Washington SB 5344: Concerning nursing fatigue.

Bill Text

S-1760.3

SUBSTITUTE SENATE BILL 5344

State of Washington

66th Legislature

2019 Regular Session

BySenate Health & Long Term Care (originally sponsored by Senators Cleveland, O'Ban, Hobbs, Takko, Mullet, Palumbo, Rivers, Wellman, and Hunt)

READ FIRST TIME 02/21/19.

AN ACT Relating to staffing committees and limiting the total number of hours nurses can work across all health care settings to sixty hours in a week; amending RCW 70.41.420, 70.41.425, 18.79.200, and 18.79.210; amending 2017 c 249 s 4 (uncodified); reenacting and amending RCW 18.79.260; creating a new section; providing an effective date; and providing an expiration date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. INTENT.(1) The legislature finds monitoring and assessing whether nurses are able to receive their meal and rest breaks as specified by law and where applicable, a collective bargaining agreement, and monitoring the use of prescheduled on-call and call-back rates for nurses is an important component of mitigating nurse fatigue and operating a hospital effectively. However, the legislature also finds that mandating rigid constraints on how hospitals provide breaks, or how they use prescheduled on-call and overtime does not allow the flexibility needed to work collaboratively to find solutions that work for complex care environments. Further, they may jeopardize quality care and patient safety, by interrupting care transitions, creating barriers to communication, and preventing safe staffing for critically important procedures.

(2) Hospital nurse staffing committees have been in place since 2008, and were granted additional authority in 2017 to increase monitoring and accountability and address nurse staffing issues collaboratively and at the local level. Collaboration between direct care nurses, other staff, and management is a hallmark of the culture of safety found in organizations that successfully lower the incidence of adverse events while carrying out complex and hazardous work.

(3) Therefore, the legislature intends to address the concern of nurse fatigue by building on the work of existing nurse staffing committees which all hospitals must have in place pursuant to law. This approach will address staffing concerns at the individual hospital level in order to ensure local patient care needs can be considered and quality and safety of care maintained. These nurse staffing committees shall have new obligations to collect, maintain, and review data on missed meal and rest breaks and the use of prescheduled on-call. The nurse staffing committees will also have a new requirement to establish a complaint process for missed rest breaks. If complaints are not addressed at the local level, the state department of health is granted the power to investigate the operations of the hospital's nurse staffing committee.

(4) The legislature further intends to address nurse fatigue by addressing the total number of hours a nurse works, especially for nurses with multiple employers or who work in multiple care settings. A maximum hours of weekly work for registered nurses is established to ensure nurses can provide safe and effective care to patients.

Sec. 2. RCW 70.41.420 and 2017 c 249 s 2 are each amended to read as follows:

(1) By September 1, 2008, each hospital shall establish a nurse staffing committee, either by creating a new committee or assigning the functions of a nurse staffing committee to an existing committee. At least one-half of the members of the nurse staffing committee shall be registered nurses currently providing direct patient care and up to one-half of the members shall be determined by the hospital administration. The selection of the registered nurses providing direct patient care shall be according to the collective bargaining agreement if there is one in effect at the hospital. If there is no applicable collective bargaining agreement, the members of the nurse staffing committee who are registered nurses providing direct patient care shall be selected by their peers.

(2) Participation in the nurse staffing committee by a hospital employee shall be on scheduled work time and compensated at the appropriate rate of pay. Nurse staffing committee members shall be relieved of all other work duties during meetings of the committee.

(3) Primary responsibilities of the nurse staffing committee shall include:

(a) Development and oversight of an annual patient care unit and shift-based nurse staffing plan, based on the needs of patients, to be used as the primary component of the staffing budget. Factors to be considered in the development of the plan should include, but are not limited to:

(i) Census, including total numbers of patients on the unit on each shift and activity such as patient discharges, admissions, and transfers;

(ii) Level of intensity of all patients and nature of the care to be delivered on each shift;

(iii) Skill mix;

(iv) Level of experience and speci