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As Introduced
136th
General Assembly
Regular
Session
H. B. No. 521
2025-2026
Representatives Lett, Cockley
To
amend sections 3333.28, 3722.01, 4723.489, 4730.203
,
and 4772.092
;
to enact sections 3333.27, 3722.21, 3722.22, 3722.23, 3722.24,
3722.25, 3722.26, 3722.27, 3722.28, 3722.29, 3722.30, 3722.31,
3722.32, 3722.33, 3722.34, 3722.35, 3722.36, 3722.37, 3722.38
,
3722.39, and 3722.40
;
and to repeal sections 3727.50, 3727.51, 3727.52, 3727.53, 3727.54,
3727.55, 3727.56, and 3727.57 of the Revised Code
to
require hospitals to establish and comply with registered nurse
staffing plans that protect patient safety, to create the Nursing
Student Loan-to-Grant Program, to make an appropriation, and to name
this act the Ohio Nurse Workforce and Safe Patient Act.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 3333.28, 3722.01, 4723.489, 4730.203
,
and 4772.092
be amended and sections 3333.27, 3722.21, 3722.22, 3722.23, 3722.24,
3722.25, 3722.26, 3722.27, 3722.28, 3722.29, 3722.30, 3722.31,
3722.32, 3722.33, 3722.34, 3722.35, 3722.36, 3722.37, 3722.38
,
3722.39, and 3722.40
of the Revised Code be enacted to read as follows:
Sec.
3333.27.
(A)
The nursing student loan-to-grant program is created in the
department of higher education. The chancellor of higher education
shall administer the program in accordance with this section.
Under
the program, a nursing student enrolled in a prelicensure nursing
education program for registered nurses that is approved under
section 4723.06 of the Revised Code may apply to be awarded an amount
that is conditioned on the student's agreement to fulfill a five-year
service obligation. Until an award recipient completes the service
obligation, the total amount received shall be considered a loan
subject to repayment. Once the service obligation is completed, the
amount shall be considered a grant and is no longer subject to
repayment.
(B)
The service obligation required by the program may be fulfilled by
doing any of the following:
(1)
Practicing as a direct-care registered nurse in a hospital licensed
under Chapter 3722. of the Revised Code;
(2)
Practicing as a direct-care registered nurse in a nursing home or
residential care facility, as defined in section 3721.01 of the
Revised Code;
(3)
Serving in this state as a faculty member in a prelicensure nursing
education program for registered nurses that is approved under
section 4723.06 of the Revised Code.
(C)
The chancellor shall establish an application form to be used and
procedures to be followed by a nursing student seeking financial
assistance through the program. An applicant shall certify that the
applicant will make a good faith effort to obtain the license and to
secure the employment necessary to begin fulfilling the program's
service obligation as soon as practicable following completion of the
highest level of education being sought.
The
chancellor shall review each application received. If the chancellor
determines that an applicant is eligible and there are sufficient
funds, the chancellor shall award to the applicant the amount
authorized by division (D) of this section.
(D)
All of the following apply with respect to an applicant's eligibility
and the amount that may be received under the program:
(1)
An applicant may submit only one application each year.
(2)
If an application is approved, the amount awarded shall not exceed
three thousand dollars.
(3)
An award recipient may apply for additional awards in subsequent
years, with each additional award not to exceed three thousand
dollars.
(4)
The maximum number of awards an individual may receive is four.
(E)
The chancellor shall establish procedures for determining whether the
recipient of an award under the program is making a good faith effort
to begin fulfilling the recipient's service obligation as soon as
practicable following completion of the highest level of education
being sought. If the chancellor determines that a good faith effort
is not being made, the chancellor shall seek repayment under the
procedures described in division (F) of this section.
The
chancellor shall establish procedures for monitoring the progress of
a recipient who has commenced the employment necessary to fulfill the
recipient's service obligation. If the chancellor determines that the
recipient has failed to fulfill the service obligation, the
chancellor shall seek repayment under the procedures described in
division (F) of this section.
(F)
The chancellor shall seek repayment of any amount awarded under this
section that remains a loan because the chancellor has determined
that the recipient failed to fulfill the recipient's service
obligation. On request of the chancellor, the attorney general shall
bring and prosecute to judgment a civil action to collect any amount
that is subject to repayment and remains unpaid.
(G)
The nursing student loan-to-grant fund is created in the state
treasury. The fund shall consist of all money appropriated to the
fund by the general assembly. The chancellor shall use the money in
the fund only for purposes of awarding amounts under the nursing
student loan-to-grant program.
Sec.
3333.28.
(A)
The chancellor of higher education shall establish the nurse
education assistance program, the purpose of which shall be to make
loans to students enrolled in prelicensure
nurse
nursing
education
programs
at
institutions
approved
by the board of nursing under section 4723.06 of the Revised Code and
postlicensure
nurse
nursing
education
programs approved by the chancellor under section 3333.04 of the
Revised Code or offered by an institution holding a certificate of
authorization issued under Chapter 1713. of the Revised Code. The
board of nursing shall assist the chancellor in administering the
program.
(B)
There is hereby created in the state treasury the nurse education
assistance fund, which shall consist of all money transferred to it
pursuant to
section
sections
3722.36 and
4743.05
of the Revised Code. The
money
in the
fund
shall be used by the chancellor
for
in
accordance with both of the following:
(1)
For
loans
made under division (A) of this section
and for
;
(2)
For
expenses of administering the
loan
program
,
subject to both of the following:
(a)
Of the money transferred pursuant to section 3722.36 of the Revised
Code, no part shall be used for administrative expenses.
(b)
Of the money transferred pursuant to section 4743.05 of the Revised
Code, the amount used for administrative expenses shall not exceed
the amount that would have been used if no money had been transferred
pursuant to section 3722.36 of the Revised Code
.
(C)
Between July 1, 2005, and January 1, 2012, the chancellor shall
distribute money in the nurse education assistance fund in the
following manner:
(1)(a)
Fifty per cent of available funds shall be awarded as loans to
registered nurses enrolled in postlicensure
nurse
nursing
education
programs described in division (A) of this section. To be eligible
for a loan, the applicant shall provide the chancellor with a letter
of intent to practice as a faculty member at a prelicensure or
postlicensure program for nursing in this state upon completion of
the applicant's academic program.
(b)
If the borrower of a loan under division (C)(1)(a) of this section
secures employment as a faculty member of an approved nursing
education program in this state within six months following
graduation from an approved
nurse
nursing
education
program, the chancellor may forgive the principal and interest of the
student's loans received under division (C)(1)(a) of this section at
a rate of twenty-five per cent per year, for a maximum of four years,
for each year in which the borrower is so employed. A deferment of
the service obligation, and other conditions regarding the
forgiveness of loans may be granted as provided by the rules adopted
under division (D)(7) of this section.
(c)
Loans awarded under division (C)(1)(a) of this section shall be
awarded on the basis of the student's expected family contribution,
with preference given to those applicants with the lowest expected
family contribution. However, the chancellor may consider other
factors the chancellor determines relevant in ranking the
applications.
(d)
Each loan awarded to a student under division (C)(1)(a) of this
section shall be not less than five thousand dollars per year.
(2)
Twenty-five per cent of available funds shall be awarded to students
enrolled in prelicensure
nurse
nursing
education
programs for registered nurses, as defined in section 4723.01 of the
Revised Code.
(3)
Twenty-five per cent of available funds shall be awarded to students
enrolled in
nurse
nursing
education
programs as determined by the chancellor, with preference given to
programs aimed at increasing enrollment in an area of need.
After
January 1, 2012, the chancellor shall determine the manner in which
to distribute loans under this section.
(D)
Subject to the requirements specified in division (C) of this
section, the chancellor shall adopt rules in accordance with Chapter
119. of the Revised Code establishing:
(1)
Eligibility criteria for receipt of a loan;
(2)
Loan application procedures;
(3)
The amounts in which loans may be made and the total amount that may
be loaned to an individual;
(4)
The total amount of loans that can be made each year;
(5)
The percentage of the money in the fund that must remain in the fund
at all times as a fund balance;
(6)
Interest and principal repayment schedules;
(7)
Conditions under which a portion of principal and interest
obligations incurred by an individual under the program will be
forgiven;
(8)
Conditions under which all or a portion of the principal and interest
obligations incurred by an individual who is deployed on active duty
outside of the state or who is the spouse of a person deployed on
active duty outside of the state may be deferred or forgiven.
(9)
Ways that the program may be used to encourage individuals who are
members of minority groups to enter the nursing profession;
(10)
Any other matters incidental to the operation of the program.
(E)
The obligation to repay a portion of the principal and interest on a
loan made under this section shall be forgiven if the recipient of
the loan meets the criteria for forgiveness established by division
(C)(1)(b) of this section, in the case of loans awarded under
division (C)(1)(a) of this section, or by the chancellor under the
rule adopted under division (D)(7) of this section, in the case of
other loans awarded under this section.
(F)
The obligation to repay all or a portion of the principal and
interest on a loan made under this section may be deferred or
forgiven if the recipient of the loan meets the criteria for
deferment or forgiveness established by the chancellor under the rule
adopted under division (D)(8) of this section.
(G)
The receipt of a loan under this section shall not affect a student's
eligibility for assistance, or the amount of that assistance, granted
under section 3333.122, 3333.22, 3333.26, 5910.03, 5910.032, or
5919.34 of the Revised Code, but the rules of the chancellor may
provide for taking assistance received under those sections into
consideration when determining a student's eligibility for a loan
under this section.
(H)
As used in this section, "active duty" means active duty
pursuant to an executive order of the president of the United States,
an act of the congress of the United States, or section 5919.29 or
5923.21 of the Revised Code.
Sec.
3722.01.
As
used in this chapter:
(A)
"Children's hospital" means either of the following:
(1)
A hospital that provides general pediatric medical and surgical care
in which at least seventy-five per cent of annual inpatient
discharges for the preceding two calendar years were individuals less
than eighteen years of age;
(2)
A distinct portion of a hospital that provides general pediatric
medical and surgical care, has a total of at least one hundred fifty
pediatric special care and pediatric acute care beds, and in which at
least seventy-five per cent of annual inpatient discharges for the
preceding two calendar years were individuals less than eighteen
years of age.
(B)
"Health care service" means any of the following:
(1)
Pediatric intensive care;
(2)
Solid organ and bone marrow transplantation;
(3)
Stem cell harvesting and reinfusion;
(4)
Cardiac catheterization;
(5)
Open heart surgery;
(6)
Operation of linear accelerators;
(7)
Operation of cobalt radiation therapy units;
(8)
Operation of gamma knives.
(C)
"Hospital" means an institution or facility that provides
inpatient medical or surgical services for a continuous period longer
than twenty-four hours. "Hospital" includes a children's
hospital.
(D)
"Political subdivision" means a county, township, municipal
corporation, or other body corporate and politic responsible for
governmental activities in a geographic area smaller than that of the
state.
(E)
"Registered
nurse" has the same meaning as in section 4723.01 of the Revised
Code.
(F)
"State
university" has the same meaning as in section 3345.12 of the
Revised Code.
Sec.
3722.21.
(A)
Notwithstanding any conflicting provision of this chapter or any
other provision of the Revised Code, but subject to division (B) of
this section, sections 3722.22 to 3722.40 of the Revised Code apply
to all hospitals and portions of hospitals that use registered nurses
to provide the type of patient care described in sections 3722.22 to
3722.40 of the Revised Code, including both of the following:
(1)
Inpatient facilities and units licensed by the department of
behavioral health under section 5119.33 of the Revised Code;
(2)
Hospitals registered under section 3701.07 of the Revised Code as
long-term acute care hospitals.
(B)
Sections 3722.22 to 3722.40 of the Revised Code do not apply to any
of the following:
(1)
Hospitals managed by the department of behavioral health under
Chapter 5119. of the Revised Code;
(2)
Freestanding inpatient rehabilitation facilities licensed by the
department of health under section 3702.30 of the Revised Code;
(3)
Freestanding birthing centers licensed by the department of health
under section 3702.30 of the Revised Code.
Sec.
3722.22.
(A)
A hospital shall develop a nurse staffing plan that provides
adequate, appropriate, and quality delivery of health care services
and protects patient safety. The hospital's plan shall address all
recommendations the hospital receives from its nurse staffing
committee created under section 3722.23 of the Revised Code.
Once
a proposed plan has been developed, the hospital shall submit the
proposal to its nurse staffing committee for review. If the committee
recommends revisions, the hospital shall revise the proposed plan
accordingly. This process shall continue until the committee has
granted its approval of the plan.
When
the hospital is notified that its nurse staffing committee has
approved the proposed plan, the hospital shall implement the plan in
whole and continue to comply with all of the plan's provisions. Any
proposal to update or otherwise revise the plan is subject to the
same procedures that applied to the development and approval of the
original plan.
The
hospital shall post a copy of its approved nurse staffing plan on a
publicly accessible area of the internet web site maintained by the
hospital. In addition, the hospital shall submit a copy of the plan
to the director of health.
(B)
If a hospital is in operation on the effective date of this section,
the hospital's initial nurse staffing plan shall be developed and
implemented not later than one year after the effective date of this
section. If a hospital begins operation after the effective date of
this section, the hospital's initial nurse staffing plan shall be
developed and implemented as soon as practicable, as determined by
the director of health.
Sec.
3722.23.
(A)
Each hospital shall establish and maintain a nurse staffing
committee. The membership of the committee is subject to all of the
following:
(1)
At least sixty per cent of the membership shall consist of direct
care registered nurses, with at least one registered nurse serving as
a member from each of the hospital's patient care units. These
members shall be elected by their peers.
(2)
If there is a collective bargaining agreement covering the nurses
employed by the hospital, the membership shall include nurses who are
appointed by the labor organization, as defined in section 3517.01 of
the Revised Code, that represents the nurses covered by that
agreement.
(3)
All or part of the remainder of the membership shall consist of a
meaningful representation of direct care staff who serve in positions
that are not considered management positions. These members shall be
elected by their peers.
(B)
The committee shall meet at intervals it considers necessary to
fulfill its responsibilities. Attending a meeting of the committee as
a member or otherwise fulfilling the duties of membership shall be
considered by the hospital as part of a member's regularly scheduled
hours of work for any pay period.
(C)
For purposes of the hospital's nurse staffing plan required by
section 3722.22 of the Revised Code, the committee shall do all of
the following:
(1)
Prepare and submit recommendations for development of the plan;
(2)
Review the hospital's proposed plan and make recommendations for
revisions as the committee considers necessary;
(3)
Approve the hospital's proposed plan once the committee determines
that the plan complies with all of the committee's recommendations;
(4)
Consider any proposed updates or other revisions to an approved plan
by using the same process that applied to its consideration of the
original plan.
(D)
In addition to its duties under division (C) of this section, the
committee may prepare and submit recommendations to the hospital on
any other matter it considers relevant to the staffing, patient
safety, and other provisions of sections 3722.21 to 3722.40 of the
Revised Code.
Sec.
3722.24.
(A)
Except as provided in sections 3722.25 and 3722.26 of the Revised
Code, at all times during each working shift within a particular
patient care unit of a hospital, the hospital shall assign a direct
care registered nurse to not more than the number of patients
identified under division (B) of this section for that unit. The
resulting nurse-to-patient ratios shall be implemented as mandatory
minimum staffing requirements, but these minimum requirements do not
preclude a hospital from electing to implement more stringent
staffing requirements.
(B)
For purposes of division (A) of this section, all of the following
apply with respect to the maximum number of patients who may be
assigned to a direct care registered nurse:
(1)
One patient in either of the following:
(a)
A trauma emergency unit;
(b)
An operating room unit, as long as there is at least one other person
assigned to serve at the same time as an operating room assistant.
(2)
Two patients in a critical care unit, including a unit with any of
the following designations: neonatal intensive care, emergency
critical care, intensive care, labor and delivery, coronary care,
acute respiratory care, postanesthesia care, or burn care;
(3)
Three patients in either of the following:
(a)
A unit with any of the following designations: emergency department
care, pediatric care, step-down care, telemetry care, or antepartum
care;
(b)
A combined unit for labor, delivery, and postpartum care.
(4)
Four patients in either of the following:
(a)
A unit with any of the following designations: medical-surgical care,
intermediate care, or acute psychiatric care;
(b)
Any other specialty care unit not specified in division (B)(4)(a) of
this section.
(5)
Five patients in either of the following:
(a)
A rehabilitation unit;
(b)
A skilled nursing unit, including a unit that has beds registered
under section 3701.07 of the Revised Code as skilled nursing beds,
long-term care beds, or special skilled nursing beds.
(6)
Six patients in either of the following:
(a)
A postpartum care unit, with each mother and infant being counted as
a separate patient;
(b)
A unit designated as a well-baby nursery.
(7)
In the case of a hospital unit that is not identified in divisions
(B)(1) to (6) of this section, the number of patients designated by
the director of health.
(C)
The direct care registered nurse-to-patient staffing ratios that
result from the requirements of divisions (A) and (B) of this section
shall be implemented by a hospital as soon as practicable, as
determined by the director of health, subject to both of the
following time frames in the case of a hospital that is in operation
on the effective date of this section:
(1)
Except as provided in division (C)(2) of this section, the staffing
ratios apply beginning on the date that is two years after the
effective date of this section.
(2)
If the hospital is located in a rural area, as identified by the
director, the staffing ratios apply beginning on the date that is
four years after the effective date of this section.
Sec.
3722.25.
(A)
The director of health may establish direct care registered
nurse-to-patient staffing ratios that are more stringent than the
nurse-to-patient staffing ratios identified in section 3722.24 of the
Revised Code, if both of the following are the case:
(1)
The director has determined that the more stringent staffing ratios
are necessary to protect patient safety.
(2)
The director has consulted with both the hospital and the registered
nurses affected by the more stringent staffing ratios.
(B)
If staffing ratios are established under this section, the affected
hospital shall comply with the staffing ratios in accordance with the
same time frames that apply to the hospital under division (C) of
section 3722.24 of the Revised Code.
Sec.
3722.26.
(A)
Subject to division (B) of this section, a hospital is not required
to comply with the direct care registered nurse-to-patient staffing
ratios identified in section 3722.24 or any more stringent ratios
established under section 3722.25 of the Revised Code during any
public health emergency that applies within this state and has been
declared by an officer of this state or the federal government.
(B)(1)
If a hospital proposes to deviate from the nurse-to-patient staffing
ratios because of a public health emergency, the hospital shall
submit the proposal to its nurse staffing committee created under
section 3722.23 of the Revised Code. The committee shall review the
proposed deviation. If the committee approves the deviation, the
hospital may implement the deviation accordingly.
(2)
Once a deviation is approved by the committee, the hospital shall do
both of the following:
(a)
Submit information to the director of health identifying the
deviation, the reason for it, and the period during which it will be
in effect;
(b)
Not later than ten days after the hospital implements the deviation,
post the same information described in division (B)(2)(a) of this
section on a publicly accessible area of the internet web site
maintained by the hospital.
Sec.
3722.27.
In
assigning registered nurses to a particular hospital unit as part of
implementing the direct care registered nurse-to-patient staffing
ratios identified in section 3722.24 and established under section
3722.25 of the Revised Code, a hospital is subject to all of the
following:
(A)
The hospital shall not assign a registered nurse to a patient care
unit unless the nurse has received an orientation that is sufficient
to provide competent care in that unit and has demonstrated
competence in providing care for that unit. This division applies to
all registered nurses who may be assigned to a unit, including nurses
provided to the hospital by temporary staffing agencies and nurses
who relieve other nurses during breaks, meals, and other routine or
expected absences from the unit.
(B)
The hospital shall not include, as part of meeting the staffing
requirements, any registered nurse who is serving in an
administrative or supervisory position, including a nurse who is
serving as a charge nurse.
(C)
The hospital shall not attempt to meet the staffing requirements by
calculating averages of the number of patients in a unit or the
number of registered nurses assigned to the unit during any
particular working shift or over any other period of time.
(D)
The hospital shall not use video monitors or any other electronic
means of observing a patient as a means of meeting the staffing
requirements.
(E)
The hospital shall not impose mandatory overtime on any registered
nurse as a means of meeting the staffing requirements.
Sec.
3722.28.
In
providing patient care as part of implementing the direct care
registered nurse-to-patient staffing ratios identified in section
3722.24 and established under section 3722.25 of the Revised Code, a
hospital is subject to all of the following:
(A)
The hospital shall not use video monitors or any other electronic
means of observing a patient as a substitute for the direct
observation that is necessary for a registered nurse to conduct
proper patient assessments.
(B)
The hospital shall not place a patient for care in a particular unit
unless the staffing ratios that apply to the unit are sufficient to
meet the level of intensity, type of care, and individual needs of
that patient.
(C)
If the hospital provides care in a unit with adjustable patient
acuity levels, the hospital shall use the staffing ratio that applies
to the highest patient acuity level that exists within the unit
during a working shift.
(D)
If an assessment of a patient's acuity level and nursing care plan
demonstrates that the patient's care requires staffing that is more
stringent than the ratios that would otherwise apply, the hospital
shall provide additional direct care registered nurses, licensed
practical nurses, and other personnel in accordance with the
assessment.
Sec.
3722.29.
(A)
In each of its patient care units, a hospital shall post a uniform
notice that explains the requirements of sections 3722.21 to 3722.40
of the Revised Code. For each working shift in a unit, the hospital
shall include with the uniform notice a posting of both of the
following:
(1)
A description of the direct care registered nurse-to-patient staffing
ratio that applies to the unit;
(2)
The actual number and titles of the direct care registered nurses who
are assigned during the shift.
(B)
The uniform notice and shift-specific information shall be prepared
in a manner prescribed by the director of health. The notice and
information shall be posted in an area of the unit that is visible,
conspicuous, and accessible to the hospital's staff, its patients,
and the public.
Sec.
3722.30.
(A)
A hospital shall develop a system to document the manner in which it
meets the requirements of sections 3722.21 to 3722.40 of the Revised
Code. In accordance with the system, the hospital shall maintain
records of each of the following for not less than three years:
(1)
A copy of each notice posted under section 3722.29 of the Revised
Code;
(2)
The actual staffing levels that occurred in each patient care unit of
the hospital during each working shift;
(3)
Information certifying whether each direct care registered nurse
assigned to a unit received rest and meal breaks during a working
shift and the identities of the individuals who relieved the nurses
during the breaks.
(B)
On request, the records maintained under this section shall be made
available to any of the following:
(1)
The director of health;
(2)
Any registered nurse or the nurse's exclusive representative, as
defined in section 4117.01 of the Revised Code;
(3)
Any member of the general public.
Sec.
3722.31.
With
respect to each patient admitted to a hospital for care in an
inpatient unit, the hospital shall provide the patient or the
patient's representative with the telephone number of the toll-free
patient safety telephone line made available to the public by the
department of health under section 3701.91 of the Revised Code. The
patient or the patient's representative may use the telephone number
to do either or both of the following:
(A)
Seek information regarding the nurse staffing requirements and other
provisions of sections 3722.21 to 3722.40 of the Revised Code;
(B)
Make reports of inadequate staffing or care at the hospital.
Sec.
3722.32.
(A)
With respect to staffing within a hospital and its patient care
units, a registered nurse may object to or refuse to participate in
any activity, policy, practice, assignment, or task if the nurse
reasonably believes any of the following:
(1)
That the hospital is not complying with its mandatory minimum
nurse-to-patient staffing ratios or is otherwise violating sections
3722.21 to 3722.40 of the Revised Code;
(2)
That the activity, policy, practice, assignment, or task poses a risk
to patient safety;
(3)
That the nurse is not prepared by education, training, or experience
to participate, and that doing so would compromise patient safety or
subject the nurse to disciplinary action by the board of nursing.
(B)
If a registered nurse in good faith exercises the authority granted
by division (A) of this section, the hospital shall not take any
retaliatory action against the nurse, including any of following:
(1)
Imposing discipline involving the nurse's employment with the
hospital, including a reduction in the number of hours available for
work, reassignment to a different position or shift, or termination
of employment;
(2)
Filing a complaint or report against the nurse with the board of
nursing.
(C)
If a violation of division (B) of this section occurs, the registered
nurse may submit a complaint against the hospital under section
3722.37 of the Revised Code. In addition to any disciplinary actions
taken against the hospital by the director of health under section
3722.36 of the Revised Code as a result of the complaint and
subsequent investigation, the registered nurse has a cause of action
against the hospital for committing the violation.
Sec.
3722.33.
(A)
The director of health shall conduct audits of a hospital to
determine both of the following:
(1)
Whether the hospital is implementing its staffing plan in accordance
with sections 3722.21 to 3722.40 of the Revised Code;
(2)
Whether the hospital is maintaining records in accordance with
section 3722.30 of the Revised Code.
(B)
The director shall conduct at least one audit of a hospital every six
months. The director may conduct other audits at any time the
director considers necessary for proper enforcement of sections
3722.21 to 3722.40 of the Revised Code.
Sec.
3722.34.
No
hospital shall knowingly do any of the following:
(A)
Fail to develop and implement a staffing plan in accordance with
section 3722.22 of the Revised Code;
(B)
Except as provided in section 3722.26 of the Revised Code, fail to
comply with the staffing plan once it has been implemented;
(C)
Fail to comply in any other manner with sections 3722.21 to 3722.40
of the Revised Code.
Sec.
3722.35.
The
director of health shall investigate alleged violations of section
3722.34 of the Revised Code, including allegations that arise from
complaints received under section 3722.37 of the Revised Code.
An
investigation may be conducted with or without giving advance notice
to the hospital that is the subject of the investigation. In either
case, the hospital shall grant access to the hospital's facilities
and records as considered necessary by the director.
Sec.
3722.36.
(A)
If the director of health determines through an investigation
conducted under section 3722.35 of the Revise Code or through any
other means that a hospital is in violation of section 3722.34 of the
Revised Code, the director shall require the hospital to establish a
corrective action plan and submit the plan to the director. The plan
is subject to approval by the director. On the director's request,
the plan shall be revised accordingly.
(B)(1)
If a violation of section 3722.34 of the Revised Code is not resolved
by the hospital's corrective action plan established under division
(A) of this section, the director shall impose a fine pursuant to an
adjudication under Chapter 119. of the Revised Code. The following
fines apply:
(a)
In the case of a fine that is imposed on the hospital as a business
entity, the amount of the fine for a first offense shall be
twenty-five thousand dollars; for each subsequent offense, the amount
of the fine shall be fifty thousand dollars.
(b)
In the case of a fine that is imposed on an individual who is
employed by the hospital, the amount of the fine shall be twenty
thousand dollars for each offense.
(2)
On the director's request, the attorney general shall bring and
prosecute to judgment a civil action to collect any fine imposed
under division (B)(1) of this section that remains unpaid.
(C)
All fines collected under division (B) of this section shall be
deposited into the state treasury to the credit of the nurse
education assistance fund created under section 3333.28 of the
Revised Code and used only as described in division (B)(1) of that
section.
Sec.
3722.37.
The
director of health shall establish procedures under which a
registered nurse, a hospital patient, or any other person may file a
complaint with the director alleging that a hospital has violated
section 3722.34 of the Revised Code. On receipt of a complaint, the
director shall conduct an investigation as provided in section
3722.35 of the Revised Code.
Sec.
3722.38.
With
respect to the requirements, rights, and remedies established under
sections 3722.21 to 3722.40 of the Revised Code, all of the following
apply:
(A)
A hospital shall not discriminate or retaliate in any manner against
a registered nurse, hospital patient, or any other person who, in
good faith, files a complaint under section 3722.37 of the Revised
Code, presents a grievance to the hospital regarding the staffing
within the hospital's patient care units, or otherwise demonstrates
opposition to any hospital policy, practice, or action that is in
violation of sections 3722.21 to 3722.40 of the Revised Code.
(B)
A hospital shall not interfere with, restrain, or prohibit a person's
exercise of, or attempt to exercise, any of the rights conferred by
sections 3722.21 to 3722.40 of the Revised Code.
(C)
A hospital shall not establish policies that, directly or indirectly,
discourage a registered nurse or any other person from disclosing
information as authorized by sections 3722.21 to 3722.40 of the
Revised Code.
(D)
A hospital shall not intimidate a registered nurse or any other
person who makes public statements regarding hospital staffing.
Sec.
3722.39.
(A)
With respect to the practice of registered nursing, particularly in
relation to a hospital's nurse staffing plan implemented under
section 3722.22 of the Revised Code, the general assembly recognizes
all of the following:
(1)
All registered nurses have a duty and right to act based on their
professional judgment and in accordance with the statutes and rules
that apply to their practice.
(2)
All registered nurses have the duty and right to provide care in the
exclusive interests of their patients.
(3)
All registered nurses have the duty and right to act as advocates for
their patients.
(B)
In recognizing the matters described in division (A) of this section,
the general assembly finds that a registered nurse, before the nurse
may accept a patient assignment, is responsible for determining all
of the following:
(1)
Whether the nurse has the necessary professional knowledge, judgment,
skills, and ability to care for the patient;
(2)
Whether the nurse is competent to provide the required care;
(3)
Whether accepting the assignment would create harm for either the
patient or the nurse.
Sec.
3722.40.
As
a means of increasing transparency and accountability regarding
hospital nurse staffing plans implemented under section 3722.22 of
the Revised Code, both of the following apply:
(A)
On a semi-annual basis, each hospital shall prepare and make publicly
available a report that includes a description of the hospital's
staffing levels in relation to its nurse staffing plan, a description
of any deviations from the plan that occurred under section 3722.26
of the Revised Code, and a summary of each meeting held by the
hospital's nurse staffing committee under section 3722.23 of the
Revised Code.
(B)
The department of health shall maintain an internet web site
dashboard that displays information regarding the extent to which
hospitals are in compliance with their nurse staffing plans and all
other provisions that apply to hospitals under sections 3722.21 to
3722.40 of the Revised Code. The dashboard may be included as a part
of the department's general web site, but regardless of whether it is
included in this manner or maintained separately, the dashboard shall
be made accessible to the public.
Sec.
4723.489.
A
person not otherwise authorized to administer drugs may administer a
drug to a specified patient if all of the following conditions are
met:
(A)
The authority to administer the drug is delegated to the person by an
advanced practice registered nurse who is a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
and holds a license issued under section 4723.42 of the Revised Code.
(B)
The drug is not listed in the formulary established in rules adopted
under section 4723.50 of the Revised Code, is not a controlled
substance, and is not to be administered intravenously.
(C)
The drug is to be administered at a location other than
a
any
of the following:
(1)
A
hospital
inpatient care unit
,
as defined in section 3727.50 of the Revised Code
;
a
(2)
A
hospital
emergency department or a freestanding emergency department;
or an
(3)
An
ambulatory
surgical facility
,
as defined in
licensed
under
section
3702.30 of the Revised Code.
(D)
The person has successfully completed education based on a recognized
body of knowledge concerning drug administration and demonstrates to
the person's employer the knowledge, skills, and ability to
administer the drug safely.
(E)
The person's employer has given the advanced practice registered
nurse access to documentation, in written or electronic form, showing
that the person has met the conditions specified in division (D) of
this section.
(F)
The advanced practice registered nurse is physically present at the
location where the drug is administered.
Sec.
4730.203.
(A)
Acting pursuant to a supervision agreement, a physician assistant may
delegate performance of a task to implement a patient's plan of care
or, if the conditions in division (C) of this section are met, may
delegate administration of a drug. Subject to division (D) of section
4730.03 of the Revised Code, delegation may be to any person. The
physician assistant must be physically present at the location where
the task is performed or the drug administered.
(B)
Prior to delegating a task or administration of a drug, a physician
assistant shall determine that the task or drug is appropriate for
the patient and the person to whom the delegation is to be made may
safely perform the task or administer the drug.
(C)
A physician assistant may delegate administration of a drug only if
all of the following conditions are met:
(1)
The physician assistant has been granted physician-delegated
prescriptive authority and is authorized to prescribe the drug.
(2)
The drug is not a controlled substance.
(3)
The drug will not be administered intravenously.
(4)
The drug will not be administered in
a
any
of the following locations:
(a)
A
hospital
inpatient care unit
,
as defined in section 3727.50 of the Revised Code
;
a
(b)
A
hospital
emergency department
;
or
a
freestanding emergency department;
or an
(c)
An
ambulatory
surgical facility licensed under section 3702.30 of the Revised Code.
(D)
A person not otherwise authorized to administer a drug or perform a
specific task may do so in accordance with a physician assistant's
delegation under this section.
Sec.
4772.092.
(A)
Acting pursuant to a supervision agreement, a certified mental health
assistant may delegate performance of a task to implement a patient's
plan of care or, if the conditions in division (C) of this section
are met, may delegate administration of a drug. Subject to division
(D) of section 4772.03 of the Revised Code, delegation may be to any
person. The certified mental health assistant must be physically
present at the location where the task is performed or the drug
administered.
(B)
Prior to delegating a task or administration of a drug, a certified
mental health assistant shall determine that the task or drug is
appropriate for the patient and the person to whom the delegation is
to be made may safely perform the task or administer the drug.
(C)
A certified mental health assistant may delegate administration of a
drug only if all of the following conditions are met:
(1)
The certified mental health assistant has been granted
physician-delegated prescriptive authority by the physician
supervising the certified mental health assistant and is authorized
to prescribe the drug.
(2)
The drug is not a controlled substance.
(3)
The drug will not be administered intravenously.
(4)
The drug will not be administered in
a
any
of the following:
(a)
A
hospital
inpatient care unit
,
as defined in section 3727.50 of the Revised Code
;
a
(b)
A
hospital
emergency department
;
or
a
freestanding emergency department;
or an
(c)
An
ambulatory
surgical facility licensed under section 3702.30 of the Revised Code.
(D)
A person not otherwise authorized to administer a drug or perform a
specific task may do so in accordance with a certified mental health
assistant's delegation under this section.
Section
2.
That
existing sections 3333.28, 3722.01, 4723.489, 4730.203
,
and 4772.092
of the Revised Code are hereby repealed.
Section
3.
That
sections 3727.50, 3727.51, 3727.52, 3727.53, 3727.54, 3727.55,
3727.56, and 3727.57 of the Revised Code are hereby repealed.
Section
4.
Not
later than one year after the effective date of this section, the
Director of Health, in consultation with the Board of Nursing and the
Department of Higher Education, shall prepare a report containing
recommendations for ensuring that sufficient numbers of nurses are
available in this state to meet the hospital nurse staffing
requirements established under sections 3722.21 to 3722.40 of the
Revised Code. On completion of the report, the Director shall submit
copies to the General Assembly in accordance with section 101.68 of
the Revised Code.
Section
5.
All
items in this act are hereby appropriated as designated out of any
moneys in the state treasury to the credit of the designated fund.
For all operating appropriations made in this act, those in the first
column are for fiscal year 2026 and those in the second column are
for fiscal year 2027. The operating appropriations made in this act
are in addition to any other operating appropriations made for these
fiscal years.
Section
6.
1
2
3
4
5
A
BOR
DEPARTMENT OF HIGHER EDUCATION
B
Dedicated
Purpose Fund Group
C
5BA1
235683
Nursing
Student Loan-to-Grant Program
$10,000,000
$10,000,000
D
TOTAL
DPF Dedicated Purpose Fund Group
$10,000,000
$10,000,000
E
TOTAL
ALL BUDGET FUND GROUPS
$10,000,000
$10,000,000
NURSING
STUDENT LOAN-TO-GRANT PROGRAM
The
foregoing appropriation item 235683, Nursing Student Loan-to-Grant
Program, shall be used by the Chancellor of Higher Education to
support the Nursing Student Loan-to-Grant Program pursuant to section
3333.27 of the Revised Code.
An
amount equal to the unexpended, unencumbered balance of the foregoing
appropriation item 235683, Nursing Student Loan-to-Grant Program, at
the end of fiscal year 2026 is hereby reappropriated for the same
purpose in fiscal year 2027.
Section
7.
Within
the limits set forth in this act, the Director of Budget and
Management shall establish accounts indicating the source and amount
of funds for each appropriation made in this act, and shall determine
the manner in which appropriation accounts shall be maintained.
Expenditures from operating appropriations contained in this act
shall be accounted for as though made in, and are subject to all
applicable provisions of, H.B. 96 of the 136th General Assembly.
Section
8.
On
the effective date of this section, or as soon as possible
thereafter, the Director of Budget and Management shall transfer
$20,000,000 cash from the General Revenue Fund to the Nursing Student
Loan-to-Grant Fund (Fund 5BA1).
Section
9.
This
act shall be known as the Ohio Nurse Workforce and Safe Patient Act.