An Act To Provide Safe Staffing Levels for Patients and To Retain Registered Nurses
Maine Legislature, Session 121, LD 0616
Committee: Health and Human Services
Sponsors: PENDLETON, RICHARDSON, CARPENTER, DAGGETT, KNEELAND, MARTIN, ANDREWS, DAVIS, PERRY
Amends: 22 MRSA §1832

Legislative Document 
No. 616 
S.P.225 
In Senate, February 11, 2003 
An Act To Provide Safe Staffing Levels for Patients and To Retain 
Registered Nurses 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator PENDLETON of Cumberland. 
Cosponsored by Representative RICHARDSON of Brunswick and 
JOY J. O'BRIEN 
Secretary of the Senate 
Senators: CARPENTER of York, President DAGGETT of Kennebec, KNEELAND of 
Aroostook, MARTIN of Aroostook, Representatives: ANDREWS of York, DAVIS of 
Falmouth, DUGA Y of Cherryfield, PERRY of Calais. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA §1832 is enacted to read: 
§1832. 
Hospital staffing 
Staffing in all hospitals licensed under this chapter is 
subject to the provisions of this section. 
1. 
Definitions. 
As 
used 
in this 
section, 
unless 
the 
context 
otherwise 
indicates, 
the 
following 
terms 
have 
the 
following meanings. 
A. 
"Acuity-based patient classification system" or "system" 
means 
a 
standardized set of criteria based on scientific 
data that acts as a measurement instrument that is used to 
predict registered nursing care requirements for individual 
patients based on the severity of patient illness, the need 
for specialized equipment and technology, the intensity of 
required 
nursing 
interventions 
and 
the 
complexity 
of 
clinical nursing judgment required to design, implement and 
evaluate the patient's nursing care plan consistent with 
professional standards. 
The system calculates, in a manner 
that can be readily understood and used, 
the 
number 
of 
direct-care registered nurses and the skill mix of nursing 
personnel required on a daily basis for each patient. 
B. 
"Direct-care registered nurse" means a registered nurse 
who 
has 
accepted direct responsibility for 
carrying out 
medical 
regimens, 
nursing 
and 
other 
bedside 
care 
for 
patients. 
2. 
Minimum staffing ratios. 
The minimum staffing ratios 
for general, acute and specialty hospitals are established in 
this subsection for direct-care registered nurses as follows: 
A. 
For 
an 
intensive 
care unit, 
one 
nurse 
to every 
patients; 
B. 
For a critical care unit, one nurse to every 2 patients; 
C. 
For a neonatal intensive care unit, one nurse to every 2 
patients; 
D. 
For a burn unit, one nurse to every 2 patients; 
E. 
For a step down, 
intermediate care unit, one nurse to 
every 3 patients; 
Page l-LR0469(1) 
F. 
For an operating room while under anesthesia, one nurse 
to every patient; and post anesthesia, one nurse to every 2 
patients; 
G. 
For 
a 
post anesthesia 
care 
unit 
while 
still 
under 
anesthesia, one nurse to every patient; and post anesthesia, 
one nurse to every 2 patients; 
H. 
For 
an 
emergency department, 
one 
nurse 
to 
every 
patients; in emergency critical care, one nurse to every 
patient; 
and 
in 
emergency 
trauma, 
one 
nurse 
to 
every 
patient. 
In 
an 
emergency 
department, 
triage, 
radio 
or 
special ty registered nurses do not count in calculation of 
nurse staffing; 
I. 
For labor and delivery in active labor, one nurse to 
every patient; in immediate postpartum, one nurse to every 2 
patients; in postpartum and well baby nursery, one nurse to 
every 6 patients; and in immediate care nursery, one nurse 
to every 4 patients; 
J. 
For 
pediatrics, 
psychiatrics, 
medical surgical, 
telemetry, observational and outpatient units, one nurse to 
every 4 patients; 
K. 
For 
a 
transitional care and rehabilitation unit, 
one 
nurse to every 5 patients; and 
~L~. __ ~F~o~r~~s~pecialty care 
of 
noncritical, 
stable-condition 
patients and any unit not listed above, one nurse to every 3 
patients. 
Addi tional direct-care registered nurses must be added and the 
ratio adjusted to ensure staffing in accordance with acuity based 
patient classification systems. 
3. 
Restriction. 
The following activities are prohibited. 
A. 
A hospital 
may 
not 
directly 
assign 
any 
unlicensed 
personnel to perform registered-nurse functions in lieu of 
care delivered by a licensed registered nurse. 
B. Unlicensed personnel may not perform tasks that require 
the clinical assessment, 
judgment and skill of a licensed 
registered 
nurse, 
including, 
without 
limitation, 
nursing 
activities 
that 
require 
nursing 
assessment 
and 
judgment 
during implementation; 
physical, 
psychological 
and social 
assessment 
that 
require 
nursing 
judgment, 
intervention, 
referral or follow-up; formulation of a plan of nursing care 
and 
evaluation 
of 
the 
patient's 
response 
to 
the 
care 
provided; and administrat.ion of medications. 
C. 
A 
hospital 
may 
not 
impose 
mandatory 
overtime 
requirements 
to 
meet 
the 
staffing 
ratios 
imposed 
in 
subsection 2. 
4. 
Consumer protection. 
A hospital subject to this section 
shall daily post in a con~ic~~lace visible to the public the 
ratio of registered nursing staff to patients on each unit. 
A 
hospital subject to this section shall give to each patient 
admitted to the hospital for inpatient care a toll-free telephone 
number for the Bureau of Medical Services, Division of Licensing 
and Certification to report inadequate staffing or care. 
5. 
Enforcement. 
A hospital that violates the provisions of 
this section is subject to enforcement action by the department, 
including suspension or revocation of license to operate, and is 
subject to a fine not to exceed $25,000 per violation. 
6. 
Rules. 
The department shall adopt rules to implement 
this section. 
By November 
1, 
2004 the department shall adopt 
rules 
for establishing an acuity-based patient classification 
system in hospitals. 
Rules adopted pursuant to this section are 
major substantive rules as defined in Title 5, 
chapter 
375, 
subchapter 2-A. 
SUMMARY 
This 
bill 
imposes 
minimum 
staffing 
requirements 
for 
nurse-to-patient staffing on all hospitals with an increase of 
nurses required based on the acuity of the patients. 
The bill 
directs the Department of Human Services to adopt rules, which 
are classified as major substantive rules, for establishing an 
acuity-based patient classification system in hospitals.