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SB2763
THE SENATE
S.B. NO.
2763
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
A BILL FOR AN ACT
relating
to Staffing standards at health care facilities
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
����
SECTION 1.
�
The legislature finds that the health and
safety of the State's residents depend on ensuring that registered nurses are
supported in providing high-quality, patient-centered care.
�
The legislature further finds that adequate
nurse-to-patient staffing ratios are critical to achieving this goal, as they
directly impact patient safety, reduce nurse burnout, and promote nurse
retention in the health care workforce.
����
The
legislature recognizes that improving nurse-to-patient staffing ratios leads to
better patient outcomes, enhanced care quality, and a more sustainable health
care system.
�
By establishing minimum
nurse-to-patient staffing ratios and requiring hospitals to implement and
adhere to enforceable staffing plans, the State can protect its health care
workforce, reduce staff turnover, and ensure that patients receive the safe,
timely care they deserve.
����
Accordingly,
the purpose of this Act is to:
����
(1)
�
Require each hospital to establish a hospital
registered nurse staffing committee and implement a hospital registered nurse
staffing plan, with minimum registered nurse staffing standards, adopted by the
staffing committee on an annual basis;
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(2)
�
Require hospital registered nurse staffing
committees to receive, review, evaluate, and respond to reports and complaints regarding
deviations from an adopted hospital registered nurse staffing plan;
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(3)
�
Establish
a variance process that allows hospitals to temporarily deviate from their
minimum registered nurse staffing standards under limited circumstances;
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(4)
�
Establish an enforcement framework to be
administered by the department of labor and industrial relations, including review
of staffing plans, complaint investigations, administrative appeals, and civil
penalties for violations;
����
(5)
�
Prohibit retaliation against registered
nurses, patients, and other persons who report staffing concerns or participate
in enforcement proceedings; and
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(6)
�
Require
the center for nursing to develop and maintain an online dashboard of staffing
standards recommended by certain professional specialty organizations for use
in hospital registered nurse staffing plans.
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SECTION
2.
�
The Hawaii Revised Statutes is
amended by adding a new chapter to be appropriately designated and to read as
follows:
"
Chapter
staffing
standards for Health Care Facilities
Part
I.
�
general provisions
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�
-1
�
Definitions.
�
As used in this chapter:
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"Center
for nursing" means the center for nursing established under section 304A-1404.
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"Department"
means the department of labor and industrial relations.
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"Director"
means the director of labor and industrial relations.
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"Hospital"
means a hospital regulated by the department of health under sections 321-11(10)
and 321-14.5.
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"
Hospital registered nurse staffing committee
" or
"staffing committee" means the committee established by a hospital
under section -11.
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"Hospital
registered nurse staffing committee charter" or "staffing committee
charter" means the charter adopted by a hospital registered nurse staffing
committee under section ‑13.
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"Hospital
registered nurse staffing plan" or "staffing plan" means a plan adopted
by a hospital registered nurse staffing committee under section
-14.
����
"Patient
care unit" means any unit or area of the hospital that provides patient
care.
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"Registered
nurse" means a person licensed under section 457-7.
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�
-2
�
Rules.
�
The department shall adopt rules pursuant to chapter 91 to
effectuate the purposes of this chapter.
Part
II.
�
Hospitals; registered nurse staffing
plans
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�
-11
�
Hospital registered
nurse staffing committee;
membership.
�
(a)
�
No later than September
1, 2026, each hospital shall establish a hospital registered nurse staffing
committee.
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(b)
�
A majority of the members of the staffing
committee shall be registered nurses who are nonsupervisory, nonmanagerial, and
currently providing direct patient care.
�
These members shall be appointed by the collective bargaining
representative or representatives of the registered nurses; provided that if
there is no collective bargaining representative, the members shall be selected
by their peers.
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(c)
�
The remaining members of the staffing
committee shall be appointed by the hospital administration; provided that these
members shall include the hospital's chief financial officer, chief nursing
officer, and patient care unit directors or managers, or their respective designees.
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(d)
�
The staffing committee shall be co-chaired by
two members.
�
One co-chair shall be
selected from among the registered nurse members of the staffing committee and
the other co-chair shall be selected from among the members appointed by the
hospital administration.
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(e)
�
Except as otherwise provided in this part, the
presence of a majority of the members of the staffing committee shall constitute
a quorum for the transaction of business.
�
Except as otherwise provided in this part, the staffing committee may
act by a majority vote of the members present and voting at a meeting at which a
quorum is present.
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(f)
�
Participation in staffing committee business by
hospital staff shall occur during the staff's scheduled work time and shall be compensated
at the staff's appropriate rate of pay.
�
Staffing committee members shall be relieved of all other work duties while
attending committee meetings.
�
The
hospital shall provide additional staffing relief as necessary to enable members
to attend staffing committee meetings.
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�
-12
�
Hospital registered nurse staffing committee;
primary responsibilities.
�
The
primary responsibilities of the hospital registered nurse staffing committee shall
include:
����
(1)
�
Annually
developing and
adopting a hospital registered nurse staffing plan;
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(2)
�
Conducting
a s
emiannual review of the hospital registered nurse staffing plan; and
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(3)
�
Receiving,
reviewing, evaluating, and responding to reports and complaints
regarding registered nurse assignments that deviate from the hospital
registered nurse staffing plan in effect.
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�
-13
�
Hospital registered nurse staffing committee charter;
adoption; filing.
�
(a)
�
No later than January 1, 2027, each hospital
registered nurse staffing committee shall adopt a hospital registered nurse
staffing committee charter that governs the procedures by which the staffing
committee carries out its responsibilities.
�
The charter shall include:
����
(1)
�
Roles and responsibilities of the staffing
committee;
����
(2)
�
Schedule for monthly staffing committee
meetings, with provisions allowing for additional meetings as needed;
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(3)
�
Operating procedures of the staffing
committee, including procedures to:
���������
(A)
�
Ensure regular attendance of members and
presence of necessary quorum, including requiring that the members receive at
least thirty days' advance notice of meetings;
���������
(B)
�
Receive, review, evaluate, and respond to
reports and complaints, including:
��������������
(i)
�
Recordkeeping procedures, including
documentation of the date each report or complaint is received; the staffing
committee's initial, contingent, and final dispositions; and any contingency
staffing plans or corrective action plans adopted by the staffing committee;
�������������
(ii)
�
Procedures to ensure complaints are resolved
no later than ninety days after receipt by the staffing committee, with
provisions allowing for an extension of that period by a majority vote of the
staffing committee;
������������
(iii)
�
Review process that affords any hospital staff
involved in a complaint, and upon the request of the staff, their collective
bargaining representative, an opportunity to be heard; and
�������������
(iv)
�
Notice requirements, including providing
complainants with written notice of the outcome of their complaint;
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����
(D)
�
Conduct
quarterly reviews of:
��������������
(i)
�
Hospital staff turnover rates, including
turnover among newly hired hospital staff during the first year of employment;
and
�������������
(ii)
�
The hospital's workforce development programs;
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(4)
�
Standards
governing the staffing committee's adoption of meeting documentation, including
meeting minutes, attendance records, and description of actions taken; and
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(5)
�
Record
retention policies requiring staffing committee
records to be maintained
for a minimum period of three years; provided that the policies shall be
consistent with the hospital's document retention policies.
����
(b)
�
No later than January 1, 2027, each staffing
committee shall file its charter with the department.
�
Thereafter, each staffing committee shall file
its charter with the department within thirty days after adoption of any
revisions to the charter.
�
A hospital
registered nurse staffing committee charter shall not be deemed properly filed
unless it contains all information required under subsection (a).
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�
-14
�
Hospital registered nurse staffing plan; minimum
registered nurse staffing standard; adoption; filing; penalty.
�
(a)
�
No
later than July 1, 2027, and annually thereafter, the hospital registered nurse
staffing committee shall develop a hospital-wide patient care unit- and
shift-based hospital registered nurse staffing plan.
�
The staffing plan shall serve as the primary
means of ensuring that the hospital is staffed sufficiently to meet the health
care needs of patients and protect the health and safety of patients and hospital
staff.
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(b)
�
The hospital registered nurse staffing plan
shall:
����
(1)
�
Be based on patient needs;
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(2)
�
Be in a form prescribed by the department, with
all applicable fields completed; provided that the staffing plan may also include
a description of the hospital, including its size and facility type, and the additional
resources available to support unit-level patient care;
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(3)
�
Incorporate minimum registered nurse staffing standards
recommended by professional specialty organizations, as posted on the online
dashboard developed and maintained by the center for nursing pursuant to
section 304A-1406(5),
including minimum nurse-to-patient ratios for each
hospital unit that are equal to or exceed the minimum ratios recommended by the
professional specialty organizations; provided that the staffing standards incorporated
into the staffing plan shall be those recommended by professional specialty
organizations selected by a majority vote of the staffing committee; provided
further that the minimum registered nurse staffing standards shall include, at
minimum, those recommended by the professional specialty organizations specifically
listed in section 304A-1406(5);
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(4)
�
Consider
the following factors
:
���������
(A)
�
Patient
census, including the total number of patients assigned to the unit on
each shift, and patient activity, including patient admissions, discharges, and
transfers;
����
����
(B)
�
Patient
acuity
, patient type, and the nature and complexity of care required on
each shift;
���������
(C)
�
The
experience of, and number and relative percentages of, nursing and ancillary
health personnel
;
���������
(D)
�
L
evel
of experience and specialty certification or training of nursing personnel
providing care;
���������
(E)
�
Applicable
national standards, if any;
���������
(F)
�
Patient
access to timely and appropriate care;
���������
(G)
�
Need
for specialized or intensive equipment;
���������
(H)
�
Architecture
and physical layout of the patient care unit, including but not limited to the
placement of patient rooms, treatment areas, nursing stations, medication
preparation areas, and equipment;
����
����
(I)
�
Availability
of non-registered nurse personnel who support nursing services on the unit;
���������
(J)
�
Ability
to comply with the terms of an applicable collective bargaining agreement and
relevant
state and federal laws and rules, including those regarding
meals and rest breaks, overtime, and on-call shifts; and
���������
(K)
�
Hospital
finances and resources; and
����
(5)
�
Not reduce, supersede, or otherwise diminish any
standards or requirements imposed by state or federal law or rules, or by any applicable
collective bargaining agreement.
����
(c)
�
No later than July 1, 2027, and annually thereafter,
the staffing committee shall adopt a staffing plan developed pursuant to
subsection (a),
by a majority vote of the members present and voting
at a meeting at which a quorum is present; provided that a vote to adopt the
staffing plan shall be valid only if the number of registered nurse members present
and voting exceeds the number of members appointed by the hospital
administration who are present and voting.
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(d)
�
Notwithstanding any law to the contrary,
if
a staffing plan is not adopted pursuant to subsection (c), the staffing plan
most recently adopted shall remain in effect; provided that the hospital shall
be subject to the following daily fines until a new staffing plan is adopted:
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(1)
�
$100 per day for:
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����
(A)
�
Hospitals
certified as critical access hospitals;
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(B)
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Hospitals
with
fewer than twenty-five licensed acute care beds in operation; and
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(C)
�
Hospitals
certified by the Centers for Medicare and Medicaid Services as sole
community hospitals that have fewer than one hundred licensed acute care beds,
have a level III adult trauma center designation from the department of health,
and are owned and operated by the State; and
����
(2)
�
$5,000 per day for all other hospitals.
����
(e)
�
The staffing committee shall conduct a
semiannual review of the staffing plan and revise the plan as necessary.
�
The review shall assess the hospital's
ability to meet the minimum registered nurse staffing standards in the staffing
plan and address patient care needs, and consider other relevant information,
including information provided by the chief executive officer pursuant to
subsection (f).
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(f)
�
Before the adoption of a new staffing plan or semiannual review thereof,
the chief executive officer of the hospital shall submit a report to the staffing
committee.
�
The report shall include:
����
(1)
�
Status
of the hospital's implementation of the staffing plan;
����
(2)
�
Evidence-based staffing information, including
nursing-sensitive quality indicators collected by the hospital, patient
surveys, and the hospital's recruitment and retention efforts; and
����
(3)
�
Any
proposed revisions to the staffing plan.
����
(g)
�
No later than July 1, 2027, each hospital
shall properly file its staffing plan with the department and thereafter, each
hospital shall file its staffing plan annually and within thirty days after adoption
of any revisions to the staffing plan.
�
A staffing plan shall not be deemed properly filed unless
all applicable fields of the form prescribed by the department are completed.
����
(h)
�
No
later than January 1, 2027, t
he department shall develop, in
consultation with stakeholders, including hospitals and labor organizations, a form
for hospital registered nurse staffing plans; provided that the form shall, at
minimum, provide for the factors described in subsection (b) and be structured
to allow patients and the public to clearly understand and compare staffing
patterns and actual staffing levels across facilities.
����
(i)
�
For the purposes of this section, "acuity" means the level of
patient need for nursing care, as determined by a nursing assessment.
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�
-15
�
Department review.
�
(a)
�
The department shall review each hospital registered nurse staffing
committee charter filed by a staffing committee to determine whether the
charter:
����
(1)
�
Is properly filed in a timely manner; and
����
(2)
�
Includes all information required under
section ‑13.
����
(b)
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The department shall review each hospital
registered nurse staffing plan filed by a hospital to determine whether the
staffing plan:
����
(1)
�
Is properly filed in a timely manner;
����
(2)
�
Is in the form prescribed by the department;
and
����
(3)
�
Incorporates the minimum registered nurse
staffing standards recommended by professional specialty organizations, as
required in section -14(b)(3).
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(c)
�
The department shall post on its website:
����
(1)
�
Each
hospital registered nurse staffing committee charter filed with the department;
����
(2)
�
Each
hospital registered nurse staffing plan filed with the department; and
����
(3)
�
A
list of hospitals and staffing committees that failed to file a charter or
staffing plan in compliance with this part
.
����
�
-16
�
Hospital registered nurse staffing plan;
implementation; complaints to staffing committee.
�
(a)
�
Beginning July 1, 2027, each hospital shall implement its hospital registered
nurse staffing plan adopted pursuant to section -14 and
assign hospital staff to each patient care unit in accordance with the staffing
plan.
����
(b)
�
Shift-to-shift adjustments in staffing levels
shall be made only as permitted by the staffing plan and by appropriate
hospital personnel responsible for overseeing patient care operations.
�
Any individual assigned to a patient care
unit who objects to a shift-to-shift adjustment may submit a complaint to the
staffing committee.
����
(c)
�
Any registered nurse, collective bargaining
representative, patient, or other person may report to, or file a complaint
with, the staffing committee regarding any deviation from the staffing plan
relating to the assignment of registered nurses in a patient care unit.
����
(d)
�
The staffing committee shall develop procedures
to receive, review, evaluate, and respond to reports and complaints submitted pursuant
to subsections (b) and (c), including procedures to dismiss a complaint that is
not substantiated by sufficient information and to determine whether a
deviation confirmed by the staffing committee has been resolved by the hospital.
�
All complaints submitted to the staffing
committee shall be reviewed, regardless of the form or manner in which the
complaint is submitted.
����
�
-17
�
Hospital registered nurse staffing plan;
posting.
�
Each hospital shall post,
in a publicly accessible area of each patient care unit, its hospital registered
nurse staffing plan and the staffing schedule for the applicable shift
currently in effect, including the relevant clinical staffing for that shift.
�
Each hospital shall make the staffing plan and
current staffing levels available to patients and visitors upon request.
����
�
-18
�
Variance.
�
(a)
�
The department may grant
a hospital a variance, not to exceed thirty days, from the minimum registered
nurse staffing standards set forth in a hospital registered nurse staffing plan
adopted pursuant to section ‑14, upon a finding of good
cause.
�
For the purposes of this
subsection, "good cause" means circumstances in which a hospital
establishes that compliance with the minimum registered nurse staffing
standards is not feasible and granting a variance will not result in a
significant adverse effect on the health, safety, and welfare of the patients
and hospital staff.
����
(b)
�
A hospital seeking a variance shall submit a
written application to the department.
�
The
application shall include:
����
(1)
�
A
statement justifying the variance and establishing good cause, including an
explanation of the hospital's inability to comply with the minimum registered
nurse staffing standards in its staffing plan;
����
(2)
�
Proposed
alternative minimum registered nurse staffing standards to apply during the
variance period;
����
(3)
�
Identification
of the
group or groups of hospital staff for whom the variance is
sought;
����
(4)
�
Evidence
that the claimed infeasibility, together with the underlying supporting data, was
discussed by the hospital registered nurse staffing committee on at least two
occasions, including a statement from the staffing committee describing areas
of consensus and areas of disagreement, if any; and
����
(5)
�
Evidence
that no later than ten working days before submitting the variance application,
the hospital provided hospital staff that will be affected by the variance and
if applicable, their collective bargaining representatives with:
���������
(A)
�
A
copy of the variance application;
���������
(B)
�
Information
regarding their right to be heard by the department during the variance
application review process;
���������
(C)
�
Information
regarding the process for submitting a written request for reconsideration
pursuant to subsection (g); and
���������
(D)
�
Department's
address, phone number, or other contact information.
����
(c)
�
When warranted by the circumstances of the
application, the department shall afford the hospital, affected hospital staff,
and if applicable, their collective bargaining representatives, an opportunity to
submit oral or written testimony during the variance application review
process.
����
(d)
�
No later than fifteen days after receipt of a complete
variance application, the department shall issue a written decision and order granting
or denying the variance; provided that the department may extend this fifteen-day
period by providing advance written notice to the hospital and if applicable,
the collective bargaining representatives of affected hospital staff.
�
The notice shall state the justification for
and duration of the extension, which shall not exceed an additional fifteen
days.
�
The hospital shall provide notice
of any extension to affected hospital staff.
����
(e)
�
Upon a finding of good cause, the department
shall grant the variance.
�
The decision
and order granting the variance shall include:
����
(1)
�
Alternative
minimum registered nurse staffing standards approved;
����
(2)
�
Basis
for the department's finding of good cause;
����
(3)
�
Group
or groups of hospital staff affected by the variance; and
����
(4)
�
Period
for which the variance is valid; provided that the variance period shall not exceed
thirty days from the date of issuance.
����
A
decision and order denying the variance shall state the basis for the denial.
����
(f)
�
Upon issuance of a decision and order, the
department shall provide written notice to the hospital and if applicable, the collective
bargaining representatives of affected hospital staff.
�
The hospital shall provide the notice to
affected hospital staff.
����
(g)
�
Any hospital, affected hospital staff, or if
applicable, the collective bargaining representative of affected hospital staff
aggrieved by a decision and order of the department may file a written request
for reconsideration with the director no later than five days after receipt of the
written notice issued pursuant to subsection (f).
�
The request shall state the grounds upon which
the reconsideration is being sought.
�
Upon
receipt of a timely request for reconsideration and a finding that reasonable
grounds for reconsideration exist, the director may grant reconsideration and,
as appropriate, afford interested parties an opportunity to be heard; provided
that the department's decision and order shall remain in effect pending
completion of the reconsideration process, which shall be completed no later
than ten days after the director's receipt of the request.
����
(h)
�
The director may revoke or terminate a
variance order at any time; provided that:
����
(1)
�
The reconsideration process under subsection
(g), if invoked, is completed; and
����
(2)
�
Written notice is provided to the hospital and
if applicable, the collective bargaining representative of affected hospital
staff at least five days before the effective date of the revocation or
termination.
�
The hospital shall provide
the notice to affected hospital staff.
����
(i)
�
If the department finds that immediate action
is necessary pending further review, the department may issue a temporary
variance, which shall remain in effect until the department determines whether
good cause exists to grant a variance.
�
A
hospital shall not be required to satisfy the requirements in subsection (b)(4)
to obtain a temporary variance.
�
If a
temporary variance is granted, the department shall issue a final decision and
order granting or denying the variance within the fifteen-day period specified
in subsection (d), and no extension of that period shall be permitted.
�
The duration of the temporary variance shall
be counted toward the thirty-day maximum variance period specified in subsection
(e)(4).
����
(j)
�
Any hospital granted a variance pursuant to this
section shall:
����
(1)
�
No later than five days after receipt of the
department's written notice approving the variance, provide written notice to affected
hospital staff of the variance period and the minimum registered nurse staffing
standards applicable during that period;
����
(2)
�
Make the information described in paragraph
(1) readily accessible to all hospital staff for the duration of the variance
period; and
����
(3)
�
Comply with the applicable minimum registered
nurse staffing standards and all other terms and conditions of the variance during
the variance period.
����
(k)
�
The director may establish additional variance
eligibility criteria by rule.
����
�
-19
�
Complaints; investigations; contingency staffing
plan; corrective action plan; exceptions.
�
(a)
�
Any person may file a
complaint with the department alleging a violation of this part; provided that
no complaint shall be filed after the expiration of sixty days
after the date:
����
(1)
�
U
pon
which the alleged violation occurred; or
����
(2)
�
Of the last occurrence in a pattern of ongoing
violations.
����
(b)
�
Upon receipt of a timely complaint, the
department shall investigate the allegations in the complaint and, no later
than ninety days after the filing of the complaint, issue either a citation and
notice of assessment or notice of case closure; provided that, for good cause, the
department may extend this ninety-day period by providing advance written
notice to the hospital and the complainant, specifying the justification for
and duration of the extension.
����
(c)
�
If the department finds, based on its investigation,
that a violation has occurred, the department shall issue a citation and notice
of assessment; provided that a hospital shall not be found in violation of section
-14 or -16(a) if:
����
(1)
�
The department finds that the deviation from
the requirements of this chapter resulted from unforeseeable emergent
circumstances; and
����
(2)
�
In case of a deviation from the staffing standards
set forth in the hospital registered nurse staffing plan, the hospital demonstrates
through documentation that the hospital, after consultation with its hospital
registered nurse staffing committee, made reasonable efforts to obtain and
retain sufficient staffing to meet the required staffing assignments but was
unable to do so.
����
(d)
�
If the violation found by the department
pertains to the hospital's compliance with its staffing plan:
����
(1)
�
No later than thirty days after the department's
issuance of a citation and notice of assessment, the hospital shall:
����
����
(A)
�
Implement
a contingency staffing plan.
�
Upon the
issuance of the citation and notice of assessment, the hospital shall report to
the hospital registered nurse staffing committee its assessment of staffing
needs and proposed plan to address those needs.
�
Upon receipt of the report, the staffing committee shall develop a
contingency staffing plan to address the identified staffing needs.
�
The hospital shall implement and remain in
compliance with the contingency staffing plan until the department approves a
corrective action plan submitted pursuant to subparagraph (B); and
����
����
(B)
�
Submit
a corrective action plan to the department for approval.
�
The corrective action plan shall:
����
����
����
(i)
�
Be developed in consultation with the staffing
committee; and
����
����
���
(ii)
�
Describe the corrective actions the hospital
will implement to remedy the violation and prevent recurrence;
����
(2)
�
The department shall review the corrective
action plan submitted by the hospital and issue a written notice approving, approving
with modifications, or rejecting the plan.
�
The department shall not approve a corrective
action plan that fails to remedy the violations found;
����
(3)
�
The hospital shall implement an approved
corrective action plan and demonstrate compliance for a period of ninety
consecutive days, unless otherwise directed by the department; and
����
(4)
�
Any hospital that fails to timely submit a
corrective action plan, fails to obtain the department's approval of a corrective
action plan, or fails to remain in compliance with an approved corrective
action plan shall be subject to the following daily fines for each violation
found by the department, until the department determines that the hospital has complied
with an approved corrective action plan for a period of ninety consecutive days:
����
����
(A)
�
$100
per day for:
����
����
����
(i)
�
Hospitals
certified as critical access hospitals;
����
����
���
(ii)
�
Hospitals
with
fewer than twenty-five licensed acute care beds in operation; and
����
����
��
(iii)
�
Hospitals
certified by the Centers for Medicare and Medicaid Services as sole
community hospitals that have fewer than one hundred licensed acute care beds,
have a level III adult trauma center designation from the department of health,
and are owned and operated by the State; and
����
����
(B)
�
$5,000
per day for all other hospitals;
���������
provided
that the department may reduce the total amount of accrued fines upon a
determination that the hospital has remained in compliance with an approved corrective
action plan for ninety consecutive days.
����
(e)
�
The department shall issue a notice of case closure if:
����
(1)
�
The department finds, based on its
investigation, that the alleged violation did not occur or cannot be
substantiated by evidence;
����
(2)
�
A violation that has been found by the
department has been remedied and any assessed fines have been paid; or
����
(3)
�
The complaint has otherwise been resolved.
The notice of case closure shall include the
basis of the department's determination.
����
(f)
�
Any citation, notice, or other document
issued by the department pursuant to this section shall be sent to the last
known addresses of the complainant and hospital by certified or registered mail,
return receipt requested, and deliverable to the addressee only.
����
(g)
�
Nothing in this section shall be construed to
limit the department's authority to initiate an investigation or take
enforcement actions on its own motion or pursuant to any other law.
����
(h)
�
For the purpose of this section:
����
"Reasonable efforts" means
that the hospital has exhausted and documented the following efforts and nevertheless
remains unable to obtain required staffing coverage:
����
(1)
�
Soliciting
qualified hospital staff who are currently working to volunteer for
additional work hours;
����
(2)
�
Contacting
qualified hospital staff who have indicated availability to work additional
hours;
����
(3)
�
Seeking
coverage through per diem staff; and
����
(4)
�
Seeking
personnel from a contracted temporary staffing agency to the extent permitted
by law and any applicable collective bargaining agreement; provided that the hospital
customarily utilizes a contracted temporary staffing agency.
����
"Unforeseeable emergent
circumstances" means:
����
(1)
�
Any
unforeseen national, state, or county emergency; or
����
(2)
�
Activation
of
a hospital's disaster plan.
����
�
-20
�
Appeals.
�
(a)
�
Any person aggrieved by a
citation and notice of assessment issued by the department pursuant to this part
may appeal the citation and notice of assessment by filing a notice of appeal
with the director within thirty days after the person's receipt of the citation
and notice of assessment issued and sent by the department pursuant to section -19.
����
(b)
�
The timely filing of a notice of appeal
pursuant to this section shall stay the effectiveness of the citation and
notice of assessment until issuance of an initial order by the hearing officer;
provided that if the initial order is appealed, the stay shall remain in effect
until issuance of a decision and order by the director.
����
(c)
�
Upon receipt of a timely notice of appeal,
the director shall assign the matter to a hearings officer to conduct a hearing
and issue an initial order.
�
The hearing shall
be conducted de novo and in accordance with chapter 91.
����
(d)
�
Any party aggrieved by an initial order may file
a petition for administrative review with the director within thirty days after
service of the initial order.
����
(e)
�
The director shall conduct administrative
review in accordance with chapter 91, and upon completion of the review, issue
a written findings of fact, conclusions of law, decision, and order, which shall
be subject to judicial review in accordance with chapter 91.
����
(f)
�
Any citation, notice of assessment, or order that
is not appealed within the time periods specified in this section or chapter 91
shall be final and binding, and shall not be subject to further administrative
or judicial review.
����
(g)
�
A hospital that fails, without good cause, to
permit adequate inspection of records requested by the department within a
reasonable time during an investigation conducted pursuant to this part shall be
precluded from using those records in any appeal under this section.
����
�
-21
�
Retaliation prohibited.
�
No hospital shall discharge, expel, threaten,
intimidate, take adverse employment action, or otherwise discriminate or
retaliate against:
����
(1)
�
A registered nurse for performing any duties
or responsibilities in connection with the hospital registered nurse staffing
committee;
����
(2)
�
A registered nurse, patient, or any other
person for opposing, reporting, or submitting a complaint to the staffing
committee, hospital administration, or a public body regarding that person's
concerns about a hospital's compliance with this chapter, including registered
nurse assignments;
����
(3)
�
A registered nurse, patient, or any other
person for testifying, assisting, or participating in any proceeding relating
to a hospital's compliance with this chapter, including investigations, hearings,
and inquiries held by a public body, and court actions; or
����
(4)
�
A registered nurse for refusing to work
overtime that is not required by law or an applicable collective bargaining
agreement.
����
� -22
�
Violation; penalty.
�
(a)
�
Except as otherwise provided in
this part, any hospital that fails to file a
hospital registered nurse
staffing plan with the department pursuant to section ‑14
or any
hospital
registered nurse staffing committee that fails to file its staffing committee charter
pursuant to section -13 shall be fined $25,000
.
����
(b)
�
Any hospital that otherwise violates this
chapter shall be fined:
����
(1)
�
Not
more than $1,000 for each of the first three violations;
����
(2)
�
$2,500
for the fourth violation; and
����
(3)
�
$5,000
for the fifth and each subsequent violation.
����
(c)
�
At any time, the department may waive or reduce a civil penalty assessed
under this section if the director determines that the hospital has taken
corrective action to resolve the violation.
����
(d)
�
Any action taken to impose or collect the
penalty provided for in this chapter shall be considered a civil action.
����
(e)
�
The department shall:
����
(1)
�
Maintain
for public inspection records of all
civil penalties imposed on hospitals and all other
administrative actions taken by the department against hospitals pursuant to
this chapter; and
����
(2)
�
Post on its website all violations of this
chapter found by the department.
����
�
-23
�
Critical access hospitals.
�
Nothing in this part shall be construed to impose
unreasonable burdens on critical access hospitals, as designated pursuant to title
42 United States Code section 1395i-4.
�
Critical
access hospitals may develop flexible approaches to comply with the
requirements of this part, including but not limited to having their hospital registered
nurse staffing committees meet or conduct business by video conference,
telephone, or electronic communication."
����
SECTION
3
.
�
Section 304A-1404, Hawaii Revised Statutes,
is amended by amending subsection (b) to read as follows:
����
"(
b)
�
The dean of the school of nursing and dental
hygiene, or the dean's designee, shall direct the activities of the center for
nursing.
�
There shall be an advisory
board composed of [
nine
]
twelve
voting members, a majority of
whom shall be nurses or representatives of nursing organizations, appointed by
the governor pursuant to section 26-34 to staggered terms, including:
����
(1)
�
Five members who are nurses with an
active Hawaii nursing license, including but not limited to:
���������
(A)
�
A nursing executive;
���������
(B)
�
An advanced practice registered nurse;
���������
(C)
�
A nurse affiliated with a nurse
collective bargaining organization; and
���������
(D)
�
A doctorally-prepared nurse educator or
a doctorally-prepared nurse researcher; [
and
]
����
(2)
�
Four members who have a background or
experience in health care delivery, finance, workforce, representation of
hospitals and acute care hospitals of the State, and community agencies or
consumer groups[
.
]
; and
����
(3)
�
Three members who are elected
officers or governing board members of a labor organization representing
registered nurses in the State.
The center may invite other members of the
public with specific backgrounds to participate as ex officio, nonvoting
members."
����
SECTION
4
.
�
Section 304A-1406, Hawaii Revised Statutes,
is amended to read as follows:
����
"
[
[
]
�304A-1406
[
]
]
�
Center for nursing; functions.
�
The center for nursing shall:
����
(1)
�
Collect
and analyze data and prepare and disseminate written reports and
recommendations regarding the current and future status and trends of the
nursing workforce;
����
(2)
�
Conduct
research on best practices and quality outcomes;
����
(3)
�
Develop
a plan for implementing strategies to recruit and retain nurses;
[
and
]
����
(4)
�
Research,
analyze, and report data related to the retention of the nursing workforce
[
.
]
; and
����
(5)
�
Develop
and
maintain a current, publicly accessible, online dashboard
that tracks and displays staffing standards recommended by the following professional
specialty organizations:
���������
(A)
�
American
Association of Critical-Care Nurses;
���������
(B)
�
Emergency
Nurses Association;
���������
(C)
�
Association
of Women's Health, Obstetric and Neonatal Nurses;
���������
(D)
�
American
Society of PeriAnesthesia Nurses;
���������
(E)
�
Association
of periOperative Registered Nurses;
���������
(F)
�
Oncology
Nursing Society;
���������
(G)
�
Academy
of Medical-Surgical Nurses;
���������
(H)
�
American
Psychiatric Nurses Association;
���������
(I)
�
Society
of Pediatric Nurses; and
���������
(J)
�
American
Nephrology Nurses Association;
���������
provided that the
center for nursing
may, in consultation with
its advisory board, track and post on the online dashboard staffing standards
for a nursing specialty or sub-specialty established or recommended by
regulation or statute in other states, by recognized authorities in other
countries, and by other professional associations.
"
����
SECTION 5.
�
There is appropriated out of the general revenues of the State of Hawaii
the sum of $ or so
much thereof as may be necessary for fiscal year 2026-2027 to implement and
enforce section 2 of this Act.
����
The sum appropriated shall be expended by
the department of labor and industrial relations for the purposes of this Act.
����
SECTION
6.
�
There is appropriated out of the
general revenues of the State of Hawaii the sum of
$ or so much
thereof as may be necessary for fiscal year 2026-2027 for the center for
nursing to develop and maintain an online dashboard pursuant to section 4 of
this Act.
����
The
sum appropriated shall be expended by the university of Hawaii for the purposes
of this Act.
����
SECTION
7.
�
This Act does not affect rights and
duties that matured, penalties that were incurred, and proceedings that were
begun before its effective date.
����
SECTION 8.
�
Statutory material to be repealed is bracketed and stricken.
�
New statutory material is underscored.
����
SECTION
9.
�
This Act shall take effect upon its
approval; provided that sections 5 and 6 shall take effect on July 1, 2026.
INTRODUCED BY:
_____________________________
Report Title:
DLIR; Center
for Nursing; Hospitals; Hospital Registered Nurse Staffing Committee; Hospital
Registered Nurse Staffing Plan; Nurse-to-Patient Ratio; Civil Penalties;
Appeals; Rules; Appropriations
Description:
Requires each hospital to
establish a Hospital Registered Nurse Staffing Committee by 9/1/2026.
�
Requires the Staffing Committee to adopt and
file a Staffing Committee Charter with the Department of Labor and Industrial
Relations by 1/1/2027.
�
Requires the
Department to develop a Hospital Registered Nurse Staffing Plan Form by
1/1/2027.
�
Requires each Staffing
Committee to adopt and file a Staffing Plan, including minimum registered nurse
staffing standards, with the Department by 7/1/2027, and annually thereafter.
�
Requires hospitals to implement their
Staffing Plan by 7/1/2027, and post the Staffing Plan and staffing schedules in
publicly accessible areas.
�
Requires
Staffing Committees to receive, review, evaluate, and respond to reports and
complaints regarding deviations from the Staffing Plan.
�
Establishes a variance process allowing hospitals
to temporarily deviate from their minimum registered nurse staffing standards.
�
Establishes an enforcement framework to be
administered by the Department, including review of Staffing Plans, complaint
investigations, administrative appeals, and civil penalties for violations.
�
Prohibits retaliation against certain persons
who report staffing concerns or participate in enforcement proceedings.
�
Increases the membership of the Center for
Nursing Advisory Board to include three elected officers or governing board
members of a labor organization representing registered nurses in the
State.
�
Requires the Center for Nursing
to develop and maintain an online dashboard of staffing standards recommended
by certain professional specialty organizations.
�
Requires the Department to adopt rules.
�
Appropriates funds.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.