For over 11 years NJ nurses and unions have lobbied for safe staffing, similar to nearly every other state. Year after year we have been denied the protection of safe staffing for our patients. (2018-2019 session) A1470/S989 Currently sponsored and stuck in the health committee. (2016-2017 session) A750/S1280 Sen Vitale and Sen Weinberg Co-sponsort Assembly Bill 750 (safe staffing) Vitale doesn't feel it has enough support to move forward with the Senate health committee and Gov. Christie will not approve the bill so it sits. Assemblyman Moriarty, sponsor of A750 withdraws the assembly version on 10/27/16. Per Vitale's aid, the bill will not be voted on this session 2106-2017, there was a discussion that the bill will be redrafted to only include med/surg units. (2014-2015 session) Safe Staffing for Nurses (A-647/S-1183). (This bill had a hearing, the only recent hearing to date, it did not have enough support for a vote) Legislation establishing staffing levels for nurses cleared the Assembly Health and Senior Services Committee by a vote of 8-4. It was the bill’s first public hearing. Voting in favor were: Assembly members Herb Conaway (D-7, Dan Benson (D-14), Tim Eustace (D-38, Jerry Green (D-22), Angelica Jimenez (D-32), Patricia Egan Jones (D-5) and Nancy Pinkin (D-18). Voting in opposition were: Mary Pat Angelini (R-11), Amy Handlin (R-13), Nancy Munoz (R-21) and Erik Peterson (R-23). The bill establishes staffing standards for registered professional nurses working in hospitals and ambulatory surgical facilities, and sets minimum nurse-to-patient staffing ratios to maximize patient safety. The New Jersey State AFL-CIO joins seven health care and nursing unions in strongly supporting this bill, Assembly members Paul Moriarty (SAG-AFTRA), Tim Eustace, Shavonda Sumter and Reed Gusciora. Union nurses have been asking for this bill on behalf of every patient in New Jersey, and every nurse and health care worker who cannot speak up. Their voices need to be heard. http://www.njaflcio.org/today_in_trenton_legislation_requiring_safe_staffing_for_nurses_full_pension_payments_advance (2012-2013 session) A2458/S1257 Sen Vitale, Sen Weinberg and Sen Turner co-sponsor (safe staffing) http://www.njleg.state.nj.us/2012/Bills/S1500/1257_I1.HTM (2010-2011 session) A660/S963 Sen Vitale, Sen Weinberg and Sen Greestein co-sponsor (safe staffing) http://www.njleg.state.nj.us/2010/Bills/S1000/963_I1.HTM (2008-2009 session) A1531/S1233 Sen Vitale and Sen Weinberg co-sponsor (safe staffing) http://www.njleg.state.nj.us/2008/Bills/S1500/1233_I1.HTM (2006-2007 Session) A754/S810 Sen Vitale and Sen Weinberg co-sponsor (safe staffing) http://www.njleg.state.nj.us/2006/Bills/S1000/810_I1.HTM (2004-2005 session) A2004/S555 Assemblywoman Weinberg and AssemblyGordon sponsor Sen Vitale co-sponsor (safe staffing) bill ftp://www.njleg.state.nj.us/20042005/A2500/2004_I1.PDF (2002-2003 session) A3676/S2523 Sen Vitale and Sen Bennett cosponsor (safe staffing) http://www.njleg.state.nj.us/2002/Bills/S3000/2523_I1.PDF
Current NJ Staffing Laws You might be wondering why there isn't a ratio for every type of unit. Well that's because there isn't a staffing law for each unit in this hospital regulation, which is the current NJ law.
ICU Staffing:
N.J.A.C. 8:43G-9.7 (2012) page 214 § 8:43G-9.7 Critical care staff time and availability (a) Nurse staffing shall be determined by the acuity of illness of the patients on the critical care unit. (b) There shall always be at least one registered professional nurse for every three patients. There shall be the capability to increase nurse staffing to one nurse for every two patients or one nurse per patient based on acuity levels. (c) There shall be a mechanism in place for the critical care service to have access to nutritional support services for advice on both enteral and parenteral nutritional techniques.
(c) At least one registered professional nurse who has successfully completed the Emergency Nursing Pediatric Course, Advanced Pediatric Life Support or Pediatric Advanced Life Support shall be present at all times in the emergency department. The hospital shall have in place a protocol to increase nurse staffing based on volume and acuity.
(d) All registered professional nurses regularly assigned to trauma resuscitation shall be trained in trauma care, including at least: 1. Compliance with each of the training requirements for emergency department nurses listed in N.J.A.C. 8:43G-12.3(g); and 2. Completion of the Trauma Nurse Core Course taught by the Emergency Nurses Association within 12 months of initial assignment, followed by a minimum of eight contact hours of education every two years in trauma assessment, intervention, and stabilization.
§ 8:43G-12.18 Trauma services patient services page 279 (a) The trauma service is required to provide on-site specialized services, including, at a minimum: 1. Acute hemodialysis; 2. Radiological services as follows: i. Angiography; ii. Computerized tomography, with a technician present in the hospital 24 hours a day; and iii. Nuclear scanning; 3. For Level I trauma centers, cardiac surgery designation; and 4. A critical care unit for trauma center patients with a nurse:patient ratio of at least 1:2 on each shift.
Cardiac Surgery
§ 8:43G-7.5 Cardiac surgery staff time and availability page 117 (a) There shall be at least a ratio of one registered professional nurse to one patient during the patient's stay in the cardiovascular surgical intensive care service or recovery room until the patient is stabilized. (b) For patients who remain in the cardiovascular surgical intensive care service or recovery room beyond the initial period of stabilization, there shall be at least a ratio of two registered professional nurses to three such patients.
(e) The circulating nurse in the cardiac catheterization laboratory shall be certified in basic cardiac life support.
§ 8:43G-7.26 Pilot catheterization program staff time and availability page 142 (a) There shall be at least one physician trained and experienced in cardiac catheterization present in the room during all catheterization and angiographic procedures. (b) There shall be at least one registered professional nurse with appropriate training and experience, in accordance with N.J.A.C. 8:33E-1.5(b)4, present in the room during each procedure. (c) There shall be at least one trained and experienced technician qualified in accordance with N.J.A.C. 8:33E-1.5(b)5 through 8 present in the room during each procedure.
§ 8:43G-7.30 PTCA staff time and availability page 146 (a) The following staff shall be present for all PTCA procedures: 1. A physician who meets the requirements in N.J.A.C. 8:43G-7.23(a); 2. A registered professional nurse certified in basic cardiac life support, and trained and experienced in cardiac catheterization and PTCA who acts as the circulating nurse; and 3. One of the following individuals: i. A scrub nurse who is either a registered professional nurse or a licensed practical nurse; or ii. A technician who has been trained in assisting with cardiac catheterization and PTCA.
EP
§ 8:43G-7.33 EPS staff time and availability page 149 (a) The following staff shall be present during all EPS procedures: 1. A physician who meets the requirements in N.J.A.C. 8:43G-7.26(a) and (b); 2. A registered professional nurse certified in basic cardiac life support and trained and experienced in cardiac catheterization and EPS who acts as the circulating nurse; and 3. One of the following individuals: i. A scrub nurse who is either a registered professional nurse or a licensed practical nurse; or ii. A technician who has been trained in assisting with cardiac catheterization and EPS.
Peds Cardiac Surgery § 8:43G-7.38 Pediatric cardiac surgery staff time and availability page 154 (a) All staff providing clinical services to the pediatric cardiac surgical patient shall be trained and experienced in pediatric cardiac surgical care. (b) There shall be at least a ratio of one registered nurse to one patient at all times during the first 24 hours of the patient's stay in the pediatric cardiovascular surgical intensive care service. (c) For patients who remain in the pediatric cardiovascular surgical intensive care service after 24 hours, there shall be at least a ratio of one registered professional nurse to two such patients with capability to adjust staff levels based on acuity level of patient illness.
Intermediate Care § 8:43G-9.20 Intermediate care policies and procedures page 227 (a) The intermediate care service shall have written policies and procedures that are reviewed at least once every three years, revised more frequently as needed, and implemented. They shall include at least: 1. Criteria for admission to the service; 2. Criteria for discharge and transfer from the service to other patient care units in the hospital; 3. Criteria for discharge from the service to other health care facilities; 4. The number or percentage of beds on the service that provide continuous electrocardiogram monitoring; 5. The frequency with which physicians must visit their patients on the unit; and 6. Acuity assignments made on a daily basis for patients in each intermediate care unit with the minimum average ratio of one nurse to every six patients. (b) There shall be a clearly defined protocol for medical administration of the service to ensure the monitoring and enforcement of the service's criteria for admission, transfer, and discharge. (c) The intermediate care nursing staff shall be represented on the critical care committee or its equivalent, and, if pediatric or coronary patients are cared for by the intermediate care service, intermediate care nursing staff shall be represented on the committees responsible for developing policies and procedures for pediatric care and coronary care.
L&D § 8:43G-19.11 Labor and delivery staff time and availability page 422 (a) There shall be at least one registered professional nurse present whenever a patient is in a labor area. Nurse staffing assignments for patients in active labor shall be determined by patient acuity levels. (b) All deliveries shall be attended by an obstetrician, a physician with obstetrical privileges, a certified nurse-midwife or an obstetric resident with at least three years of training. (c) There shall be at least one registered professional nurse attending the patient once she reaches full dilation until she enters the recovery phase of delivery. (d) If oxytoxics are administered, the following shall occur within one hour prior to administration: the patient shall be examined vaginally by either a physician with obstetric privileges, a certified nurse midwife or an advance practice nurse in accordance with hospital bylaws, and electronic fetal heart rate monitoring shall be initiated. (e) All obstetrics departments shall have the capability of starting an emergency cesarean section within 30 minutes of the decision to perform a cesarean section. (f) A health professional certified in neonatal resuscitation shall be available within the obstetrics unit for each delivery.
7. For patients undergoing surgical deliveries, including cesarean sections, anesthesia care shall be in accordance with all applicable sections of N.J.A.C. 8:43G-6, Anesthesia Services. 8. There shall be a program of quality assurance for anesthesia care provided in obstetric services that is integrated into the hospital and the anesthesia service quality assurance programs. (c) There shall be written policies and procedures for the care of patients during the recovery phase of delivery. The policies and procedures shall be reviewed annually, revised as needed, and implemented. These policies and procedures shall include at least: 1. Delineation of the primary medical responsibility for postanesthesia care of the patient; 2. Monitoring of patients, including availability of monitoring equipment, and use of an objective scoring system to determine when the patient has recovered from anesthesia; 3. Requirements for documentation of patient status; 4. Protocol for patient emergencies; 5. Criteria and responsibility for discharge from recovery; 6. Recovery staff qualifications, which shall be as follows: i. All registered professional nurses assigned to recovery services shall have training in basic cardiac life support. ii. Recovery services shall be staffed at all times by at least one registered professional nurse with critical care training, as defined by the hospital, whenever a patient recovering from a cesarean section and/or classified as ASA Class III, IV, V or Emergency is present; 7. Recovery staff time and availability, which shall be as follows: i. There shall be at least two health care personnel, one of whom is a registered professional nurse and the other of whom is either a registered professional nurse or a licensed practical nurse, present in recovery services whenever a patient in the recovery phase of delivery is present. The nurse identified in (c)6ii a (f) The normal newborn nursery shall have a registered professional nurse present whenever a neonate is in the newborn nursery. Additional staffing, assignments shall be determined by acuity levels appropriate to infants.
New Born Nursery
§ 8:43G-19.16 Normal newborn nurse staff qualifications, staff time and availability page 432 g) The normal newborn nursery shall have at least one registered professional nurse to every eight neonates. However, so long as one registered nurse is on duty as required by (d) above, licensed practical nurses may be used to comply with the nurse:infant ratio requirement. above may function as the registered professional nurse required herein. ii. There shall be a ratio of at least one registered professional nurse present in the recovery service area for every three patients in the recovery phase of delivery; and
N.J.A.C. 8:43G-19.17 (2012) § 8:43G-19.17 Intermediate nursery staff qualifications, staff time and availability page 434 (f) The intermediate nursery shall have at least one registered professional nurse to every four infants requiring intermediate care services. Additional staffing assignments shall be determined by the acuity levels of the infants.
Peds ICU § 8:43G-22.16 Pediatric intensive care staff time and availability page 523 (a) There shall be a physician who can handle pediatric emergencies, other than the physician assigned to the emergency department, in the hospital at all times. (b) There shall be at least one registered professional nurse to every two patients in the pediatric intensive care unit.
Oncology § 8:43G-21.5 Oncology staff qualifications page 495 (a) There shall be a clinical coordinator with responsibility to administer the program of care who is a registered professional nurse with the equivalent of two years of full-time experience in oncology. (b) There shall be a clinical resource person who is a registered professional nurse with the equivalent of two years of clinical experience in oncology who is available to the unit.
Nurse Staffing Regs § 8:43G-17.1 Nurse staffing page 369 (a) The hospital shall have in place a staffing plan that addresses nurse staffing requirements and identifies patient needs, including, at a minimum: 1. A daily staffing schedule that ensures at least one registered professional nurse in charge and assigned exclusively to each patient care unit on each shift; 2. A provision that at least 65 percent of direct patient care hours in inpatient units on a hospital wide average be provided by licensed nursing personnel; 3. A method for assessing each unit's additional nursing needs for each shift, including, at a minimum, objective criteria such as: i. Documented skills, training and competency of staff to plan and provide nursing services in the nursing areas where they function; ii. Patient data base incorporating objective factors such as case mix index, specific or aggregate patient diagnostic classifications or acuity levels, patient profiles, critical pathways or care progression plans, length of stay, and discharge plans; iii. Operational factors such as unit size, design, and capacity, admission/discharge/transfer index, and support service availability; iv. Contingency plans to address critical departures from staffing plan, including policies and procedures to regulate closure of available beds if staffing levels fall below specified levels; v. Policies and procedures for the reassignment of staff including float and agency staff; and 4. On-going internal institutional evaluation of outcome-based quality indicators related to nursing care to assess and provide a safe and adequate level of patient care including at least: i. Patient injury rate; ii. Medication process errors; iii. Maintenance of skin integrity; iv. Nosocomial infection rates; Page 369 v. Hospital-wide patient satisfaction with overall care, including nursing care; vi. Nursing turnover rate; vii. Patient satisfaction with pain management; and viii. Mix of RNs, LPNs and unlicensed staff caring for patients. (b) There shall be a registered nurse manager for each patient care unit or units and for surgery, emergency department, and other units, as specified in the hospital organizational plan or policies and procedures. (c) There shall be at least one registered professional nurse in charge and assigned exclusively to each patient care unit on each shift. Additional staff shall be assigned by the hospital as required by the acuity levels. (d) Patient care assignments shall be made on an individual basis by a registered professional nurse and reflect staff competence, skill, and aptitude and patient needs. (e) The hospital shall have in effect a contingency plan for assuring adequate nurse staffing at all times. The plan shall detail policies and procedures to regulate closure of available beds, if actual staffing levels fall below specified levels. (f) Nurse staffing for all patient care units within the hospital shall also be in accordance with:
In Patient Dialysis § 8:43G-30.6. Staffing requirements for inpatient dialysis services page 652 (b) The staffing ratio in the inpatient dialysis setting shall be no greater than one registered nurse to three patients, except in the critical care setting which shall be a ratio of one to one. Staffing shall be increased if warranted by the acuity needs of the patients. (c) In those instances where the staffing ratio requirement is one to one, a registered nurse with a minimum of six months experience in hemodialysis, obtained within the last 24 months, shall provide the service. In those instances where the staffing requirement is other than one to one, for the first three patients, a registered nurse meeting the requirement identified above shall provide the treatments.
(d) An inpatient facility providing dialysis services shall have at least one registered nurse providing treatments to the first three patients. There shall be an additional registered nurse, licensed practical nurse, or trained technician to assist the required registered nurse for the next three patients. There shall be two additional staff, one of which is a registered nurse, for each additional group of one to six patients.
Psych Units § 8:43G-26.5 Psychiatry staff time and availability page 577 (a) A psychiatrist shall be on-site or on call at all times. (b) Nurse staffing shall be based on hospital acuity levels, but in no case shall fewer than two nursing staff members, at least one of whom is a registered professional nurse, be on the unit.
Staffing Bills On At The National Level
The history for staffing bills at the national level is no better. For years Congress has been aware of the need for safe staffing, but bills have never become laws. Year after year from 2004, the safety of our patients gets pushed aside. How do you get support for this national bill? You start by telling your Congress and US Senate representative that you want this passed and made law. Find Your Congressman/ Congresswoman and US Senators
www.govtrack.us/congress/bills/114/hr1602 "H.R. 1602 (114th) was a bill in the United States Congress.A bill must be passed by both the House and Senate in identical form and then be signed by the President to become law. This bill was introduced in the 114th Congress, which met from Jan 6, 2015 to Jan 3, 2017. Legislation not enacted by the end of a Congress is cleared from the books.
“H.R. 1602 — 114th Congress: Nurse Staffing Standards for Patient Safety and Quality Care Act of 2015.” www.GovTrack.us. 2015. April 23, 2017 <https://www.govtrack.us/congress/bills/114/hr1602> Where is this information from?GovTrack automatically collects legislative information from a variety of governmental and non-governmental sources. This page is sourced primarily from Congress.gov, the official portal of the United States Congress. Congress.gov is generally updated one day after events occur, and so legislative activity shown here may be one day behind. Data via the congress project. "