2023 Colorado Revised Statutes › Title 25 - PUBLIC HEALTH AND ENVIRONMENT (§§ 25-1-101 — 25-59-106) › HOSPITALS (§§ 25-3-100.5 — 25-3.5-1401) › Article 3 - HOSPITALS (§§ 25-3-100.5 — 25-3-801) › Part 1 - HOSPITALS (§§ 25-3-100.5 — 25-3-131) › Section 25-3-128 - Hospitals - nurses, nurse aides, and EMS providers - staffing requirements - enforcement - waiver - rules - definitions

(1)
As used in this section:
(a)
"Clinical staff nurse" means a practical nurse or registered professional nurse licensed pursuant to article
255
of title
12
who provides direct care to patients.
(b)
"EMS provider" means an individual who holds a valid certificate or license issued by the department as provided in article
3.5
of this title 25.
(c)
"Nurse aide" means a person certified pursuant to article
255
of title
12
to practice as a nurse aide who provides direct care to patients or who works in an auxiliary capacity under the supervision of a registered nurse.
(d)
"Staffing plan" means the master nurse staffing plan developed for a hospital pursuant to subsection (2)(b) of this section.
(2)
(a)
On or before September 1, 2022, each hospital shall establish a nurse staffing committee pursuant to rules promulgated by the state board of health, either by creating a new committee or assigning the nurse staffing functions to an existing hospital staffing committee. The nurse staffing committee must have at least sixty percent or greater participation by clinical staff nurses, in addition to auxiliary personnel and nurse managers. The nurse staffing committee must include a designated leader of workplace violence prevention and reduction efforts.
(b)
The nurse staffing committee:
(I)
Shall annually develop and oversee a master nurse staffing plan for the hospital that:
(A)
Is voted on and recommended by at least sixty percent of the nurse staffing committee;
(B)
Includes minimum staffing requirements as established in rules promulgated by the state board of health for each inpatient unit and emergency department that are aligned with nationally recognized standards and guidelines;
(C)
Includes strategies that promote the health, safety, and welfare of the hospital's employees and patients;
(D)
Includes guidance and a process for reducing nurse-to-patient assignments to align with the demand based on patient acuity; and
(E)
May include innovative staffing models;
(II)
(A)
Shall submit the recommended staffing plan to the hospital's senior nurse executive and the hospital's governing body for approval. If the final plan approved by the hospital changes materially from the recommendations put forth by the staffing committee, the senior nurse executive shall provide the nurse staffing committee with an explanation for the changes.
(B)
If, after receiving the explanation referenced in subsection (2)(b)(II)(A) of this section, the staffing committee believes the final plan does not meet nurse staffing standards established in rules promulgated by the state board of health, the staffing committee, with a vote of sixty percent or more of the members, may request the department review the final adopted staffing plan for compliance with rules promulgated by the state board of health.
(III)
May publish a report that is responsive to the changes made to the recommended plan pursuant to subsection (2)(b)(II) of this section, if any;
(IV)
Shall describe in writing the process for receiving, tracking, and resolving complaints and receiving feedback on the staffing plan from clinical staff nurses and other staff; and
(V)
Shall make the complaint and feedback process available to all providers, including clinical staff nurses, nurse aides, and EMS providers.
(c)
The department is authorized to and shall enter, survey, and investigate each hospital as necessary to ensure compliance with the nursing staffing standards established in rules promulgated by the state board of health.
(3)
A hospital shall:
(a)
Submit the final, approved nurse staffing plan to the department on an annual basis;
(b)
On a quarterly basis, evaluate the staffing plan and prepare a report for internal review by the staffing committee;
(c)
Provide the relevant unit-based staffing plan to:
(I)
Each applicant for a nursing position on a given unit upon an offer of employment; and
(II)
A patient upon request; and
(d)
Prepare an annual report containing the details of the evaluation required in subsection (3)(b) of this section and submit the report to the department, in a form and manner determined by rules promulgated by the state board of health.
(4)
A hospital shall not assign a clinical staff nurse, nurse aide, or EMS provider to a hospital unit unless, consistent with the conditions of participation adopted for federal medicare and medicaid programs, hospital personnel records include documentation that the training and demonstration of competency were successfully completed during orientation and on a periodic basis consistent with hospital policies.
(5)
(a)
On or before September 1, 2022, each hospital shall report, in a form and manner determined by rules promulgated by the state board of health, the baseline number of beds the hospital is able to staff in order to provide patient care and the hospital's current bed capacity. The reporting may include:
(I)
Seasonal or other anticipated variances in staffed-bed capacity; and
(II)
Anticipated factors impacting staffed-bed capacity.
(b)
In promulgating rules pursuant to subsection (5)(a) of this section, the state board of health shall:
(I)
Use the data provided to the department by each hospital throughout the COVID-19 pandemic through an internet-based resource management and communication tool developed for and commonly used by hospitals;
(II)
Determine the number of seasonal variations allowable with regard to subsection (5)(a)(I) of this section with a minimum of two and a maximum of four allowable variances; and
(III)
Define "staffed-bed capacity" for the purposes of this section.
(c)
On or before September 1, 2022, as determined by rules promulgated by the state board of health, if a hospital's ability to meet staffed-bed capacity falls below eighty percent of the hospital's reported baseline for not less than seven and not more than fourteen consecutive days, the hospital shall notify the department and submit:
(I)
A plan to ensure staff is available, within thirty days, to return to a staffed-bed capacity level that is eighty percent of the reported baseline; or
(II)
A request for a waiver due to a hardship, which request articulates why the hospital is unable to meet the required staffed-bed capacity, if:
(A)
The hospital's current staffed-bed capacity falls below eighty percent of the hospital's reported baseline for not less than seven and not more than fourteen consecutive days; or
(B)
The hospital's current staffed-bed capacity threatens public health.
(d)
The department may impose fines, not to exceed one thousand dollars per day, for a hospital's failure to:
(I)
Meet the reported staffed-bed capacity of eighty percent or more of the hospital's reported baseline; or
(II)
Accurately report a hospital's baseline staffed-bed capacity.
(6)
Each hospital with more than twenty-five beds shall articulate in its emergency plan a demonstrated ability to expand the hospital's staffed-bed capacity up to one hundred twenty-five percent of the hospital's baseline staffed-bed capacity and intensive care unit capacity within fourteen days after:
(a)
A statewide public health emergency is declared or the hospital is notified by the department that surge capacity is needed; and
(b)
The state has used all available authority to expedite workforce availability and maximize hospital throughput and capacity, such as:
(I)
Licensing or certification flexibility for health facilities;
(II)
Reducing requirements for licensing, credentialing, and the receipt of staff privileges;
(III)
Waiving scope of practice limitations; and
(IV)
Waiving state-regulated payer provisions that create barriers to timely patient discharge.
(7)
Each hospital shall update its emergency plan at least annually and as often as necessary, as circumstances warrant. The emergency plan must include the actions the hospital will take to maximize staffed-bed capacity and appropriate utilization of hospital beds to the extent necessary for a public health emergency and through the following activities:
(a)
Cross-training, just-in-time training, and redeployment of staff;
(b)
Supporting all hospital facilities, including hospital-owned facilities, to provide any necessary, available, and appropriate preventive care, vaccine administration, diagnostic testing, and therapeutics;
(c)
Maximizing hospital throughput by discharging patients to skilled nursing, post-acute, and other step-down facilities; and
(d)
Reducing the number of scheduled procedures in the hospital.
(8)
Beginning September 1, 2022, the department may fine a hospital an amount not to exceed ten thousand dollars per day for the failure to:
(a)
Achieve the required staffed-bed capacity described in subsection (6) of this section within fourteen days after a declared statewide public health emergency or other notification by the department that surge capacity is needed;
(b)
Include the amount of necessary vaccines for administration in its annual emergency plan and have the vaccines available, to the extent that the vaccines are available, at each of its hospital facilities and hospital-owned primary care sites during and outside of the public health emergency, as determined by rules promulgated by the department; and
(c)
Include the necessary testing capabilities available in its annual emergency plan and at each of its hospital facilities and hospital-owned primary care sites during and outside of a public health emergency, to the extent that the testing is available, as determined by rules promulgated by the department.
(9)
For the purposes of this section, the department shall enter, survey, and investigate each hospital:
(a)
As deemed necessary by the department;
(b)
For purposes of infection control and emergency preparedness; and
(c)
To ensure compliance with this section.
(10)
The department shall annually report on the information contained in the quarterly report described in subsection (3)(d) of this section as a part of its presentation to its committee of reference at a hearing held pursuant to section
2-7-203(2)(a)
of the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act".
(11)
The department may promulgate rules to require health facilities licensed pursuant to section
25-1.5-103
to develop and implement infection prevention plans that align with national best practices and standards and that are responsive to COVID-19 and other communicable diseases. The requirements may include testing, vaccination, and treatment in accordance with applicable state laws, rules, and executive orders.
(12)
The state board of health shall promulgate rules as necessary to implement this section.
Added by 2022 Ch. 178,§1, eff. 5/18/2022.