BILL NUMBER: SB 1721 INTRODUCED BILL TEXT INTRODUCED BY Senator Yee FEBRUARY 22, 2008 An act to add Section 1276.45 to the Health and Safety Code, relating to direct care nurses. LEGISLATIVE COUNSEL'S DIGEST SB 1721, as introduced, Yee. Health facilities: direct care nurses. Under existing law, the Department of Consumer Affairs, Board of Registered Nursing regulates the licensing of registered nurses. Existing law requires the State Department of Public Health to license and regulate health facilities, including hospitals, and establish minimum hospital nurse-to-patient ratios by licensed nurse classification and by hospital unit. A violation of these provisions is a crime. This bill would require each new direct care registered nursing hire to receive and complete an orientation to the hospital and patient care unit in which he or she will be working. It would preclude a nurse who has not completed this orientation from being assigned direct patient care, and would require observation of the nurse during the orientation by a direct care registered nurse. This bill would specify that, until the nurse completes orientation, he or she would not be counted as staff in computing the nurse-to-patient ratio. By creating a new crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1276.45 is added to the Health and Safety Code, to read: 1276.45. (a) Each general acute care hospital, acute psychiatric hospital, and special hospital, as defined in subdivisions (a), (b), and (f) of Section 1250, shall ensure that all direct care registered nurses, including new hires, casual, per diem, temporary agency, registry, and traveler staff, shall receive and complete orientation to the hospital and patient care unit or clinical care area in which they will be working. (b) (1) Every direct care registered nurse shall have current demonstrated and validated competency required for the specific individual needs of the patient population admitted to the unit or clinical area before being assigned to patient care. In accordance with paragraph (2), current competency may only be demonstrated and validated by the direct observation of the orientee by another direct care registered nurse who has previously demonstrated current competency in the relevant patient population. Self-assessments are prohibited. (2) The observing direct care registered nurse shall be required to directly observe and assess the orientee within the relevant clinical area and with the relevant patient population for a minimum of five standard nursing shifts in order to determine if the orientee displays the required knowledge, performance, and skills of patient assessment, patient care planning, intervention, patient evaluation, and patient advocacy to satisfactorily fulfill the duties required by the Nursing Practice Act (Chapter 6 (commencing with Section 2700) of Division 2 of the Business and Professions Code) and the Standards of Competent Performance. (c) An orientee shall not count as staff for the purposes of calculating the nurse-to-patient ratio required by Section 1276.4. (d) As used in this section, "orientee" means a direct care registered nurse who has not received and completed orientation to the hospital and patient care unit or clinical area and whose current competency has not been demonstrated and validated. SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.