CHAPTER 257. NURSE STAFFING
HEALTH AND SAFETY CODE
TITLE 4. HEALTH FACILITIES
SUBTITLE B. LICENSING OF HEALTH FACILITIES
CHAPTER 257. NURSE STAFFING
Sec. 257.001. DEFINITIONS. In this chapter:
(1) "Committee" means a nurse staffing committee required by
this chapter.
(2) "Department" means the Department of State Health Services.
(3) "Hospital" means:
(A) a general hospital or special hospital, as those terms are
defined by Section 241.003, including a hospital maintained or
operated by this state; or
(B) a mental hospital licensed under Chapter 577.
(4) "Patient care unit" means a unit or area of a hospital in
which registered nurses provide patient care.
Added by Acts 2009, 81st Leg., R.S., Ch.
742, Sec. 1, eff. September 1, 2009.
Sec. 257.002. LEGISLATIVE FINDINGS. (a) The legislature finds
that:
(1) research supports a conclusion that adequate nurse staffing
is directly related to positive patient outcomes and nurse
satisfaction with the practice environment;
(2) nurse satisfaction with the practice environment is in large
measure determined by providing an adequate level of nurse
staffing based on research findings and patient intensity;
(3) nurse satisfaction and patient safety can be adversely
affected when nurses work excessive hours; and
(4) hospitals and nurses share a mutual interest in patient
safety initiatives that create a healthy environment for nurses
and appropriate care for patients.
(b) In order to protect patients, support greater retention of
registered nurses, and promote adequate nurse staffing, the
legislature intends to establish a mechanism whereby nurses and
hospital management shall participate in a joint process
regarding decisions about nurse staffing.
Added by Acts 2009, 81st Leg., R.S., Ch.
742, Sec. 1, eff. September 1, 2009.
Sec. 257.003. NURSE STAFFING POLICY AND PLAN. (a) The
governing body of a hospital shall adopt, implement, and enforce
a written nurse staffing policy to ensure that an adequate number
and skill mix of nurses are available to meet the level of
patient care needed. The policy must include a process for:
(1) requiring the hospital to give significant consideration to
the nurse staffing plan recommended by the hospital's nurse
staffing committee and to that committee's evaluation of any
existing plan;
(2) adopting, implementing, and enforcing an official nurse
services staffing plan that is based on the needs of each patient
care unit and shift and on evidence relating to patient care
needs;
(3) using the official nurse services staffing plan as a
component in setting the nurse staffing budget;
(4) encouraging nurses to provide input to the committee
relating to nurse staffing concerns;
(5) protecting from retaliation nurses who provide input to the
committee; and
(6) ensuring compliance with rules adopted by the executive
commissioner of the Health and Human Services Commission relating
to nurse staffing.
(b) The official nurse services staffing plan adopted under
Subsection (a) must:
(1) reflect current standards established by private
accreditation organizations, governmental entities, national
nursing professional associations, and other health professional
organizations;
(2) set minimum staffing levels for patient care units that are:
(A) based on multiple nurse and patient considerations; and
(B) determined by the nursing assessment and in accordance with
evidence-based safe nursing standards;
(3) include a method for adjusting the staffing plan for each
patient care unit to provide staffing flexibility to meet patient
needs; and
(4) include a contingency plan when patient care needs
unexpectedly exceed direct patient care staff resources.
(c) The hospital shall:
(1) use the official nurse services staffing plan:
(A) as a component in setting the nurse staffing budget; and
(B) to guide the hospital in assigning nurses hospital-wide; and
(2) make readily available to nurses on each patient care unit
at the beginning of each shift the official nurse services
staffing plan levels and current staffing levels for that unit
and that shift.
Added by Acts 2009, 81st Leg., R.S., Ch.
742, Sec. 1, eff. September 1, 2009.
Sec. 257.004. NURSE STAFFING COMMITTEE. (a) A hospital shall
establish a nurse staffing committee as a standing committee of
the hospital.
(b) The committee shall be composed of members who are
representative of the types of nursing services provided in the
hospital.
(c) The chief nursing officer of the hospital is a voting member
of the committee.
(d) At least 60 percent of the members of the committee must be
registered nurses who:
(1) provide direct patient care during at least 50 percent of
their work time; and
(2) are selected by their peers who provide direct patient care
during at least 50 percent of their work time.
(e) The committee shall meet at least quarterly.
(f) Participation on the committee by a hospital employee as a
committee member is part of the employee's work time, and the
hospital shall compensate that member for that time accordingly.
The hospital shall relieve a committee member of other work
duties during committee meetings.
(g) The committee shall:
(1) develop and recommend to the hospital's governing body a
nurse staffing plan that meets the requirements of Section
257.003;
(2) review, assess, and respond to staffing concerns expressed
to the committee;
(3) identify the nurse-sensitive outcome measures the committee
will use to evaluate the effectiveness of the official nurse
services staffing plan;
(4) evaluate, at least semiannually, the effectiveness of the
official nurse services staffing plan and variations between the
plan and the actual staffing; and
(5) submit to the hospital's governing body, at least
semiannually, a report on nurse staffing and patient care
outcomes, including the committee's evaluation of the
effectiveness of the official nurse services staffing plan and
aggregate variations between the staffing plan and actual
staffing.
(h) In evaluating the effectiveness of the official nurse
services staffing plan, the committee shall consider patient
needs, nursing-sensitive quality indicators, nurse satisfaction
measures collected by the hospital, and evidence-based nurse
staffing standards.
Added by Acts 2009, 81st Leg., R.S., Ch.
742, Sec. 1, eff. September 1, 2009.
Sec. 257.005. REPORTING OF STAFFING INFORMATION TO DEPARTMENT.
(a) A hospital shall annually report to the department on:
(1) whether the hospital's governing body has adopted a nurse
staffing policy as required by Section 257.003;
(2) whether the hospital has established a nurse staffing
committee as required by Section 257.004 that meets the
membership requirements of that section;
(3) whether the nurse staffing committee has evaluated the
hospital's official nurse services staffing plan as required by
Section 257.004 and has reported the results of the evaluation to
the hospital's governing body as provided by that section; and
(4) the nurse-sensitive outcome measures the committee adopted
for use in evaluating the hospital's official nurse services
staffing plan.
(b) Information reported under Subsection (a) is public
information.
(c) To the extent possible, the department shall collect the
data required under Subsection (a) as part of a survey required
by the department under other law.
Added by Acts 2009, 81st Leg., R.S., Ch.
742, Sec. 1, eff. September 1, 2009.