in excess of two thousand dollars per violation pursuant to subdivision
one of section twelve of the public health law and subdivision two of
section twelve-b of the public health law, AND ALL CIVIL PENALTIES
ASSESSED PURSUANT TO SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THE
PUBLIC HEALTH LAW.
3. Moneys of this account, following appropriations by the legisla-
ture, shall be available to the department of health for the patient
S. 3691 10
safety center created by title two of article twenty-nine-D of the
public health law. SUCH DEPARTMENT SHALL GIVE SUBSTANTIAL WEIGHT TO
FUNDING INITIATIVES TO IMPROVE STAFFING RATIOS IN HEALTH CARE FACILITIES
OR TO REDUCE THE USE OF EXCESSIVE OVERTIME AMONG NURSING STAFFS.
S 8. 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 regu-
lation, 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 9. This act shall take effect on the one hundred eightieth day after
it shall have become a law; provided that the amendments to section
97-iiii of the state finance law, made by section seven of this act,
shall not affect the expiration and repeal of such section and shall
expire and be deemed repealed therewith; and provided, further, 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.
