An Act to Address Unsafe Staffing of Nurses and Improve Patient Care
Maine Legislature, Session 131, LD 1639
Committee: Labor and Housing
Sponsors: BRENNER, TALBOT ROSS, HICKMAN, JACKSON, TIPPING, GEIGER, GRAHAM, MADIGAN, ROEDER, STOVER
Amends: 22 MRSA §1817

Legislative Document
No. 1639
S.P. 656
In Senate, April 12, 2023
An Act to Address Unsafe Staffing of Nurses and Improve Patient 
Care
Reference to the Committee on Labor and Housing suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator BRENNER of Cumberland.
Cosponsored by Speaker TALBOT ROSS of Portland and
Senators: HICKMAN of Kennebec, President JACKSON of Aroostook, TIPPING of 
Penobscot, Representatives: GEIGER of Rockland, GRAHAM of North Yarmouth, 
MADIGAN of Waterville, ROEDER of Bangor, STOVER of Boothbay.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA c. 404-A is enacted to read:
CHAPTER 404-A
HEALTH CARE FACILITY STAFFING
§1791.  Short title
This chapter may be known and cited as "the Maine Quality Care Act."
§1792. Application and construction
1. Application.  All health care facilities are subject to the requirements of this chapter.
2. Construction.  This chapter may not be construed to:
A. Change the scope of practice of registered nurses licensed under Title 32, chapter 
31, subchapter 3; or
B. Provide an exemption from the minimum staffing requirements of direct-care 
registered nurses if the patient condition or patient care unit name is different from the 
term used in this chapter but the services provided are substantially similar.
§1793. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1. Ancillary staff person.  "Ancillary staff person" means any person who supports 
patient care services in a health care facility through regular, delegated tasks performed 
under the coordination of a direct-care registered nurse for the delivery of safe, therapeutic 
and effective patient care.
2. Competency.  "Competency" means the ability of a direct-care registered nurse to 
integrate and act on the nurse's knowledge, skills, professional judgment and experience to 
ensure safe, therapeutic and effective care to a specific patient population and for the 
severity of illness in each patient care unit.
3. Declared state of emergency.  "Declared state of emergency" means an emergency 
declared by an authorized person within federal, state or local government relating to 
circumstances that are unpredictable and unavoidable, affect the delivery of medical care 
and require an immediate or exceptional level of emergency or other medical services at a 
particular health care facility.  "Declared state of emergency" does not include an 
emergency relating to a labor dispute in the health care industry or consistent understaffing 
in a health care facility.
4. Direct-care registered nurse.  "Direct-care registered nurse" means a registered 
nurse licensed under Title 32, chapter 31, subchapter 3 who is primarily responsible for 
providing direct, in-person, hands-on patient care in a health care facility by engaging in 
the nursing process within the nurse's scope of practice while exercising professional 
judgment in the best interests of the patient at all times.
5. Health care facility.  "Health care facility" means a hospital licensed under chapter 
405, a freestanding emergency department or an ambulatory surgical facility licensed under 
chapter 405.
6. Patient care unit.  "Patient care unit" means any area of a health care facility in 
which a patient receives care.
7. Professional judgment.  "Professional judgment" means the application of a direct-
care registered nurse's knowledge, expertise and experience and the nurse's assessment of 
a patient, data, information and scientific evidence to understand the problems, issues or 
concerns of a patient, to ensure safe, therapeutic and effective patient care and to make 
independent decisions about a patient's care, including whether the assignment of ancillary 
staff persons is appropriate.
§1794. Minimum staffing requirements of direct-care registered nurses
Except as provided in section 1795, a health care facility shall assign at least the 
number of direct-care registered nurses at all times during every shift consistent with the 
minimum requirements established in this section and at no time may a health care facility 
assign fewer than 2 direct-care registered nurses in a patient care unit.
1. Requirements.  A health care facility shall assign a direct-care registered nurse to 
no more than:
A. One patient when:
(1)  The patient is receiving critical care or intensive care; or
(2)  The nurse is assigned to a patient care unit, other than a unit providing 
emergency services, that receives patients requiring critical care or intensive care, 
including, but not limited to, a critical care unit, an intensive care unit or a patient 
care unit with neonatal intensive care or pediatric intensive care patients;
B. One patient when:
(1)  The patient is in an operating room; or
(2)  The nurse is assigned to an operating room.
The health care facility shall assign a minimum of one scrub assistant for each patient 
in an operating room in addition to the assigned direct-care registered nurse;
C. One patient when the patient is receiving conscious sedation;
D. One patient when:
(1)  The patient is receiving postanesthesia care; or
(2)  The nurse is assigned to a patient care unit that receives patients who require 
postanesthesia care, including, but not limited to, a pediatric postanesthesia care 
unit;
E. Three patients when:
(1)  The patients are receiving step-down or intermediate care; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring step-
down or intermediate care, including, but not limited to, a step-down or 
intermediate care unit;
F. Three patients when:
(1)  The patients are receiving emergency medical services and do not require 
critical care or trauma services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring 
emergency medical services, including, but not limited to, an emergency 
department or emergency room;
G. One patient when the patient is receiving emergency services and requires critical 
care;
H. One patient when the patient is receiving emergency services and requires trauma 
services;
I. Three patients when the patients are antepartum and not in active labor;
J. Two patients when the patients are antepartum and require continuous fetal 
monitoring;
K. One patient when the nurse is assigned to initiate the patient for epidural anesthesia 
or the nurse is assigned as the circulating nurse for a cesarean delivery;
L. One patient when the patient is in active labor;
M. One patient who is giving birth when the nurse has been assigned only to that patient 
and one newborn patient when the nurse has been assigned only to that newborn 
patient;
N. One newborn patient when the patient is unstable, as determined by the nurse;
O. One patient couplet of one parent and one newborn when the parent has given birth 
within the previous 2 hours.  In the case of multiple births, one direct-care registered 
nurse must be assigned for each additional newborn when the direct-care registered 
nurse has been assigned only to that newborn;
P. Two patient couplets of one parent and one newborn when the patients are 
postpartum;
Q. Four patients when the patients are receiving postpartum or postoperative 
gynecological care and when the nurse has been assigned only to patients receiving 
postpartum or postoperative gynecological care;
R. Two newborn patients when:
(1)  The patients are receiving intermediate care; or
(2)  The nurse has been assigned to a patient care unit that receives newborn 
patients requiring intermediate care, including, but not limited to, an intermediate 
care nursery;
S. Three patients when:
(1)  The patients have not attained 18 years of age; or
(2)  The nurse is assigned to a patient care unit that receives patients who have not 
attained 18 years of age, including, but not limited to, a pediatric unit;
T. Two patients who have not attained 18 years of age when: 
(1)  The patients are receiving bone marrow transplant services; or
(2)  The nurse is assigned to a patient care unit that receives bone marrow transplant 
patients who have not attained 18 years of age;
U. One patient when:
(1)  The patient is receiving coronary care services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring 
coronary care services;
V. One patient when:
(1)  The patient requires burn care services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring burn 
care services;
W. One patient when: 
(1)  The patient is receiving acute respiratory care services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring acute 
respiratory care services;
X. Three patients when: 
(1)  The patients are receiving telemetry services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring 
telemetry services;
Y. Four patients when:
(1)  The patients are receiving medical surgical care services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring 
medical surgical care services;
Z. Three patients when:
(1)  The patients are receiving observational care services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring 
observational care services;
AA. Four patients when:
(1)  The patients are receiving acute rehabilitation services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring acute 
rehabilitation services;
BB. Four patients when:
(1)  The patients are receiving specialty care services; or
(2)  The nurse is assigned to a patient care unit receiving patients requiring 
specialty care services, including, but not limited to, a specialty care unit, 
neurological care unit, gastrointestinal unit, orthopedic unit or any other unit that 
is organized, operated and maintained to provide care for a specific medical 
condition or a specific patient population;
CC. Four patients when:
(1)  The patients are receiving presurgical admissions services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring 
presurgical admissions services;
DD. Four patients when:
(1)  The patients are receiving ambulatory surgical care services or procedures; or
(2)  The nurse is assigned to a patient care unit that provides ambulatory surgical 
care services or procedures;
EE. Four patients when:
(1)  The patients are receiving psychiatric treatment or services; or
(2)  The nurse is assigned to a patient care unit that receives patients requiring 
psychiatric treatment or services; and
FF. Four patients in any other patient care unit or for any other patient condition.
A health care facility may assign a direct-care registered nurse to patients receiving triage 
services as long as the nurse is performing only triage functions and is able to be 
immediately available to patients requiring triage services arriving in a patient care unit 
that receives patients requiring emergency medical services, including, but not limited to, 
an emergency department or emergency room.
2. Intensity of care.  A health care facility shall assign direct-care registered nurses in 
a patient care unit in accordance with subsection 1 in order to meet the highest level of 
intensity and type of care provided in the patient care unit.  If more than one requirement 
in subsection 1 applies to a patient, a health care facility shall assign a direct-care registered 
nurse in accordance with the lowest numerical patient assignment applicable to the patient.
3. Patient need.  If, in the professional judgment of a direct-care registered nurse, a 
patient requires the assignment of more than the number of direct-care registered nurses 
required in accordance with this section, a health care facility shall assign additional direct-
care registered nurses to the patient consistent with the direct-care registered nurse's 
professional judgment.
§1795. Exception to staffing requirements
The direct-care registered nurse staffing assignments required pursuant to section 1794 
do not apply when there is a declared state of emergency.  It is a defense to a complaint 
alleging a violation of section 1794 filed against a health care facility under chapter 405 if 
the facility demonstrates that it undertook prompt and diligent efforts to maintain the 
staffing assignments required pursuant to section 1794, despite the declared state of 
emergency.
§1796. Staffing calculation requirements
The following provisions apply to the calculation of the direct-care registered nurse 
staffing assignments required pursuant to section 1794.  
1.  Assignment.  A patient must be assigned to a direct-care registered nurse.  A patient 
is considered to be assigned to a direct-care registered nurse if the nurse accepts 
responsibility for the patient's care and meets the requirements under section 1797.
2. Averaging prohibited.  A health care facility may not average the number of 
patients or number of direct-care registered nurses in a patient care unit during any one 
shift or over any period of time.
3. Direct care required.  A health care facility may not include in the calculation an 
ancillary staff person or a nurse who does not provide direct, in-person, hands-on care to a 
patient, including, but not limited to, a nurse administrator, nurse supervisor, nurse 
manager, charge nurse or case manager.  A registered nurse who is also a nurse 
administrator, nurse supervisor, nurse manager, charge nurse, case manager or any other 
health care facility administrator or supervisor may be included in the calculation of the 
direct-care registered nurse staffing assignments required pursuant to section 1794 if the 
registered nurse:
A.  Has a current and active direct patient care assignment;
B.  Provides direct patient care in compliance with the requirements of this chapter;
C.  Has demonstrated current competency in providing care in the assigned patient care 
unit and has received orientation to the unit sufficient to provide competent, safe, 
therapeutic and effective care to patients in the unit;
D.  Has the principal responsibility of providing direct patient care and has no 
additional job duties during the time period during which the nurse has a patient 
assignment; and
E.  Is providing relief for a direct-care registered nurse during breaks, meals and other 
routine or expected absences from the unit.
4. Prohibited assignments.  A health care facility may not assign an ancillary staff 
person to perform tasks that involve professional judgment or the skill of a direct-care 
registered nurse, including, but not limited to, patient assessment, evaluation and 
implementation of a nursing care plan and administration of medications, even if the 
provision of care is under the supervision of a direct-care registered nurse.
5. Additional duties.  A health care facility may not include a direct-care registered 
nurse in the calculation unless the nurse has the principal responsibility of providing direct 
patient care to the assigned patient and has no additional job duties other than direct patient 
care, such as a nurse with triage, external communications or emergency transport duties.
6. Mandatory overtime prohibited.  A health care facility may not impose a 
mandatory overtime requirement on a direct-care registered nurse.
7. Layoffs prohibited.  A health care facility may not lay off or otherwise reduce the 
availability of ancillary staff persons in order to meet the direct-care registered nurse 
staffing assignments required pursuant to section 1794.
8. Electronic monitoring prohibited.  A health care facility may not use any form of 
electronic monitoring, including, but not limited to, video monitoring or other remote 
monitoring, to fulfill the staffing requirements.
9. Planning required.  A health care facility shall plan for routine fluctuations in the 
number of patients being treated in the facility resulting from circumstances such as 
admissions, discharges and transfers of patients in order to maintain staffing ratios pursuant 
to section 1794.
§1797. Assignment of direct-care registered nurses
A health care facility shall, no less frequently than each shift, assign to a patient a 
direct-care registered nurse responsible for the provision of care to the patient in accordance 
with this section.
1. Assignment of direct-care registered nurses generally.  A health care facility may 
not assign a direct-care registered nurse to a patient unless the nurse has demonstrated 
current competency in providing care to patients in the patient care unit and has also 
received orientation to the unit sufficient to provide care to patients.
2. Anticipated absences of direct-care registered nurses.  A health care facility may 
assign a direct-care registered nurse to relieve the originally assigned direct-care registered 
nurse for breaks, meals or other routine, expected absences only if the relieving nurse has 
demonstrated to the facility competency in providing care to patients in the patient care 
unit and received orientation to the unit sufficient to provide care to patients.
3. Criteria.  A health care facility shall include its criteria for making a staffing 
assignment under this section in its policies and procedures.
§1798. Use of technology
1. Electronic monitoring prohibited for patient protection.  A health care facility 
may not use any form of electronic monitoring, including, but not limited to, video 
monitoring or other remote monitoring to substitute for the direct observation by a direct-
care registered nurse or an ancillary staff person that is required for patient protection.
2. Technology prohibited for nursing process.  A health care facility may not adopt 
policies or practices that:
A.  Employ health information technology, algorithms used to achieve a medical or 
nursing care objective, systems based on artificial intelligence or clinical practice 
guidelines that limit or substitute for the direct care provided by an assigned direct-care 
registered nurse in the performance of functions that are part of the nursing process, 
including the full exercise of independent professional judgment, or that limit a direct-
care registered nurse from acting as a patient advocate in the exclusive interests of the 
patient; or
B.  Penalize a direct-care registered nurse for overriding technology or guidelines 
prohibited in paragraph A if in the direct-care registered nurse's professional judgment 
and in accordance with the direct-care registered nurse's scope of practice in 
accordance with Title 32, chapter 31 it is in the best interest of the patient to do so.
§1799. Patient advocacy
1. Patient advocacy.  A direct-care registered nurse has a duty and right to act based 
on the nurse's professional judgment and provide care in the exclusive interests of the 
patient and to act as the patient's advocate.
2. Professional judgment.  A direct-care registered nurse shall exercise professional 
judgment in the performance of the nurse's duties within the nurse's scope of practice in 
accordance with Title 32, chapter 31 in the exclusive interests of the patient.  A direct-care 
registered nurse's actions under this subsection may not, for any purpose, be considered, 
relied upon or represented as a job function, authority, responsibility or activity undertaken 
for the purpose of serving the business, commercial, operational or other institutional 
interests of the employer.
3. Nursing care.  A direct-care registered nurse shall provide competent, safe, 
therapeutic and effective nursing care to an assigned patient.
A.  Before accepting a patient assignment, a direct-care registered nurse shall:
(1)  Have the necessary knowledge, judgment, skills and ability to provide the 
required care;
(2)  Determine using the nurse's professional judgment whether the nurse is 
competent to perform the nursing care needed by a patient who is in a particular 
patient care unit or who has a particular diagnosis, condition, prognosis or other 
determinative characteristic affecting nursing care; and
(3)  Determine using the nurse's professional judgment whether acceptance of a 
patient assignment would expose the patient or direct-care registered nurse to the 
risk of harm.
4.  Objections.  As part of a direct-care registered nurse's patient advocacy, a direct-
care registered nurse may object to or refuse to accept or participate in any activity, policy, 
practice, assignment or task in a health care facility if the direct-care registered nurse:
A.  Believes, based on the nurse's professional judgment, that the activity, policy, 
practice, assignment or task would violate Title 32, chapter 31 or rules adopted 
pursuant to that chapter or be outside the nurse's scope of practice;
B.  Believes, based on the nurse's professional judgment, that the activity, policy, 
practice, assignment or task would violate the staffing requirements under section 1794 
or would violate any other provision of this chapter; or
C.  Believes, based on the nurse's professional judgment, that the nurse is not prepared 
by education, training or experience to fulfill the assignment without compromising 
the safety of a patient or jeopardizing the license of the direct-care registered nurse.
5. Interference and retaliation prohibited.  A health care facility, an employee of a 
health care facility who is primarily responsible for managing the facility or an employee 
of the facility who is primarily responsible for providing patient care services may not:
A.  Interfere with or prevent a direct-care registered nurse from exercising professional 
judgment under this section;
B.  Limit a direct-care registered nurse in performing duties that are a part of the nursing 
process, including full exercise of professional judgment in assessment, planning, 
implementation and evaluation of care;
C.  Limit a direct-care registered nurse in acting as a patient advocate in the exclusive 
interests of the patient; or
D.  Discharge from duty, threaten or otherwise retaliate against a direct-care registered 
nurse who reports an unsafe practice or violation of policy, federal or state law, federal 
regulation or state rule.
6. Application of Whistleblowers' Protection Act.  A violation of subsection 5 is a 
violation of Title 26, chapter 7, subchapter 5-B.
§1800. Record and notice requirements
A health care facility shall maintain and disclose records relating to actual staffing 
assignments and any method used to meet the requirements of this chapter in accordance 
with this section and rules adopted by the department.
1.  Record contents.  Records maintained and disclosed under this section must 
include:
A. The number of patients in each patient care unit during each shift;
B. The identity and duty hours of each direct-care registered nurse assigned to each 
patient in each patient care unit during each shift;
C. The identity and duty hours of each ancillary staff person for each patient care unit 
during each shift;
D. Certification that each direct-care registered nurse received rest and meal breaks and 
the identity and duty hours of each direct-care registered nurse who provided relief 
during the breaks; and
E. A copy of each notice required under subsection 4.
2.  Required duration of records maintenance.  Records under this section must be 
maintained for at least 3 years.
3.  Records submitted to department. A health care facility shall submit all records 
under this section to the department as a condition of licensure under chapter 405.  The 
chief nursing officer shall certify that records submitted to the department pursuant to this 
subsection completely and accurately reflect staffing assignments in each patient care unit.  
The certification must be executed under penalty of perjury and must contain an express 
acknowledgment that any false statement constitutes fraud and is subject to criminal 
prosecution or civil penalties.
4.  Notice requirements.  A health care facility shall post in each patient care unit a 
notice in a form specified by department rule that:
A.  Explains the requirements of record maintenance under this section;
B.  Includes actual direct-care registered nurse staffing assignments in each patient care 
unit during each shift;
C.  Includes the actual number of ancillary staff persons and the skill mix of the 
ancillary staff persons in each patient care unit during each shift;
D.  Identifies the variance between the required and actual staffing assignments in each 
patient care unit during each shift; and
E.  Is visible, conspicuous and accessible to health care facility staff, patients and the 
public.
5.  Records publicly accessible.  Records maintained under this section must be made 
available to the department, direct-care registered nurses, a nurse's collective bargaining 
representative and the public.
§1801. Audits
The department shall conduct periodic audits to ensure that a health care facility has 
implemented the direct-care registered nurse staffing requirement pursuant to this chapter.
§1802. Administrative sanctions; investigation
In addition to the penalties available under section 1804 and licensure requirements 
under section 1817, the department may impose a sanction under this section in conformity 
with Title 5, chapter 375, subchapter 4.
1. Notice. The department may direct by written notice a health care facility to correct 
any violations under this chapter and any rules adopted under this chapter in a manner and 
within a time frame that the department determines appropriate to ensure compliance or 
protect the public health.  The health care facility shall correct any violations within the 
time frame determined by the department.
2. Investigation.  The department may investigate complaints against a health care 
facility in order to ensure compliance with this chapter and any rules adopted under this 
chapter.
3. Sanctions. The department may impose the following administrative penalties on a 
health care facility.
A. For violations of subsection 1 or sections 1794, 1796, 1797, 1798 and 1800 a rule 
adopted to implement this section or those sections, the department may assess a fine 
of not more than $10,000 per nursing shift in violation.  Each day a health care facility 
violates subsection 1 or section 1794, 1796, 1797, 1798 or 1800 is a separate offense.
B. For violations of section 1799, subsection 5 or a rule adopted to implement that 
subsection, the department may assess a fine of not more than $25,000 per nursing 
shift.
§1803.  Civil violations
This section governs violations under this chapter.
1.  Violation of health care facility staffing requirements.  This subsection applies 
to violations of sections 1794, 1796, 1797, 1798 and 1800 and section 1803, subsection 1.
A.  A health care facility may not violate section 1794, 1796, 1797, 1798 or 1800 or 
section 1803, subsection 1 or a rule adopted to implement those sections.
B.  A health care facility that violates paragraph A commits a civil violation for which 
a fine of not more than $10,000 per nursing shift in violation may be adjudged.  Each 
day a health care facility violates paragraph A is a separate offense.
2.  Violation for interfering or retaliating for a nurse's objection or refusal; 
violation.  This subsection applies to violations of section 1799, subsection 5.
A.  A health care facility, an employee of a health care facility who is primarily 
responsible for managing the health care facility or an employee of a health care facility 
who is primarily responsible for providing patient care services may not violate section 
1799, subsection 5 or a rule adopted to implement that subsection.
B.  A health care facility, an employee of a health care facility who is primarily 
responsible for managing the health care facility or an employee of a health care facility 
who is primarily responsible for providing patient care services who violates paragraph 
A commits a civil violation for which a fine of not more than $25,000 per nursing shift 
in violation may be adjudged.
§1804.  Enforcement
The Attorney General may file a complaint with the District Court seeking civil 
penalties or injunctive relief or both for violations of this chapter.
§1805. Complaints
A person may file a complaint with the department against a facility for violations of 
this chapter.  The department shall refer any complaint alleging a violation of section 1799, 
subsection 5 to the Maine Human Rights Commission.
§1806. Rulemaking
The department may adopt rules to implement this chapter.  The department shall rely 
on and incorporate principles of the nursing profession in rules adopted pursuant to this 
section.  Rules adopted pursuant to this section are routine technical rules as defined in 
Title 5, chapter 375, subchapter 2-A.
Sec. 2.  22 MRSA §1817, as repealed and replaced by PL 2007, c. 324, §4, is 
amended to read:
§1817.  Issuance of licenses
The department is authorized to issue licenses to operate hospitals, sanatoriums, 
convalescent homes, rest homes, nursing homes, ambulatory surgical facilities and other 
related institutions that, after inspection, are found to comply with this chapter, chapter 
404-A and any rules adopted by the department.  An initial license may be issued for up to 
months. A license may be renewed for up to 24 months.  The fee for this temporary or 
conditional license is $15 and is payable at the time of issuance of the license regardless of 
the term.  When an institution, upon inspection by the department, is found not to meet all 
requirements of this chapter or department rules, the department is authorized to issue 
either:
1.  Temporary license.  A temporary license for a specified period not to exceed 90 
days, during which time corrections specified by the department must be made by the 
institution for compliance with this chapter, chapter 404-A and departmental rules, if in the 
judgment of the commissioner the best interests of the public will be so served; or
2.  Conditional license.  A conditional license setting forth conditions that must be 
met by the institution to the satisfaction of the department.
Failure of the institution to meet any of the department's conditions immediately voids 
the temporary or conditional license by written notice by the department to the licensee or, 
if the licensee cannot be reached for personal service, by notice left at the licensed premises. 
A new application for a regular license may be considered by the department if, when and 
after the conditions set forth by the department at the time of the issuance of this temporary 
or conditional license have been met and satisfactory evidence of this fact has been 
furnished to the department. The department may amend, modify or refuse to renew a 
license in conformity with the Maine Administrative Procedure Act, or file a complaint 
with the District Court requesting suspension or revocation of any license on any of the 
following grounds: violation of this chapter or the rules issued adopted pursuant to this 
chapter; violation of chapter 404-A or the rules adopted by the department pursuant to 
chapter 404-A; permitting, aiding or abetting the commission of any illegal act in that 
institution; or conduct of practices detrimental to the welfare of a patient. Whenever, on 
inspection by the department, conditions are found to exist that violate this chapter or 
department rules issued adopted pursuant to this chapter or violate chapter 404-A or the 
rules adopted by the department pursuant to chapter 404-A that, in the opinion of the 
commissioner, immediately endanger the health or safety of patients in an institution or 
create an emergency, the department by its duly authorized agents may, under the 
emergency provisions of Title 4, section 184, subsection 6, request that the District Court 
suspend or revoke the license.  Rules adopted pursuant to this section are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A.
SUMMARY
This bill establishes the Maine Quality Care Act in order to ensure adequate direct-care 
registered nurse staffing assignments in health care facilities, including hospitals, 
freestanding emergency departments and ambulatory surgical facilities, to provide safe and 
effective patient care.  It establishes minimum direct-care registered nurse staffing 
requirements based on patient care unit and patient needs, specifies the method to calculate 
a health care facility's compliance with the staffing requirements, protects direct-care 
registered nurses from retaliation and includes notice, record-keeping and enforcement 
requirements.