NurseCheck · Nurse Staffing Plan
Chapter 258 of the Texas Health and Safety Code says when a nurse may refuse mandatory overtime. Chapter 257 is the chapter before it: it requires the governing body to adopt a written nurse staffing policy, to maintain an official nurse services staffing plan with minimum levels and a contingency plan, and to establish a standing nurse staffing committee of which at least 60 percent are registered nurses chosen by their peers. It also requires two numbers to be made available to nurses on each unit at the beginning of every shift. What chapter 257 does not contain is a ratio, a deadline for resolving a complaint, or any mention of a critical access hospital. This page sets out what the text says and leaves the characterisation of your own situation with you.
Answer the questions below. The result shows the rules that turn on your answers, the statutory text behind them, and the facts you still need to confirm yourself.
A record-keeping aid built from what the law makes relevant.
Everything above is derived from the text reproduced here. Read it before relying on any summary.
(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.
(3) nurse satisfaction and patient safety can be adversely affected when nurses work excessive hours; and
(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.
(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.
(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.
(a-1) The chief nursing officer of each hospital shall attest to the accuracy of information reported under Subsection (a).
(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.
A hospital may not retaliate against a nurse who provides information to the committee or reports violations of this chapter to hospital management or the commission.
(a) The commission shall enforce this chapter in accordance with: (1) Subchapter C, Chapter 241, against a hospital licensed under that chapter as if the hospital violated that chapter; (2) Chapter 577 and rules adopted under Sections 577.010 and 577.013, against a hospital licensed under Chapter 577 as if the hospital violated that chapter; and (3) rules adopted under Section 241.026(a).
(b) The commission shall establish a process to provide prompt review and timely resolution of each complaint submitted under this chapter. The commission must: (1) develop a procedure, or designate an existing procedure, through which a party may submit a written or verbal complaint; (2) establish a time to review and respond to the complaint; and (3) provide the complainant written notice of the commission's decision regarding the complaint, including: (A) the contact information of the commission employee responsible for the complaint; (B) commission actions in reviewing, evaluating, or investigating the complaint; (C) the results of the commission's review of the complaint; (D) for each reviewed complaint for which an investigation is not conducted, an explanation of the reason the commission resolved the complaint without investigation; and (E) the date the complaint is resolved.
(c) All information and materials in the possession of or obtained or compiled by the commission in connection with a complaint and investigation are confidential and not subject to disclosure in accordance with: (1) Section 241.051(d) for a complaint submitted against a hospital licensed under Chapter 241; or (2) Section 577.013(e) for a complaint submitted against a hospital licensed under Chapter 577.
The CAH's health care services are furnished in accordance with appropriate written policies that are consistent with applicable State law.
These policies are reviewed at least biennially by the group of professional personnel required under paragraph (a)(2) of this section and updated as necessary by the CAH.
(d) Standard: Nursing services. Nursing services must meet the needs of patients. (1) A registered nurse must provide (or assign to other personnel) the nursing care of each patient, including patients at a SNF level of care in a swing-bed CAH. The care must be provided in accordance with the patient's needs and the specialized qualifications and competence of the staff available. (2) A registered nurse or, where permitted by State law, a physician assistant, must supervise and evaluate the nursing care for each patient, including patients at a SNF level of care in a swing-bed CAH. (3) All drugs, biologicals, and intravenous medications must be administered by or under the supervision of a registered nurse, a doctor of medicine or osteopathy, or, where permitted by State law, a physician assistant, in accordance with written and signed orders, accepted standards of practice, and Federal and State laws. (4) A nursing care plan must be developed and kept current for each inpatient.
(5) "General hospital" means an establishment that: (A) offers services, facilities, and beds for use for more than 24 hours for two or more unrelated individuals requiring diagnosis, treatment, or care for illness, injury, deformity, abnormality, or pregnancy; and (B) regularly maintains, at a minimum, clinical laboratory services, diagnostic X-ray services, treatment facilities including surgery or obstetrical care or both, and other definitive medical or surgical treatment of similar extent.
(7) "Hospital" includes a general hospital and a special hospital.
(15) "Special hospital" means an establishment that: (A) offers services, facilities, and beds for use for more than 24 hours for two or more unrelated individuals who are regularly admitted, treated, and discharged and who require services more intensive than room, board, personal services, and general nursing care; (B) has clinical laboratory facilities, diagnostic X-ray facilities, treatment facilities, or other definitive medical treatment; (C) has a medical staff in regular attendance; and (D) maintains records of the clinical work performed for each patient.