H. B. 2584


(By Delegates Hatfield, Brown, Marshall,

Caputo, Varner and Mahan)


[Introduced February 28, 2001; referred to the

Committee on Government Organization then Finance.]




A BILL to amend chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article thirty-eight, relating to services provided by nurses in hospitals and nursing homes; requiring the development of nurse-to-patient ratios for hospitals and nursing homes; and creating a safe staffing advisory council.

Be it enacted by the Legislature of West Virginia:

That chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article thirty-eight, to read as follows:

ARTICLE 38. NURSING STAFF IN HOSPITALS AND NURSING HOMES.

§16-38-1. Legislative findings.

The Legislature finds the following:

(1) Health care services are becoming complex and it is increasingly difficult for patients to access integrated services;

(2) Quality of patient care is jeopardized because of staffing changes implemented in response to managed care;

(3) To ensure the adequate protection of patients in acute 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 acute care setting should be based on the patient's care needs, the severity of condition, services needed and the complexity surrounding those services.

§16-38-2. Development of nurse-patient ratios.

(a) By the first day of January, two thousand two, the health care authority, created in article twenty-nine-b of this chapter, with the concurrence of the safe staffing advisory council, shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code that establish minimum, specific and numerical licensed nurse-to-patient ratios by licensed nurse classification and by unit for:

(1) All facilities licensed under the provisions of article five-b of this chapter, all hospitals operated by the state or any agency of the state and all hospitals which are staffed, in whole or in part, by public employees; and

(2) All nursing homes licensed under the provisions of article five-c of this chapter.

(b) The authority shall consider providing flexibility for rural primary care hospitals in response to their special needs.

(c) With regards to hospitals, as used in subsection (a) of this section, "unit" includes, but is not limited to, a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down/intermediate care unit, specialty care unit, telemetry unit, general medical care unit, subacute care unit and transitional inpatient care unit.

(d) The rules addressing emergency units shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to care for critical care patients in an emergency unit.

(e) The ratios shall be the minimum number of registered and licensed nurses that may be allocated. Additional staff shall be assigned in accordance with a documented patient classification
system for determining 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.
(f) "Critical care unit" as used in this section means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring, and complex intervention by licensed nurses.

(g) The health care authority shall take into consideration the findings of the legislative oversight commission on health and human resources accountability when establishing licensed nurse-to-patient ratios.

(h) The health care authority may take into consideration the unique nature of state sponsored teaching hospitals as educational institutions when establishing licensed nurse-to-patient ratios. The authority shall coordinate with the board examiners for registered professional nurses to ensure that staffing ratios are consistent with the board's approved nursing education requirements. This includes nursing clinical experience incidental to a work-study program rendered in a state-sponsored teaching hospital if there are sufficient direct care registered
professional nurse preceptors available to ensure safe patient care.
(i) Hospitals operated by a county are subject to a phase-in process developed in conjunction with the health care authority. The phase-in process shall be completed within one year of the adoption of the rules that implement this section.

§16-38-3. Safe staffing advisory council; members, appointment and expenses; appointment; duties.

(a) The safe staffing advisory council is created within the health care authority. The council consists of fifteen members. The governor shall appoint:
(1) One registered nurse who is employed in a school of nursing in a teaching hospital in this state;
(2) Two individuals who are on the board of examiners for registered professional nurses;
(3) Four individuals that are employed as registered professional nurses in a hospital and who work primarily providing direct patient care;
(4) One registered professional nurse who works as a long-term care nurse in a nursing home and who works primarily providing direct patient care;
(5) One administrator of a hospital in this state;
(6) One doctoral prepared nurse educator;
(7) One doctoral prepared nurse researcher;
(8) One nursing home administrator; and
(9) Three representatives of the public not currently or previously employed in hospital, nursing home or for a related entity.
(b) Of the members first appointed, the governor shall, at the time of their appointment, designate five members to serve terms expiring on the thirtieth day of June, two thousand two, five members to serve terms expiring on the thirtieth day of June, two thousand three, and five members to serve terms expiring on the thirtieth day of June, two thousand four. As the original appointments expire, each subsequent appointment is for a three-year term. Any member whose term has expired serves until a successor has been duly appointed and qualified. Any person appointed to fill a vacancy serves only for the unexpired term. In cases of any vacancy in the office of a member, the vacancy shall be filled by the governor in the same manner as the original appointment was made.
(c) Members of the council are not entitled to compensation for services performed as members, but are entitled to reimbursement for all reasonable and necessary expenses actually incurred in the performance of their duties. Eight of the appointed members is a quorum for the purpose of conducting business. The governor shall designate a chair, who is not a public official, for a term to run concurrently with the term of office of the member designated as chair. The council shall conduct all meetings in accordance with the open meeting law pursuant to article nine-a, chapter six of this code.
(d) The council:
(1) Shall assist the health care authority in developing the nurse-to-patients ratios required by this article; and
(2) Must approve the final proposed rules prior to submission to the legislative rule-making review committee.



NOTE: The purpose of this bill is to address the safe provision of nursing services in hospitals and nursing homes. It does this by requiring the development of nurse-to-patient ratios for hospitals and nursing homes. The bill also creates a Safe Staffing Advisory Council to assist the Health Care Authority in developing nurse-to-patient ratios for hospitals and nursing homes.

This article is new; therefore, strike-throughs and underscoring have been omitted.