BILL ANALYSIS �
SB 455
Page 1
SENATE THIRD READING
SB 455 (Ed Hernandez)
As Amended August 6, 2014
Majority vote
SENATE VOTE :23-10
HEALTH 14-3 APPROPRIATIONS 13-4
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|Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Bocanegra, |
| |Bonilla, Bonta, Chesbro, | |Bradford, |
| |Gomez, | |Ian Calderon, Campos, |
| |Roger Hern�ndez, | |Eggman, Gomez, Holden, |
| |Lowenthal, Maienschein, | |Linder, Pan, Quirk, |
| |Mitchell, Nazarian, | |Ridley-Thomas, Weber |
| |V. Manuel P�rez, | | |
| |Wieckowski | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Mansoor, Wagner, Wilk |Nays:|Bigelow, Donnelly, Jones, |
| | | |Wagner |
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SUMMARY : Requires a committee for each general acute care
hospital to review, at least annually, the reliability of its
patient classification system and requires at least 50% of the
committee members to be registered nurses (RNs) who provide
direct patient care, and that these RNs be appointed by their
bargaining agent, if any. Requires the Department of Public
Health (DPH), during every periodic state inspection of a
general acute care hospital, to inspect for compliance with the
nurse-to-patient ratios.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, minor costs to DPH (Licensing and Certification Fund)
to modify regulations that conflict with this bill's provisions.
COMMENTS : According to the author, selecting representatives
for workplace committees is a fundamental tenet of collective
bargaining. The author also notes that, although hospitals are
inspected for compliance with state and federal law every three
years, there is no requirement that DPH check for compliance
with nurse-to-patient staffing requirements, and by placing the
patient classification committee in statute, and requiring DPH
SB 455
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to inspect for ratio compliance, this bill will ensure that
hospitals are following the law.
Regulations implementing nurse-to-patient ratios in California
hospitals pursuant to AB 394 (Kuehl), Chapter 945, Statutes of
1999, went into effect on January 1, 2004. Before California
had specific nurse-to-patient ratios, hospitals were required by
regulation to establish a patient classification system. This
patient classification system is a method by which hospitals
establish staffing requirements by unit, patient, and shift, and
includes a method by which the amount of nursing care needed for
each category of patient is validated for each unit. The
regulations implementing the AB 394 nurse-to-patient ratios law
set the minimum ratio of nurses to patient by unit, including
one-to-one in operating rooms, one-to-two in intensive care
units, and one-to-five in general medical-surgical units. The
nurse-to-patient ratio regulations also incorporated the patient
classification system requirement.
In essence, the specific nurse-to-patient ratios establish the
minimum number of nurses by unit, while the patient
classification system determines whether there needs to be a
higher level of staffing beyond the minimum ratio after taking
into consideration factors such as the severity of the illness,
the need for specialized equipment and technology, and the
complexity of clinical judgment needed to evaluate the patient
care plan, among other factors. The nurse-to-patient ratio
regulations require that the minimum ratios must be met at all
times.
Current law specifies that hospitals must undergo an unannounced
inspection at least once every three years that looks for
compliance with both state law and regulations. DPH has a
patient safety licensing survey which is the tool used by staff
during inspections, the purpose of which is to ensure patient
safety in the hospital setting. The survey is comprised of
statutes that have been implemented since 2006, and does not
include verifying compliance with nurse-to-patient ratios.
The United Nurses Associations of California/Union of Health
Care professionals is the sponsor of this bill and says that
many laws incorporate protections that could be subject to
collective bargaining. Examples include the minimum wage, the
eight hour day, and indeed nurse ratios in hospitals. The
SB 455
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American Federation of State, County and Municipal Employees,
American Federation of Labor and Congress of Industrial
Organizations writes that they are the co-sponsor of this bill
because hospitals need to respect the right of the collective
bargaining agent to appoint direct care nurses to the patient
classification committee. Service Employees International Union
California supports this bill because requiring participation by
direct care nurses in the review committee will provide
important on the ground perspective for patient safety and nurse
staffing capacity.
The California Hospital Association writes in opposition to this
bill that the hospital has the ultimate responsibility for
ensuring quality patient care, including ensuring appropriate
staffing levels. Given this responsibility, it is inappropriate
to require the hospital to delegate a major component of its
assessment tool to a third party. Requiring a hospital to
delegate this authority is particularly problematic given that
the hospital's interests and the union's interests may not
always align. For example, the hospital may want to have
particular units or individuals represented on the committee.
Further, the hospital must maintain the prerogative to appoint
staff in good standing who are eligible and qualified to perform
the duties vested in the patient classification committee. The
bargaining unit agent is not a hospital representative and
cannot determine performance eligibility requirements.
The California Nurses Association opposes this bill and states
that it will undermine hard-won gains in RN staffing by not
taking into account staffing based on the severity of illness,
the complexity of clinical judgment involved in the patient's
care, and the licensure of the personnel required to provide
that care.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097
FN: 0004657