FEBRUARY 22, 2008

   An act to add Section 1276.45 to the Health and Safety Code,
relating to direct care nurses.


   SB 1721, as introduced, Yee. Health facilities: direct care
   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
   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
   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.


  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
   (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