Connecticut: Mandatory Staffing Plans, Committees, and Reporting Requirements for Hospitals
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APPLIES TO Hospital Employers with Employees in CT |
EFFECTIVE October 1, 2023
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QUESTIONS? Contact HR On-Call |
Quick Look
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Discussion
Governor Ned Lamont recently signed HB 6941 which creates new requirements for Connecticut hospitals with respect to nurse staffing plans, staffing committees, reporting requirements, civil penalties for non-conforming hospitals and the right of nurses to object to participating in certain hospital activities. Effective October 1, 2023, the changes brought by the new law are summarized below. The legislation affects both unionized and non-unionized hospitals.
Creation of Hospital Staffing Committees for Nurse Staffing Plans
Under the new law, Connecticut hospitals are required to dedicate a staffing committee to develop annual nurse staffing plans. The committee must be comprised of at least 50% direct care registered nurses (RNs) employed by the hospital as well as non-direct care RNs and a “broad base” of representatives “across hospital services.” The committee’s membership selection will depend on whether the hospital is unionized or not; however, in both unionized and non-unionized hospitals, the staffing committee is required to have two co-chairpersons with direct patient care experience. One chair will be elected by the committee’s direct care RNs and the other chair will be elected by committee members who are not direct care RNs.
Employees who are selected to serve on the staffing committee must be compensated at their regular pay rate, including differentials, for their time spent serving on the committee. Under the legislation, hospitals are asked to treat time spent serving on the committee as part of an employee’s regularly scheduled work week to the extent possible, although this is not a direct mandate.
Responsibilities of the Hospital Staffing Committee
Each staffing committee will be tasked with evaluating research about patient outcomes, sharing procedures for communicating concerns about the staffing plan and staffing assignments, and reviewing all reports communicated to the committee about these concerns or any RN objection or refusal to participate in a particular staffing assignment.
The new law also sets forth procedures required for conducting committee business. Specifically, a majority of the committee must be present, and the committee must take minutes of each meeting. Additionally, upon request, the committee must make the minutes available to any hospital staff member or to the Connecticut State Department of Public Health (DPH).
Hospital Notice and Recordkeeping Requirements Pertaining to Staffing Committees
At the time of hire, and annually each year after, the hospital must inform nurses about the staffing committee. This notice should include the staffing committee’s purpose, the criteria and process for becoming a member, the hospital’s internal review process for the nurse staffing plan, and how input is obtained from direct care RNs and other members of patient care teams in developing the plan.
Additionally, hospitals must maintain accurate records of the ratios of patients to direct care RNs and patients to assistive personnel providing patient care in each direct care unit for each shift. These records must be maintained for at least the three preceding years, and must include the number of: (1) patients in each unit on each shift, (2) direct care RNs assigned to each patient in each unit on each shift, and (3) assistive personnel providing patient care assigned to each patient in each unit on each shift. Upon request, these records must be made available to the DPH, hospital staff, patients, collective bargaining representatives, and/or the public.
Submission of Staffing Plans and Reporting Requirements to DPH
Hospitals must submit their proposed nurse staffing plans to DPH on a semi-annual basis, by January 1 and July 1. The proposed plan must include written certification that the plan is sufficient to provide adequate and appropriate patient health care services. Hospitals are also required to post the plans on each patient care unit in a location that is accessible and visible to staff, patients, and the public.
Beginning January 1, 2024, each proposed plan must include: (1) information about any objections to or refusals to comply with the nurse staffing plan by hospital staff that were communicated to the hospital staffing committee; (2) measurements of and evidence to support successful implementation of the nurse staffing plan; (3) retention, turnover and recruitment metrics for direct care RN staff; (4) each time since the last plan was submitted that the hospital was non-compliant with the plan, including nurse staffing ratios, a description of how and why the hospital was non-compliant, and the hospital’s plans to avoid future noncompliance; and (5) certification that the hospital and its hospital staffing committee are meeting the law’s requirements, with a description of how each requirement is being met.
Hospitals must report twice a year to DPH regarding their compliance with nurse staffing assignments as outlined in the nurse staffing plans. This reporting obligation begins October 1, 2024. If the DPH receives complaints of noncompliance, it will investigate and, if necessary, issue orders that require the hospital to implement corrective action plans and pay civil fines.
RN Objections to Participation
Under the new law, hospitals cannot require RNs to perform patient tasks that are beyond the scope of their license, training, or experience. If required to do so, RNs can object to such assignments, unless their objection/refusal occurs: (1) during an ongoing surgical procedure (RNs must wait until it is completed); (2) in critical care units, labor and delivery, or emergency departments (RNs must wait until they are relieved by another nurse); (3) public health or institutional emergencies; and (4) where the RN’s inaction or abandonment would jeopardize patient safety.
RNs who plan to object to refuse an assignment must immediately notify a supervisor to coordinate a suitable replacement. Within 12 hours of objecting, the objecting/refusing RN must submit a written report on a form developed by the hospital and approved by DPH.
Hospitals are prohibited from taking adverse action against an RN for objecting or refusing to perform patient tasks outside of their expertise/experience. However, a hospital, DHP, or the State Board of Examiners for Nursing may require a nurse to complete additional training or education consistent with the nurse’s job description.
Action Items
- Review the full committee selection and staffing plan requirements here.
- Develop the required RN objection and/or refusal of assignment form, with approval from DPH.
- Review and revise policies and procedures to be consistent with new staffing committee requirements, notice obligations, and recordkeeping requirements.
- Consult with legal counsel regarding existing labor-management procedures to ensure compliance with any applicable staffing plans developed under the new law.
- Subscribers can call our HR On-Call Hotline at (888) 378-2456 for further assistance.
Disclaimer: This document is designed to provide general information and guidance concerning employment-related issues. It is presented with the understanding that ManagEase is not engaged in rendering any legal opinions. If a legal opinion is needed, please contact the services of your own legal adviser. © 2023 ManagEase