Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 111 of the General Laws is hereby amended by inserting after section 216 the following new section: - 

Section 217.

         (a) As used in this section, the following words shall
have the following meanings unless the context or subject matter
clearly require otherwise:

            (1) "Board", the board of registration in nursing.

            (2) "Department", the department of public health.

            (3) "Facility", any hospital, clinic, convalescent
or nursing home, charitable home for the aged, community health
agency, or other provider of nursing services licensed, or subject
to licensing by the department, any state hospital operated by the
department; and "facility" as defined in section three of chapter
one hundred and eleven B; any private, county or municipal facility,
department or unit which is licensed or subject to licensing by the
department of mental health pursuant to section nineteen of chapter
nineteen; or by the department of mental retardation pursuant to
section fifteen of chapter nineteen B; any "facility" as defined in
section one of chapter one hundred and twenty-three; the Soldiers'
Home in Holyoke, the Soldiers' Home in Chelsea, and any facility
set forth in section one of chapter nineteen or section one of
chapter nineteen B.

            (4) "Nurse", any registered nurse or licensed practical
nurse duly licensed under the provisions of chapter 112, section 74
and chapter 112, section 74A.

            (5) "Nursing services", nursing care as provided by a
facility.

            (6) "Nursing staff", all individuals, including both
licensed and unlicensed personnel, providing nursing care in a
facility.

         (b) The department, in collaboration with the nurse staffing commission designated in Section (c) of this act, shall promulgate rules and regulations within one year of the passage of this act, to ensure that each facility shall anticipate, design and adhere to a daily written staffing plan specific to each unit or specialty area of practice and as required by patients or residents of said facility to maintain safety and to support nursing staff compliance with applicable professionally recognized standards of nursing practice.  Said regulations shall be enforced by the department and based upon accepted standards of nursing practice, patient or resident classification system(s), patients’ or resident’s’ acuity level and functional capacity for self-care.

         (c) The department shall upon promulgation of, and any amendment to, rules and regulations for the development, adherence and enforcement of a written plan for sufficient nurse staffing, incorporate the recommendations of a nurse staffing commission consisting of licensed nurses and consumer representatives appointed by the commissioner.  Said nurse staffing commission shall include, but not limited to, two representatives of the Massachusetts Nurses Association one of whom represents the labor program, one representative from the Massachusetts Organization of Nurse Executives, one representative of the Licensed Practical Nurses of Massachusetts, Inc., one representative from the Board of Registration in Nursing, one representative from the Massachusetts Hospital Association, one representative from the Group Insurance Commission, one representative from a health care purchasers group, one registered staff nurse representative who is employed by the commonwealth, one registered staff nurse representative from a rehabilitation facility, one registered staff nurse representative from a large teaching hospital, one registered staff nurse representative from a community hospital, one registered staff nurse representative from a long term care facility, one registered staff nurse representative from a community health setting, and two health care consumers, one of whom is a senior citizen.

         (d) Such rules and regulations shall require that a full time registered nurse executive leader be employed by each facility to be responsible for the overall execution of resources to ensure sufficient nurse staffing is provided by said facility.

         (e) Such rules and regulations shall require that a full time registered nurse be designated by the facility to be responsible for the overall quality assurance of nursing care as provided by the facility.

 (f) Such rules and regulations shall require that a full time registered nurse be designated by each facility to ensure the overall occupational health and safety of nursing staff employed by said facility.

 (g) Such rules and regulations shall require that a registered nurse is designated by each facility as responsible for the direct and indirect nursing care of said patients or residents at all times during their admission and length of stay. 

(h) No facility may directly assign any unlicensed personnel to perform non-delegable licensed nurse functions in lieu of care delivered by a licensed nurse.  Additionally, unlicensed personnel shall work only under the direct supervision of a licensed nurse and are prohibited from performing tasks, which require the clinical assessment, judgment and skill of a licensed nurse.  Such functions shall include, but are not  limited to: medication administration, intravenous therapy,  assessment, laboratory and therapeutics analyses, coordination of a plan of care, patient education and discharge planning. 

(i) Such rules and regulations shall require in any written plan for sufficient nurse staffing within a facility that said plan be unit specific, incorporate accepted standards of specialty nursing practice and include certain criteria that include, but are not limited to the following: 

1. a patient classification system which accounts for the patients’ or 
residents’ acuity of illness, complexity of care and ability for self care;

2. degree of clinical judgment, experience, skill and education  necessary to assess, plan, implement and evaluate patient or resident care;

3. the resources necessary for licensed nurses to provide care consistent with applicable professionally recognized standards of nursing practice;

4. identification of the daily nurse to patient or resident ratio for each unit and shift;

5. research by the designated quality assurance registered nurse to evaluate nursing services and nurse staffing in relation to medical errors and patient outcomes;

6. consideration of the need for any orientation of nursing staff to assigned clinical practice areas, including any temporary assignment(s) and

7. consideration of the need for specialized equipment and technology, including any related in-service education to said equipment or technology.

(j) Each facility must prominently post on each unit the daily written nurse staffing plan to reflect the nurse to patient ratio per each shift as a means of consumer information and protection. 

(k) Each facility will provide each patient and/or family member with a toll-free hotline number for the Division of Health Care Quality at the department, which may be used to report inadequate nurse staffing.  Such complaint shall cause investigation by the department to determine whether any violation of law or regulation by the facility has occurred. 

(l) Any facility that fails to anticipate, design, maintain or adhere to a daily written nurse staffing plan in accordance with the provisions of this section, or any rule or regulation promulgated hereunder, (1) shall be subject to revocation of said facility’s license or registration, or by a fine of not more than twenty-five thousand dollars, or both, (2) shall be subject to a civil penalty of not more than twenty-five thousand dollars, for each such violation. Each day each such violation occurs or continues shall be deemed a separate offense. These penalties shall be in addition to any other penalties that may be prescribed by law.  The department shall have jurisdiction to coordinate enforcement related activities. The civil penalty may be assessed in any action brought on behalf of the commonwealth or on behalf of any patient or resident aggrieved hereunder in any court of competent jurisdiction.