Read 1st time February 28, 2000, and 1000 copies ordered printed.
ANNE C. WALKER, Chief Clerk
AN ACT
To amend chapter 197, RSMo, relating to medical treatment facilities by adding thereto three new sections relating to the same subject, with a penalty provision.
Section A. Chapter 197, RSMo, is amended by adding thereto three new sections, to be known as sections 197.710, 197.712 and 197.714, to read as follows:
197.710. 1. The general assembly finds and declares the following:
(1) Health care services are becoming complex and it is increasingly difficult for patients to access integrated services;
(2) Quality of patient care is jeopardized because of staffing changes implemented in response to managed care;
(3) To ensure adequate protection of patients in acute care settings, it is essential that qualified registered nurses and other licensed nurses be accessible and available to meet the needs of patients; and
(4) The basic principles of staffing in the acute care setting should be based on the patient's care needs, the severity of the condition, services needed and the complexity surrounding such services.
2. As used in sections 197.710 to 197.714, the following terms mean:
(1) "Critical care unit", a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by licensed registered nurses;
(2) "Department", the department of health;
(3) "Hospital", a general acute care hospital, an acute psychiatric hospital or any other hospital licensed pursuant to this chapter. The term "hospital" does not include convalescent, nursing, shelter or boarding homes, as defined in chapter 198, RSMo.
3. No hospital shall assign unlicensed personnel to perform nursing functions in lieu of a registered nurse or allow unlicensed personnel to perform functions under the direct clinical supervision of a registered nurse if such functions require a substantial amount of scientific knowledge and technical skills, including but not limited to:
(1) Administration of medication;
(2) Venipuncture or intravenous therapy;
(3) Parenteral or tube feedings;
(4) Invasive procedures, including inserting nasogastric tubes or catheters, or tracheal suctioning;
(5) Assessment of patient condition;
(6) Educating patients and their families concerning the patient's health care problems, including postdischarge care; and
(7) Moderate complexity laboratory tests.
The provisions of this subsection shall not preclude any person from performing any act or function that he or she is authorized to perform.
197.712. 1. By July 1, 2001, the department shall adopt rules that establish minimum specific and numerical licensed nurse-to-patient ratios for nurse staffing of hospital care units on a shift-by-shift, day-by-day basis for all hospitals. Hospitals shall determine and provide nurse staffing in accordance with the provisions of this section.
2. The following nurse-to-patient ratios shall be presumed by the department to be the minimum ratios necessary for safe and adequate patient care:
(1) One professional registered nurse to two patients for staffing of critical care units, burn units, labor and delivery, postanesthesia units, neonatal intensive care units and critical patients in emergency departments requiring care in an intensive care or critical care setting. The ratio of one registered nurse to two critical care patients temporarily held in the emergency departments shall be in addition to the regularly scheduled emergency room staff;
(2) Sufficient nursing personnel so that one registered nurse is not serving as a circulating assistant for more than one operating room;
(3) One professional registered nurse to three patients for staffing pediatric and stepdown or intermediate care units;
(4) One professional registered nurse to four patients for staffing specialty care, such as oncology, nephrology and telemetry; and
(5) One professional registered nurse to six patients for staffing general medical or surgical care units that include subacute care and transitional inpatient care units.
3. All hospitals licensed pursuant to this chapter shall adopt written policies and procedures for training and orientation of nursing staff.
4. No nurse or other direct patient care staff person shall be assigned to a nursing unit or clinical area unless such nurse or person has first received orientation in such clinical area sufficient to provide competent care to patients in such area and has demonstrated current competence in providing care in such area.
5. The written policies and procedures for orientation of nursing and direct patient care staff shall require that all temporary personnel shall receive the same amount and type of orientation as is required for permanent staff.
6. In case of conflict between this section and any provision or administrative rule defining the scope of nursing practice, the scope of practice provisions shall take precedence.
197.714. Any hospital that fails to maintain sufficient nursing care in accordance with sections 197.710 to 197.714
shall be subject to license revocation or a fine of not more than ten thousand dollars, or both, and shall be subject
to a civil penalty of not more than one thousand dollars for each violation. Every day that a violation occurs or
continues shall be deemed a separate violation. Such penalties shall be in addition to any other penalties that may
be prescribed by law.
Missouri House of Representatives