S. 1032 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.
§ 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 RESIDEN-
TIAL HEALTH CARE FACILITY AND SHALL ALSO INCLUDE ANY FACILITY THAT
PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW, ARTI-
CLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACIL-
ITY 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-
ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
S. 1032 3
8. "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF THIS
SECTION AND SECTIONS TWENTY-EIGHT HUNDRED TWENTY-SEVEN, TWENTY-EIGHT
HUNDRED TWENTY-NINE, TWENTY-EIGHT HUNDRED THIRTY, TWENTY-EIGHT HUNDRED
THIRTY-ONE, TWENTY-EIGHT HUNDRED THIRTY-TWO, TWENTY-EIGHT HUNDRED THIR-
TY-THREE, TWENTY-EIGHT HUNDRED THIRTY-FOUR AND TWENTY-EIGHT HUNDRED
THIRTY-FIVE OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU-
ANT 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.
§ 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 ADMINIS-
TRATOR. NO LESS THAN TWO MEMBERS OF THE ACUTE CARE FACILITY COUNCIL
SHALL BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAIN-
ING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO
REPRESENTATIVES OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A NURS-
ING 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, INCLUD-
ING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS AND
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 EVAL-
UATE 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 COUN-
CIL, 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
REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
PURSUANT TO SUCH REQUIREMENTS.
§ 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 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. 1032 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 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 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 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-
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 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;
(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);
(V) ONE NURSE TO FOUR PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS,
POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI-
ATRIC UNITS;
S. 1032 5
(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 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 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 DETERMIN-
ING NURSING CARE REQUIREMENTS, INCLUDING THE SEVERITY OF THE ILLNESS,
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.
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.
§ 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,
S. 1032 6
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 ARTI-
CLE, 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 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. 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. EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURS-
ING 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.
§ 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
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.
S. 1032 7
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 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.
§ 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 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.
§ 2834. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE-
GATE ITS RESPONSIBILITIES TO ENFORCE THE SAFE STAFFING REQUIREMENTS
PROMULGATED PURSUANT TO THIS ARTICLE.
§ 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 ASSIGN-
MENT POLICY UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-TWO OF THIS ARTI-
CLE 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 REQUIRE-
MENTS, 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
S. 1032 8
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.
§ 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 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 PRAC-
TICES, 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.
§ 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.
§ 6. The public health law is amended by adding a new section 2895-b
to read as follows:
§ 2895-B. RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS. 1. DEFI-
NITIONS. AS USED IN THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
FOLLOWING MEANINGS:
(A) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE RESIDEN-
TIAL HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION TWEN-
TY-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 NURS-
ES, 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 OPERA-
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-
OPMENT OF REGULATIONS RELATING TO THE STAFFING STANDARDS UNDER THIS
SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLA-
TURE, 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 RESIDEN-
S. 1032 9
TIAL HEALTH CARE FACILITY MINIMUM STAFFING LEVELS TO MEET APPLICABLE
STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAIN-
TAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BE-
ING OF EACH RESIDENT OF THE FACILITY. THE COMMISSIONER SHALL ALSO
REQUIRE BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAIN-
TAIN 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
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 FACIL-
ITY 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.
S. 1032 10
(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.
§ 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 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.
§ 8. This act shall take effect on the one hundred eightieth day after
it shall have become a law. Effective immediately, the addition, amend-
ment and/or repeal of any rule or regulation necessary for the implemen-
tation of this act on its effective date are authorized to be made and
completed on or before such effective date.
