BILL 1426: Hospital Patient Protection

Complex healthcare services driven by health care trend and patients' needs
Negatively impacted quality of care secondary to inconsistent staffing
Necessity for nurse to meet the need of patients at all times to ensure protection
Establishment of professional nursing practice standards and professional practice protections
1. Hospital Nursing Practice Standards
  1. Professional Obligation and Right
    1. Nurse has the duty and right to act and care in exclusive interests of a patient
    2. Nurse is required to advocate for the patient as circumstances require
  2. Acceptance of Patient Care Assignment
    1. Qualified direct care registered nurse is required to provide assigned patients with nursing care that is:
      1. Competent
      2. Safe
      3. Therapeutic
      4. Effective
    2. Health care facility is required to adopt, disseminate to direct care nurses and comply with a written policy that details the circumstances under which a direct care nurse may refuse a work assignment.
      1. At the minimum, the policy shall permit a direct care nurse to refuse a patient assignment with the conditions of:
        Insufficiency
        Knowledge
        Judgement
        Compromising/Jeopardizing patient's safety
        Skill
        Ability
      2. At a minimum, the policy shall permit a direct care nurse to assess an order initiated by a physician or legally authorized health care professional before implementation to determine if the order is:
        In the best interests of the patient;
        initiated by a person legally authorized to issue the order;
        In accordance with applicable law and regulation governing nursing care
      3. At a minimum, the work assignment policy shall contain procedures for the following:
        Reasonable requirements for prior notice to the nurse's supervisor regarding the nurse's request and supporting reasons for being relieved of the assignment, continued duty or implementation of an order.
        An opportunity for the supervisor to review the specific conditions supporting the nurse's request and to decide whether to:
        Remedy the conditions
        Deny the nurse's request to be relieved of the assignment, continued duty or implementation of an order
        Relieve the nurse of the assignment or order
        A process that permits the nurse to exercise the right to refuse the assignment, continued on-duty status or implementation of an order when the supervisor denies the request to be relieved if
        The supervisor rejects the request without proposing a remedy or the proposed remedy would be inadequate or untimely
        The complaint and investigation process with a regulatory agency would be untimely to address concern
        The employee, in good faith, believes that the assignment or implementation of an order meets conditions justifying refusal
  3. Professional Duty of Patient Advocacy
    1. Nurse has the duty to:
      1. Initiate actions to improve patient's health care
      2. Change decisions or activities that are against the patient's wishes
      3. Give the patient the opportunity to make informed decisions
  4. Free Speech
    1. Prohibition against discharge and retaliation for nurses who whistleblow or report unsafe practices/violation of policy, regulation, rule, or law
    2. Rights guaranteed as essential to effective patient advocacy:
      1. Protected free speech of health care professionals
        Essentials to protect health and safety of patients
    3. DO NOT misinterpret protected free speech as authorization to disclose private and confidential patient information
      1. Exception
        Compelled by proper legal process
        Required by law
        Consented to be the patient
        Provided in confidence to regulatory or accreditation agencies or other government entities for investigatory purposes
  5. Direct Care Registered Nurse-to-Patient Staffing Ratios
    1. Minimum staffing by direct care registered nurses in accordance with:
      1. Demonstration of competence in specific clinical area
      2. Appropriate orientation
    2. Staffing for patient care tasks not requiring a direct care registered nurse is not included within these ratios, including: Nurse administrators, nurse supervisors, nurse managers, charge nurses and case managers
    3. No averaging of the number of patients and the total number of direct care registered nurses
    4. intensive care newborn nursery service units: 1 nurse: 2 or fewer infants
      1. Emergency department: only direct care nurses can be assigned to triage and critical trauma patients
        (Neonatal)ICU/Critical care unit/Burn unit/Post-anesthesia/Critical care patient in ED/Immediate post-partum: 1:2 or fewer at all times
        Conscious sedation/Epidural anesthesia 1:1
        Step-down/Intermmediate care: 1:3 or fewer
  6. Hospital Unit Staffing Plam
    1. Acuity-base patient classification system
    2. Development of written staffing plan
    3. Record keeping
    4. Review comittee
    5. Time period for adjustments
    6. Process for staff input
    7. Limitation on administrator nursing service
    8. Minimum requirement for each shift
    9. Temporary nursing agencies
    10. Planning for routine fluctuations
Ethical and legal obligations from nurse to patient's right, advocacy, and protection
Increase in adverse patient outcomes from unsafe staffing practices
Mandating adoption of nurse-to-patient ratio based on individual patient's need for competent, safe, therapeutic and effective professional nursing care

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BILL 1426: Hospital Patient Protection

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	Erstellt von Thai Dang vor fast 7 Jahre