SENATE, No. 1244

SECTION 1. Analysis of Workforce and Faculty Resources

 (a)       Review of Workforce Initiatives

(1) The Secretary for Administration and Finance is hereby authorized and directed to make an investigation and study of all state agencies, or quasi-state agencies, to determine the efficacy of existing programs related to workforce development and report back to the legislature by April 15, 2009 with recommendations for the development of new or redesigned state programs to create a pathway for an enhanced health care workforce. 

(2)  Said investigation and study shall include, but not be limited to, identifying ways to increase the number and diversity of people choosing health care occupations, increase retention rates among Massachusetts current health care workers, and recommending measures to coordinate health care worker shortage solutions in the state.

(b)        Review of Nurse Faculty Resources

(1) The Board of Higher Education, in collaboration with the Department of Labor and Workforce Development, the Board of Registration in Nursing, and the Massachusetts Center for Nursing, Inc., in addition to the nurse scholar program established pursuant to subsection 4, of section 19F of chapter 15 as inserted by this act, is hereby authorized and directed to make an investigation and study of the nurse faculty shortage in the Commonwealth and report back to the legislature by April 15, 2009 with recommendations to enhance the nurse faculty pipeline within the state.

(2) Said investigation and study shall include, but not be limited to, the collection and analysis of: school capacity data including numbers of doctoral and masters prepared faculty; budgeted and vacant positions; projections on intentions to retire; data on the numbers of students who have been turned away or are on waiting lists due to shortage of budgeted faculty positions; vacant faculty positions; the capability of both undergraduate and graduate schools to develop nursing programs based on the number of qualified undergraduate and/or graduate students interested in nursing, as well as the number of available faculty to develop a nursing program, or lack of clinical placement sites; the supply of masters and doctoral prepared nurses in the state who might be available to move into education positions; and, the types and components of partnerships between schools and healthcare facilities focused on sharing of resources to enhance nursing education, research or leadership development.

(3) Said investigation and analysis shall be conducted on a statewide basis and include both publicly funded and private schools to provide comprehensive data on the current and future extent of the faculty shortage.

SECTION 2. Promoting Health Care Professions

The Executive Office of Economic Development, in collaboration with the State Board of Education, the Board of Higher Education, and the Massachusetts Hospital Association, is hereby authorized and directed to develop a comprehensive statewide plan to promote healthcare professions to the general public.  Said plan shall include specific recommendations that various state agencies may act upon to further the goals of enhancing public interest in health care professions, including but not limited to school age children and adults seeking a change in career, and increasing the supply of health care workforce .  The Department shall complete said plan and file a copy with the House and Senate clerks no later than April 15, 2009.

SECTION 3. Enhancing the Availability of Nursing Workforce Data

Notwithstanding any general or special law to the contrary, the Executive Office of Health and Human Services and all agencies, departments and boards within said secretariat, the Department of Labor and Workforce Development, the Board of Higher Education and any other state agency, board or department that collects data, conducts surveys or gathers information related to the practice of nursing, the supply of nursing workforce, the supply of nursing faculty or other nursing workforce issues shall regularly submit said data and information to the Massachusetts Center for Nursing, Inc.

SECTION 4. Establishing the Clara Barton Nursing Excellence Programs

(a)        To provide for certain unanticipated obligations of the commonwealth, to provide for certain other activities and projects and to meet certain requirements of law, the sums set forth in subsection (b)  are hereby appropriated from the General Fund for the several purposes and subject to the conditions specified therein, and subject to the provisions of law regulating the disbursement of public funds; provided, that notwithstanding the provisions of any general or special law to the contrary, the appropriations made in section 3 shall expire on June 30, 2009; provided, however, that funding shall, subject to appropriation, be authorized to continue said programs in subsequent fiscal years:

(b)        Chapter 10 of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by adding the following section:

Section 64.  There shall be established and set up on the books of the commonwealth a separate fund, to be known as the Clara Barton Nursing Excellence Trust Fund.  Said fund shall consist of all revenues from public and private sources as appropriations, gifts, grants, donations, and from the federal government as reimbursements, grants-in-aid or other receipts to further the purposes of said fund in accordance with the provisions of sections 19F through 19J, inclusive, of chapter 15A, and any interest or investment earnings on such revenues.  All revenues credited to said fund under this section shall remain in said fund and shall be expended, without further appropriation, for applications pursuant to sections 19F through 19J, inclusive, of chapter 15A.  The state treasurer shall deposit and invest monies in said fund in accordance with the provisions of sections 34, 34A and 38 of chapter 29 in such a manner as to secure the highest rate of return consistent with the safety of the fund.  Said fund shall be expended only for the purposes stated in said sections 19F through 19J, inclusive, of said chapter 15A, at the direction of the chancellor of the system of public higher education, hereinafter referred to as the chancellor. On February 1 of each year, the state treasurer shall notify the chancellor of any projected interest and investment earnings available for expenditure from said fund for each fiscal year.

(c)        Chapter 15A of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by inserting after section 19E, the following sections:

Section 19F.  The board of higher education is authorized and directed to establish a student loan repayment program and a faculty position payment program, to be known as the Clara Barton Nursing Loan Repayment Program, for the purpose of encouraging existing nurses or nurse student graduates committed to becoming clinical instructors or nursing faculty to  teach nursing within the commonwealth by providing financial assistance for the repayment of qualified education loans or by providing compensation to health care facilities to cover nurse scheduled work time spent teaching, as further defined herein.  The board shall adopt guidelines governing the implementation of the program, which shall include, but need not be limited to, the following:

(1) eligibility for the program shall be limited to persons who have graduated in the top twenty-five percent of their practical or diploma nursing program, undergraduate, or graduate class, as certified by the college, university, or school of nursing attended by such applicant, or who are otherwise qualified;

(2) eligibility shall be limited to persons licensed to practice nursing in the commonwealth or entering the nursing profession after September first, two thousand and four, or to persons entering the teaching of nursing profession at a college, university, or school of nursing within the commonwealth after such date;

(3) the commonwealth shall repay a participants’ student loan at a rate not to exceed two hundred dollars per month for a period not to exceed forty-eight months.  Participants who work less than full time shall receive loan repayment amounts in direct proportion to the percentage of full time worked;

(4) repayment shall be made to the participant annually upon the presentation by the participant of satisfactory evidence of payments under the loan;

(5) payments by the commonwealth shall cover only loan payments made by the participants in the months during which the participant is employed as a nurse in, but not limited to, acute care hospitals, long term care/chronic disease hospitals, acute inpatient rehabilitation hospitals, public health hospitals, psychiatric and mental health clinics or hospitals, community or neighborhood health centers, rehabilitation centers, nursing homes, or as a home health, school or public health nurse in the commonwealth, or is employed to teach nursing at a college, university, or school of nursing in the commonwealth.  Payments by the commonwealth shall not commence until participants have been employed as nurses in the commonwealth, or teachers of nursing at a college, university, or school of nursing in the commonwealth, for a period of one year.  Participants must be employed as nurses in the commonwealth, or as teachers of nursing at a college, university of school of nursing in the commonwealth, for a minimum period of four years during the loan repayment period, or reimburse the commonwealth for the expense incurred during the repayment period.

(6) in the case of  those employed as nurses, the board may limit the program to those who work in communities designated by the department of public health, in consultation with the federal department of health and human services and the center for health professions at Worcester State College, as underserved communities;

(7) the program shall set forth an affirmative action policy and specific annual affirmative action goals.  The board shall annually publish a report detailing its efforts to publicize the loan repayment program in order to advance the goals of this affirmative action policy and its success in meeting those goals.

The term "qualified education loan" shall mean any indebtedness including interest on such indebtedness incurred to pay tuition or other direct expenses incurred in connection with the pursuit of a practical or diploma nursing program, an associate’s, baccalaureate, or graduate degree by an applicant, but shall be limited to any loan which was or is administered by the financial aid office of a practical or diploma nursing program, two year or four year college, university, or school of nursing at which the applicant was enrolled as a practical or diploma nursing school student, or as an undergraduate or graduate student, and which loan has been secured through a state or federal student loan program, or which was or is administered by a commercial or institutional lender.   

Section 19G. The board of higher education is authorized and directed to establish an expert nursing corps program, to be known as the Clara Barton Expert Nursing Corps Program, for the purpose of building a group of recognized nurses of high achievement in the profession who shall serve to mentor incoming or novice nurses and to further the goals of the nursing profession. The board shall adopt guidelines governing the implementation of the program. Such guidelines shall include, but need not be limited to, the following provisions:

(1) the board may select expert nurses who achieve such status by obtaining specialty, modular, or advanced practice certification from the American Nurses Credentialing Center, who remain in good standing with the board of registration in nursing, who are current on their continuing education units, and who agree to mentor incoming or novice nurses. The board may develop and include alternatives to such American Nurses Credentialing Center program provided such alternatives maintain equivalent or higher standards of excellence in the practice of nursing;

(2) the board may provide expert nurses with partial or full reimbursement for the assessment costs of said American Nurses Credentialing Center certification. The board shall provide expert nurses with ongoing salary bonuses.  Such ongoing salary bonuses shall be limited to $5,000 per year not to exceed five years; provided, that such expert nurses continue to remain in good standing with the board of registration in nursing and employed in nursing in the commonwealth, and continue to mentor incoming or novice nurses. The board shall require evaluation on an annual basis of the efficacy of the incentive provided to participants in the expert nurse mentoring program.  The board may authorize grants, in addition to the bonus to the expert nurse, to the health care facility, school district, local health agency, home health agency, or nursing home in Massachusetts of such expert nurse to facilitate time for the expert nurse to engage in mentoring activity; to increase the number of clinical facilities or to allow for the hiring of more nurse faculty; provided further, that said health care facility, school district, local health agency, home health agency, or nursing home in Massachusetts shall continue the expert nurse’s salary at a level irrespective of the expert nurse’s salary bonus;

(3) the board shall set forth an outreach plan to attract underrepresented populations and nurse specialists in the nursing profession in areas which are designated by the department of public health, in consultation with the federal department of health and human services and the Center for Health Professions at Worcester State College, as underserved communities.

(4) the board may provide experienced nurses with graduate degrees and such courses in education as the board may determine, who have agreed to teach in a nursing education program in the Commonwealth with ongoing salary bonuses to reasonably compensate for the difference between clinical nursing salaries and nursing faculty salaries.  Such ongoing salary bonuses for nurse scholars shall be limited to $25,000 per year not to exceed ten years for nursing faculty who carry a full-teaching load as defined by the institution; provided, that such nurse scholar continues to remain in good standing with the board of registration in nursing and employed in nursing education in the commonwealth, and continues to educate nurses; provided further, that institution of higher education that employs a nurse scholar shall continue the  nurse scholar’s salary at a professional level irrespective of the expert nurse’s salary bonus.

Section 19H. The board of higher education shall make available grants to institutions of higher education and health care institutions in the commonwealth for the purpose of fostering partnerships between higher education institutions and clinical agencies that promote the recruitment and retention of nurses. Such grants may also be made available to such institutions for the purpose of establishing and maintaining nurse mentoring or nursing internship programs.  The board shall adopt guidelines governing the implementation of this section.

Section 19I. The board of higher education is authorized and directed to establish a scholarship program, to be a known as the Clara Barton Scholarship Program, to provide students in approved Massachusetts’ colleges, universities and schools of nursing with scholarships for tuition and fees for the purpose of encouraging outstanding Massachusetts’ students, to work as nurses in, but not limited to, acute care hospitals, psychiatric and mental health clinics or hospitals, community or neighborhood health centers, long term care hospitals, inpatient rehabilitation facilities and other rehabilitation centers, nursing homes, or as a home health, school or public health nurse in the commonwealth, or to teach nursing in colleges, universities, or schools of nursing in the commonwealth.  The board shall adopt guidelines governing the implementation of the program.

Colleges, universities, and schools of nursing in the commonwealth may administer the Clara Barton Scholarship Program and select recipients, in accordance with guidelines adopted by the board.  Scholarships may be made available to full or part time matriculating students in courses of study leading to a degree in nursing or the teaching of nursing.  Recipients shall be residents of the commonwealth and outstanding prospects based on objective measures such as leadership skills, clinical knowledge, class rank, test scores, grade point average, income need and such other criteria as the board may determine.  In any given year, the board may target awards to students from geographic and nurse specialty areas in the commonwealth determined by the department of public health, in consultation with the federal department of health and human services, and the Center for Health Professions at Worcester State College, to be areas experiencing an acute shortage of nurses. Scholarship recipients at any public or private institution of higher education in the commonwealth shall receive no more than a $3,500 scholarship for each academic semester that the recipient remains enrolled at such institution and remains in good standing.  The names of recipients of such scholarships shall remain confidential, unless the recipient waives such confidentiality in writing.

The board may also provide a scholarship recipient with a housing voucher, in such form and manner as the board may determine, which shall be equal to not more than two hundred dollars per month, that may be utilized by the recipient to assist in paying housing costs, including rent or mortgage payments, while such recipient is enrolled in good standing in the college, university, school of nursing. 

The board, in coordination with the board of education and Massachusetts’ colleges, universities and schools of nursing, shall aggressively market the existence of the program to high school students and to non-traditional students to encourage outstanding candidates to apply to nursing or the teaching of nursing programs in institutions of higher education in the commonwealth. Such marketing shall focus on candidates who would otherwise not consider a career in nursing or the teaching of nursing.  The board shall set forth an outreach plan to attract underrepresented populations to the nursing profession. 

Recipients must be employed as a nurse in the commonwealth, or teacher of nursing at a college, university, or school of nursing in the commonwealth, for a minimum period of two years following graduation.  Recipients who participate in the program but do not complete their college education within seven years of entering college, or who fail to complete their two year nursing commitment within seven years following graduation from college, or whose license to practice in Massachusetts is not maintained in good standing, or those who fail to complete their two year teaching commitment within seven years following graduation from college or from a graduate school, if such is required for teaching nursing at a college, university or school of nursing, shall be obligated to repay the commonwealth any tuition, fees, and housing voucher payments advanced to them, with interest set by the board. 

Section 19J. The board of higher education is authorized and directed to develop a program to provide matching grants to any hospital that commits resources or personnel to nurse education programs. Such program shall provide a dollar-for-dollar match for any funds committed by a hospital to pay for nurse faculty positions in publicly funded schools of nursing, including the costs of providing hospital personnel loaned to said schools of nursing.

(e) Notwithstanding the provisions of any general or special law to the contrary, any state or community college, or the University of Massachusetts may enter into employment contracts for a minimum period of five years with faculty members who teach nursing at such institutions, unless both parties agree to a shorter term of employment.

(f) The board of higher education shall establish an advisory committee consisting of seven members whose membership shall be comprised of professionals representing the nursing profession.  At least one half of the membership of the committee shall be nursing educators from higher education institutions and the remaining members shall be nurses in practice.  The advisory committee shall advise the board as to the practice of nursing and how to implement the provisions of this act in a manner that would best benefit the profession of nursing and fulfill the goals of recruiting and retaining people to the profession of nursing.

SECTION 5. Accountability of Nurse Staffing for Patient Care

Chapter 111 of the general laws, as appearing in the 2004 official edition, is hereby amended by adding after Section 56 the following new section:

Section 56A: Nurse Staffing Accountability

a) Definitions:  For the purposes of this section the following words shall have the following meanings:

“Hospital”, a hospital subject to this chapter limited to a general acute care hospital, a public hospital owned by the Commonwealth, a chronic disease hospital, an acute inpatient rehabilitation hospital, and the teaching hospital of the University of Massachusetts Medical School.

“Nurse Staffing Plan”, an annual written plan that addresses patient nursing needs by identifying the appropriate number and mix of staff for each hospital, specific to each shift in the hospital inpatient services, critical care beds, and emergency departments by day of week.

b) Hospitals shall develop and implement an annual written nurse staffing plan based on the following requirements:

(1) Addresses patient nursing needs in each hospital and that covers all inpatient services, critical care beds, and the emergency department in said hospital;

(2) Sets forth a mechanism to obtain input from direct care givers, including nurses and other members of the patient care team, in developing the nurse staffing plan that promotes a collaborative practice that takes into consideration the quality of patient care and the health care services provided by nurses and other members of the patient care team; 

(3) provides an individual nurse or other member of the patient care team with a process and format to communicate specific concerns with their current patient care assignment to an immediate supervisor in a timely basis with the assurances of a timely response and no retribution or dismissal for communicating such concerns;

(4) Identifies factors relevant to the nurse staffing plan in each hospital including, but not limited to, the number of patients in a unit; intensity of care required; skill and experience of care givers including registered nurses, licensed practical nurses,  ancillary personnel, and other members of the patient care team consistent with the level of authority and responsibility delegated  under state licensure; admission, discharge, and transfers; geography of a unit; and the availability of technological support; and

(5) Addresses appropriate measures and actions to be taken by the hospital when there is significant variation from the plan.

c) The hospital shall include in the nurse staffing plan a description of the staffing effectiveness process used to monitor and improve nursing care pursuant to the applicable Joint Commission on Accreditation of Healthcare Organizations standards.

d) The hospital shall post a copy of the nurse staffing plan inside the hospital in a manner that is readily available to hospital staff and the general public;

e) The nurse staffing plan shall be reviewed and updated by the hospital when necessary to reflect any significant changes in services; any such updates shall be incorporated as part of the annual nurse staffing plan filed with the department.

f) The nurse staffing plan shall be approved by the hospital governing board prior to filing with the Department.

g) Hospitals shall file the nurse staffing plan with the department 2 weeks following the start of the hospital’s fiscal year.  Beginning in the second hospital fiscal year following April 15, 2009, each hospital shall include with said filing an aggregate review of significant variations of its actual staffing for the prior hospital fiscal year as compared with the nurse staffing plan filed with the department for that prior year. Also included with said filing, shall be a description of the actions taken by said hospital should there have been significant variations. Said plan shall be published on the department web site and available to the public.”

h) If a hospital fails to file its nurse staffing plan within the time required by law, the department shall give immediate notice by mail, postage prepaid, to such hospital of its default. If the hospital omits to file such report after twenty-one (21) days in which such notice of default has been received, the department shall impose a late fine of $1,000 per day.  The hospital may request an administrative review in writing within 15 days of the date it receives notice of the imposition of a late fine by the department.  The request shall state the reasons why the hospital considers the imposition of the late fine to be incorrect and be accompanied by any supporting evidence and arguments.  The department shall notify the hospital, in writing, of the results of the administrative review within 20 days of receipt of request for informal review.  Failure of the department to respond within that time shall be considered confirmation of the imposition of the late fine.  The department may require a hospital to resubmit the nurse staffing plan if the plan fails to provide the information required and shall, by regulation, establish an administrative fee for review of the plan and for review of any required resubmission of the plan.  For any deadline established by the department for a resubmission of a nurse staffing plan, the same procedure for late re-submission shall apply as in the case of the initial, and subsequent annual submissions.  Any late fines collected by the department shall be deposited in the Clara Barton Nursing Excellence Trust Fund established pursuant to Section 4 (c ) of this act.

i) The department may conduct random audits of a hospital’s nurse staffing plan to ensure that said plan conforms to the provisions of this section.  The department shall further afford the hospital at least 30 days to develop a corrective action plan for the nurse staffing plan prior to any action taken by the department.

j) The department shall promulgate regulations consistent with the provisions of this section.

 SECTION 6: Evaluation of Patient Care Using Nurse-Sensitive Performance Measures

Hospitals shall include in their quality improvement programs a process to collect, monitor, and evaluate patient care through the statewide use of three evidence-based nurse-sensitive performance measures, including, but not limited to the National Databank of Nursing Quality Indicators (NDNQI), to be selected by the Betsy Lehman Center, herein called “The Center.”  The Center, in consultation with the Massachusetts Hospital Association, shall select the three evidence-based nurse-sensitive performance measures from the nationally recognized measures endorsed by the National Quality Forum; one of which shall be nursing care hours per patient day as specified in said Forum’s performance measures.  The Massachusetts Department of Public Health shall study and provide a methodology for the Betsy Lehman Center to adjust said nursing care hours per patient day for differences in patient characteristics.  The Center shall develop a uniform format for hospitals to annually report on the selected performance measures to said Center.  The Center shall report to the general public both hospital-specific performance measure data as well as aggregated industry trends and best practices developed from said reports.  Nursing sensitive measures shall include, but not be limited to: patient falls, pressure ulcers, physical/sexual assault, pain management, peripheral IV infiltration, staff mix of Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Nurse Assistants (NAs) and Unlicensed Assistive Personnel (UAP); nursing care hours provided per patient day, RN education/certification, and an RN satisfaction survey.

SECTION 7. Chapter 111 of the general laws, as so appearing, is hereby amended by adding after Section 56A the following new section 56B:

56B:  Limits on mandatory overtime and hours worked by the nursing profession

1.  As used in this section, unless the context otherwise indicates, the following terms have the following meanings:

A. “Hospital”, a hospital subject to this chapter limited to a general acute care hospital, a public hospital owned by the Commonwealth, a chronic disease hospital, an acute inpatient rehabilitation hospital, and the teaching hospital of the University of Massachusetts Medical School

B. “Nurse” means a Registered Nurse licensed under the provision of section 74 of chapter 112 of the general laws, Licensed Practical Nurse licensed under the provisions of section 74A of chapter 112 of the general laws.

C. “On-Call”, time spent by a nurse who is not currently working on the premises of the hospital, and who is either compensated for availability or as a condition of employment has agreed to be available to return to the hospital on short notice if the need arises.

D. “Overtime” means the hours worked by a nurse to deliver patient care, beyond the predetermined and regularly scheduled hours.

2.  A hospital, as defined in this section, shall not require or permit a nurse to work more than 12 hours in any given shift and not to exceed 16 hours in a 24 hour period.  A nurse may not be disciplined, dismissed, or discharged for refusing to work beyond the hours specified in this paragraph.  A nurse that works 12 consecutive hours in a shift must be given at least 10 hours off from any work between shifts. 

3.  A hospital shall be limited to using mandatory overtime for emergency situations where the safety of a patient requires its use and when there is no reasonable alternative. Whenever a nurse is required to work mandatory overtime, the hospital shall document, in an aggregated manner, such use in the annual nurse staffing plan as filed with the department pursuant to Chapter 111, Section 56A. 

4. The provisions of this section shall not apply to:

A.     Work performed in response to: (i) any unforeseen declared national, state, or municipal emergency; (ii) an activation of the health care facility disaster or diversion plan; or (iii)  any unforeseen event which is necessary to protect the public health or safety of the patient;

B.     Any additional time beyond the scheduled shift, not to exceed one hour, that is needed to: (i) assist with a staff vacancy for the next shift that becomes known at the end of the current shift or, (ii) ensure appropriate and complete documentation and transfer of care to the next shift; or

C.     Work necessary to continue critical continuity of care if there is potential harm to the patient or disruption of ongoing treatment if the nurse leaves or transfers care to another.

SECTION 8:  Section 71 of chapter 111 of the general laws, as so appearing, is hereby amended by adding after subsection (iv), the following new subsection:

     (v) A nursing home licensed under the provisions of this section shall certify that it will, at all times, have at least one registered nurse on duty on all shifts, on all days throughout the term of the license.

SECTION 9:  Section 80B of Chapter 112 of the general laws, as so appearing, is hereby amended by adding at the end of the Section, the following new paragraph:

Each individual licensed to practice as a registered nurse or as a licensed practical nurse in the commonwealth, shall not work more than 12 hours in any given shift and shall not work in excess of 16 hours in a 24 hour period.  Such registered or licensed practical nurse that works 12 consecutive hours in a shift must take at least 10 hours off between shifts.  During said 10 hour period, such registered or licensed practical nurse shall not work for employment compensation for a health care facility or for any other employer, employer as defined in section 3401(d) of the Internal Revenue Code.  Furthermore, a registered or licensed practical nurse shall not work for employment compensation more than 60 hours in any seven day period whether such work is for a health care facility or other employer.  For the purposes of this paragraph, it shall not be the responsibility of the employer to ensure that a registered or licensed practical nurse has not violated the limitation of hours worked as specified in this subsection except for those hours worked in the employment of the employer.  Registered nurses and licensed practical nurses shall solely be responsible for certifying with the board of registration in nursing compliance with the provisions of this subsection during their applicable licensure renewal period.  Provided that any exceptions to the hour limitations as addressed in Chapter 111, section 56B shall apply.  Provided further, that the provisions of this paragraph shall not apply to “on-call” time, so defined under Chapter 111, section 56B, while the nurse is not on the hospital premises.

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SECTION 10. Commission to Study Limitations of Nursing Hours in Order to Reduce Fatigue and Improve Patient Care.

There shall be a special commission within the Executive Office of Health and Human Services and with the support of the Department of Public Health for the purpose of studying the limitations of nursing hours in order to reduce fatigue and to improve patient care in hospitals. In particular, the special commission shall review the recommendations of  the Institute of Medicine’s report “Keeping Patients Safe: Transforming the Work Environment of Nurses” (issued on November 4, 2003) regarding the limitation of nursing hours. The Commission shall review and study the most current studies and clinical evidence regarding limitation of nursing hours and the effect of such limitation on fatigue and patient safety. The commission shall also review the experience of hospitals in Massachusetts that have limited nursing hours in accord with the recommendations of the Institute of Medicine as stated in the “Keeping Patients Safe” reported cited above. The special commission shall also work with hospitals to identify the best practices to be used in implementing such limitation on nursing hours. The special commission shall consist of the Chairs of the Ways and Means Committees, Commissioner of the Department of Public Health and a representative from the Massachusetts Hospital Association, the Massachusetts Organization of Nurse Executives, the Massachusetts Nurses Association, the Massachusetts Association of Registered Nurses, the Massachusetts Medical Society, the Blue Cross and Blue Shield of Massachusetts, the Massachusetts Association of Health Plans, the Associated Industries of Massachusetts, the Massachusetts League of Community Health Centers, three Teaching and three Community Hospitals, a Chronic Disease hospital, an Inpatient Rehabilitation hospital, the Massachusetts Coalition for the Prevention of Medical Errors, the Massachusetts Association of Colleges of Nursing, Community Colleges, other nursing organizations, nursing schools, and medical schools. The commission shall be jointly chaired by the Chairs of the Joint Committee on Health Care Financing.  No action of the commission shall be considered official unless approved by a majority of the members of the commission.  The special commission shall file its final report and any recommendations for legislation and revisions to this act regarding limitation of nursing hours to reduce fatigue and improve patient care with the clerks of the Senate and House of Representatives, with the House and Senate Committees on Ways and Means, the House and Senate Chairs of the Joint Committee on Health Care Financing, the House and Senate Chairs of the Joint Committee on Public Health, the Betsy Lehman Center and with the Governor no later than April 15, 2010.

SECTION 11:   Effective dates.

(a)                 The provision of Sections 6, and 7 of this Act shall become effective on April 15, 2009.

(b)                The provisions of Section 9 and 10 of this Act shall become effective on January 1, 2010.

(c)                 Section 8 of this act shall take effect on October 1, 2010.

(d)                The balance of the act shall take effect upon passage.