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As Introduced
136th
General Assembly
Regular
Session
S. B. No. 373
2025-2026
Senators Blessing, Antonio
To
amend sections 3727.50, 3727.51, 3727.52, 3727.55, and 3727.56; to
enact new section 3727.53 and section 4123.293; and to repeal
sections
3727.53
and 3727.54
of the Revised Code
to
revise the law governing hospital-wide nursing care committees and
hospital nursing services staffing plans.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 3727.50, 3727.51, 3727.52, 3727.55, and 3727.56 be amended
and new section 3727.53 and section 4123.293 of the Revised Code be
enacted to read as follows:
Sec.
3727.50.
As
used in this section and sections 3727.51 to 3727.57 of the Revised
Code:
(A)
"Direct
patient care" means care provided by a nurse with direct
responsibility to carry out medical regimens or nursing care for one
or more patients.
(B)
"Hospital"
means a facility or institution licensed under Chapter 3722. of the
Revised Code.
(B)
"Hospital administrator" means an individual who is both of
the following:
(1)
Employed by or under contract with a hospital in an executive,
managerial, or supervisory capacity;
(2)
Authorized by the hospital to direct, discipline, evaluate, fire, or
hire nursing staff or to establish one or more hospital-wide policies
affecting nursing practice, staffing levels, or patient care
operations.
"Hospital
administrator" includes a hospital's chief executive officer,
chief nursing officer, or chief operating officer, the director of a
hospital department, or the manager of a hospital unit.
(C)
"Inpatient
care unit" means a hospital unit, including an operating room or
other inpatient care area, in which nursing care is provided to
patients who have been admitted to the hospital.
(C)
"Nurse" means a person who is licensed to practice as a
registered nurse under Chapter 4723. of the Revised Code or, if the
hospital employs licensed practical nurses, a person who is licensed
to practice as a licensed practical nurse under that chapter.
(D)
"Licensed practical nurse" and "registered nurse"
have the same meanings as in section 4723.01 of the Revised Code.
(E)
"Unit-specific minimum staffing level" means the minimum
number of registered nurses and licensed practical nurses assigned to
provide direct patient care in a specific inpatient care unit of a
hospital during an employment shift.
Sec.
3727.51.
(A)
Each
hospital shall convene a hospital-wide nursing care committee not
Not
later
than ninety days after the effective date of this
section
or, if the hospital is not treating patients on the effective date of
this section, ninety days after the hospital begins to treat
patients
amendment,
each hospital shall convene a hospital-wide nursing care committee
.
The
In
the case of a hospital that begins operation after the effective date
of this amendment, the hospital shall convene such a committee not
later than ninety days after the hospital begins operation.
The
hospital
shall select the members of the committee, subject to all of the
following:
(1)
The hospital's chief nursing officer shall be included as a member of
the committee
and other hospital administrators also may be included as members,
but only if the total number of hospital administrator members does
not exceed thirty per cent of the committee's membership
.
(2)
At
Subject
to division (B) of this section, at
least
fifty
fifty-one
per
cent of the committee's membership shall consist of registered nurses
who provide direct patient care in the hospital.
(3)
The number of registered nurses included as members of the committee
shall be sufficient to provide adequate representation of all types
of nursing care services provided in the hospital.
(B)
The
committee member who is the hospital's chief nursing officer shall
establish a mechanism for obtaining input from nurses in all
inpatient care units who provide direct patient care regarding what
the nursing services staffing plan recommendations described in
division (B) of section 3727.52 of the Revised Code should include
In
the case of a hospital that has bargained collectively with the
registered nurses who are employed by or under contract with the
hospital, the hospital shall not select all of the members of the
committee described in division (A)(2) of this section. In such a
case, the collective bargaining representative for the hospital's
registered nurses shall select a majority of the members described in
division (A)(2) of this section, with the hospital being responsible
for selecting the remainder of those members
.
Sec.
3727.52.
A
(A)
Not later than ninety days after a
hospital-wide
nursing care committee
is
convened
pursuant to section 3727.51 of the Revised Code
,
and
then every two years thereafter, the hospital-wide nursing care
committee
shall
do
both
all
of
the following:
(A)
If one exists, evaluate the hospital's current
(1)
Review the hospital's
nursing
services staffing plan
in effect at the time of the review
;
(B)
Recommend a nursing services staffing plan that is, at a minimum,
consistent with current standards established by private
accreditation organizations or governmental entities and addresses
(2)
Consider
all
of the following
factors related to nursing services staffing
:
(1)
(a)
The selection, implementation, and evaluation of minimum staffing
levels
that
ensure,
for
all inpatient care units
that ensure
,
that the hospital has a staff of competent nurses with the
specialized skills needed to meet patient needs in accordance with
evidence-based safe nurse staffing standards;
(2)
(b)
The complexity of complete care
,
;
the requirements for
assessment
of
patients
on
patient
admission
,
;
the
volume of patient admissions, discharges
,
and transfers
,
;
the
evaluation of the progress of a patient's problems
,
;
and
the amount of time needed for patient education, ongoing
physical
patient
assessments,
planning for a patient's discharge, assessment after a change in
patient condition, and assessment of the need for patient referrals;
(3)
(c)
Patient acuity and the number of patients for whom care is being
provided;
(4)
(d)
The need for ongoing assessments of a unit's
patients
and its
nursing
staff levels
relative to its patients
;
(5)
(e)
The hospital's policy for identifying additional nurses who can
provide direct patient care when patients' unexpected needs exceed
the planned workload for direct care staff.
(3)
Following the review of a nursing services staffing plan under
division (A)(1) of this section, develop a replacement plan that
establishes for a two-year period unit-specific minimum staffing
levels for each inpatient care unit, ensuring that the hospital has a
staff of competent nurses with the specialized skills needed to meet
patient needs in accordance with evidence-based safe nurse staffing
standards.
(B)
In developing one or more nursing services staffing plans under this
section, in particular such a plan's unit-specific minimum staffing
levels, the hospital-wide nursing care committee shall express those
minimum staffing levels in either of the following terms:
(1)
A fixed nurse-to-patient ratio;
(2)
A ratio range that specifies a permissible minimum and maximum number
of patients per nurse, provided that such a range ensures safe
patient care and meets evidence-based safe nurse staffing standards.
(C)
As soon as practicable after the development of a nursing services
staffing plan, the hospital-wide nursing care committee shall hold a
vote to determine if the committee should approve the plan. Such a
plan may be approved only by a majority vote of the committee.
Sec.
3727.53.
(A)
Except as provided in division (B) of this section, as soon as
practicable after a hospital-wide nursing care committee develops and
approves a nursing services staffing plan under section 3727.52 of
the Revised Code, the hospital shall adopt and implement the staffing
plan for the two-year period that begins on the date of the plan's
adoption.
(B)
Subject to division (C) of this section, during the two-year period
in which a nursing services staffing plan is in effect, a hospital
may adjust the plan's unit-specific minimum staffing levels, but only
in either the following circumstances:
(1)
When patient care needs exceed the plan's unit-specific minimum
staffing levels, but only if staffing levels are adjusted with the
assistance of the model identified in section 3727.55 of the Revised
Code and the patient acuity assessment tool adopted under that
section;
(2)
When a public health emergency has been declared for a time period
not exceeding ninety days, for the geographic area in which the
hospital is located, and in response to a health threat that poses a
significant risk to the area's population.
(C)
Any adjustment to the nursing staffing services plan as described in
division (B) of this section takes effect only on approval by a
majority vote of the hospital-wide nursing care committee.
(D)
A hospital shall file with the department of health a nursing
services staffing plan in accordance with the following schedule:
(1)
Not later than thirty days after any such plan is adopted under
division (A) of this section;
(2)
Not later than thirty days after an adjusted plan is approved under
division (C) of this section.
(E)
Each calendar quarter, a hospital shall make a prompt and diligent
effort to adhere to its nursing services staffing plan at least
eighty per cent of the time in each inpatient unit, except that
during a public health emergency as described in division (B)(2) of
this section, a hospital shall make a prompt and diligent effort to
adhere to its nursing services staffing plan at least sixty per cent
of the time in each hospital unit.
(F)(1)
A hospital shall submit to the department of health on a quarterly
basis compliance reports for the hospital. Each report shall include
the following information: compliance rates organized by unit-level;
approved variances; and a summary of corrective actions taken when
the percentages described in division (E) of this section were not
met.
(2)
Before a report is submitted under division (F)(1) of this section,
the report shall be certified by the hospital's chief nursing officer
and a direct care nurse who serves as a co-chairperson for the
hospital's hospital-wide nursing care committee.
(3)
Not later than thirty days after receiving a compliance report
submitted under division (F)(1) of this section, the department of
health shall make the report publicly available on the internet web
site maintained by the department.
(4)
When making reports publicly available under division (F)(3) of this
section, the department shall use a format that is accessible to the
public and searchable by hospital name, location, and reporting
period. The department also shall ensure that such reports include
the information described in division (F)(1) of this section.
(G)
The department of health may audit a hospital if either of the
following circumstances occurs:
(1)
A compliance report submitted by a hospital as required by division
(F) of this section indicates that the hospital's compliance rate for
any unit falls below the percentages described in division (E) of
this section;
(2)
The department receives three or more complaints about the hospital's
compliance rates that the department determines are credible and
substantiated.
(H)
If the department of health determines that a hospital has not made a
prompt and diligent effort to adhere to the hospital's nursing
services staffing plan at the percentages described in division (E)
of this section, the department shall assess a fine on the hospital
in an amount that is equal to five times the average hourly wage for
each hour of staffing under the staffing percentages. The department
shall deposit any fines collected under this division to the credit
of the nurse education grant program fund created under section
4723.063 of the Revised Code.
Sec.
3727.55.
To
provide staffing flexibility to meet patient needs, every
hospital
hospital-wide
nursing care committee
shall
identify a model for adjusting
the
a
nursing
services staffing plan
created
adopted
under
section 3727.53 of the Revised Code for each inpatient care unit.
Every
hospital-wide nursing care committee also shall adopt a standardized,
evidence-based patient acuity assessment tool for use in adjusting a
nursing services staffing plan.
Sec.
3727.56.
(A)
A hospital shall provide copies of its nursing services staffing plan
created
adopted
under
section 3727.53 of the Revised Code, in accordance with both of the
following:
(1)
Free of charge, a copy of the staffing plan and subsequent changes to
the plan shall be provided to each member of the hospital's nursing
staff.
(2)
For a fee not to exceed actual copying costs, a copy of the staffing
plan shall be provided to any person who requests it.
(B)
In a conspicuous location in the hospital, a notice shall be posted
informing the public of the availability of the staffing plan. The
notice shall specify the appropriate person, office, or department to
be contacted to review or obtain a copy of the staffing plan.
Sec.
4123.293.
(A)
As used in this section, "hospital" has the same meaning as
in section 3727.50 of the Revised Code.
(B)
The administrator of workers' compensation, subject to the approval
of the bureau of workers' compensation board of directors, shall
establish a program to encourage a hospital to adhere to its nursing
services staffing plan adopted under section 3727.53 of the Revised
Code. The administrator, in consultation with the director of health,
shall establish all of the following:
(1)
A discount on premium rates for a hospital that adheres to a staffing
plan at least eighty per cent of the time in each inpatient unit in a
calendar year during normal operations and at least sixty per cent of
the time in each hospital unit during a public health emergency as
described in division (B)(2) of section 3727.53 of the Revised Code;
(2)
Procedures for verifying eligibility for a discount under the
program;
(3)
A process for resolving disputes related to the amount of a discount
and the eligibility for a discount.
Section
2.
That
existing sections 3727.50, 3727.51, 3727.52, 3727.55, and 3727.56 of
the Revised Code are hereby repealed.
Section
3.
That
sections
3727.53
and 3727.54
of the Revised Code
are
hereby
repealed.