BILL NUMBER: SB 360	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Yee

                        FEBRUARY 25, 2009

   An act to amend Section 1276.4 of, and to add Section 1276.45 to,
the Health and Safety Code, relating to direct care nurses.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 360, 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. Under existing law, specified
hospitals are required to adopt written policies and procedures for
training and orientation of nursing staff. These provisions prohibit
a registered nurse from being assigned to a nursing unit or clinical
area until that nurse has received the specified orientation and
demonstrated sufficient competency. A violation of these health
facility 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. This bill would exempt a state inpatient mental health
hospital, a state developmental center, or a state veterans' home
from these provisions.
   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 1276.4 of the Health and Safety Code is amended
to read:
   1276.4.  (a) By January 1, 2002, the State Department of 
Public  Health  Services  shall adopt
regulations that establish minimum, specific, and numerical licensed
nurse-to-patient ratios by licensed nurse classification and by
hospital unit for all health facilities licensed pursuant to
subdivision (a), (b), or (f) of Section 1250. The department shall
adopt these regulations in accordance with the department's licensing
and certification regulations as stated in Sections 70053.2, 70215,
and 70217 of Title 22 of the California Code of Regulations, and the
professional and vocational regulations in Section 1443.5 of Title 16
of the California Code of Regulations. The department shall review
these regulations five years after adoption and shall report to the
Legislature regarding any proposed changes. Flexibility shall be
considered by the department for rural general acute care hospitals
in response to their special needs. As used in this subdivision,
"hospital unit" means 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. The
regulation addressing the emergency department shall distinguish
between regularly scheduled core staff licensed nurses and additional
licensed nurses required to care for critical care patients in the
emergency department.
   (b) These ratios shall constitute the minimum number of registered
and licensed nurses that shall 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.
   (c) "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. 
   (d)  All health facilities licensed under subdivision (a), (b), or
(f) of Section 1250 shall adopt written policies and procedures for
training and orientation of nursing staff.  
   (e)  No registered nurse shall be assigned to a nursing unit or
clinical area unless that nurse has first received orientation in
that clinical area sufficient to provide competent care to patients
in that area, and has demonstrated current competence in providing
care in that area.  
   (f)  The written policies and procedures for orientation of
nursing staff shall require that all temporary personnel shall
receive orientation and be subject to competency validation
consistent with Sections 70016.1 and 70214 of Title 22 of the
California Code of Regulations.  
   (g) 
    (d)  Requests for waivers to this section that do not
jeopardize the health, safety, and well-being of patients affected
and that are needed for increased operational efficiency may be
granted by the state department to rural general acute care hospitals
meeting the criteria set forth in Section 70059.1 of Title 22 of the
California Code of Regulations. 
   (h) 
    (e)  In case of conflict between this section and any
provision or regulation defining the scope of nursing practice, the
scope of practice provisions shall control. 
   (i) 
    (f)  The regulations adopted by the department shall
augment and not replace existing nurse-to-patient ratios that exist
in regulation or law for the intensive care units, the neonatal
intensive care units, or the operating room. 
   (j) 
    (g)  The regulations adopted by the department shall not
replace existing licensed staff-to-patient ratios for hospitals
operated by the State Department of Mental Health. 
   (k) 
    (h)  The regulations adopted by the department for
health facilities licensed under subdivision (b) of Section 1250 that
are not operated by the State Department of Mental Health shall take
into account the special needs of the patients served in the
psychiatric units. 
   ( ) 
    (i)  The department may take into consideration the
unique nature of the University of California teaching hospitals as
educational institutions when establishing licensed nurse-to-patient
ratios. The department shall coordinate with the Board of Registered
Nursing to ensure that staffing ratios are consistent with the Board
of Registered Nursing approved nursing education requirements. This
includes nursing clinical experience incidental to a work-study
program rendered in a University of California clinical facility
approved by the Board of Registered Nursing provided there will be
sufficient direct care registered nurse preceptors available to
ensure safe patient care.
  SEC. 2.  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. All health facilities subject to this section
shall adopt written policies and procedures for the training and
orientation of nursing staff.
   (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 for that unit or
clinical area. 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, education, 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) The written policies and procedures for the orientation of
nursing staff shall require that all temporary personnel shall
receive orientation and be subject to validation of demonstrated
competency consistent with the requirements of this section and with
Sections 70016.1 and 70214 of Title 22 of the California Code of
Regulations.
   (d) An orientee shall not be included in the calculation of the
licensed nurse-to-patient ratio required by Section 1276.4.
   (e) 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.
   (f) This section shall not apply to a state inpatient mental
health hospital, as defined in Section 4100 of the Welfare and
Institutions Code, a state developmental center, as defined in
Section 4400 of the Welfare and Institutions Code, or a state
veterans' home, as defined in Chapter 1 (commencing with Section
1010) of Division 5 of the Military and Veterans Code.
  SEC. 3.  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.