AB489,3,1210 (b) A hospital shall, in its nurse staffing plan, provide for a collaborative
11practice in the hospital that enhances patient care and the level of services provided
12by nurses and other members of the hospital's patient care team.
AB489,3,1313 (c) A hospital shall include all of the following in its nurse staffing plan:
AB489,3,1514 1. A written certification that the nurse staffing plan is sufficient to provide
15adequate and appropriate delivery of health care services to patients during the year.
AB489,3,1716 2. The hospital's employment practices concerning the use of temporary and
17traveling nurses.
AB489,3,1818 3. The hospital's process for internal review of the nurse staffing plan.
AB489,3,2119 4. The hospital's mechanism for obtaining input from staff that provide direct
20patient care, including registered nurses and other members of the hospital's patient
21care team, in the development of the nurse staffing plan.
AB489,3,2322 5. The minimum registered nurse skill mix for each patient care unit in the
23hospital, including inpatient, critical care, and emergency department staffing.
AB489,3,2524 6. The method used by the hospital to determine and adjust direct patient care
25nurse staffing levels.
AB489,4,1
17. The supporting personnel assisting on each patient care unit of the hospital.
AB489,4,32 8. The number of registered nurses providing direct patient care and the ratio
3of registered nurses to patients in each care unit of the hospital.
AB489,4,64 (d) A hospital shall provide in its nurse staffing plan that, at all times during
5each shift within a hospital unit, a registered nurse providing direct patient care is
6assigned to not more than the following number of patients in that hospital unit:
AB489,4,77 1. Four patients in an emergency unit.
AB489,4,88 2. Two patients in an intensive care emergency unit.
AB489,4,99 3. Two trauma patients in a trauma emergency unit.
AB489,4,1010 4. Two patients in an intensive care unit.
AB489,4,1111 5. Three patients in a progressive care unit.
AB489,4,1212 6. Four patients in a telemetry unit.
AB489,4,1313 7. Five patients in a medical-surgical unit.
AB489,4,1414 8. Four patients in a pediatric unit.
AB489,4,1515 9. One patient in an operating room unit.
AB489,4,1616 10. Two patients in a postanesthesia care unit.
AB489,4,1717 11. Five patients in an oncology unit.
AB489,4,1818 12. Five patients in an orthopedic unit.
AB489,4,1919 13. Six patients in a psychiatry unit.
AB489,4,2020 14. Four patients in a labor obstetrics unit.
AB489,4,2121 15. Four patients in a postpartum obstetrics unit.
AB489,4,2222 16. Four patients in a nursery obstetrics unit.
AB489,4,2323 17. Two patients in a neonatal intensive care unit.
AB489,4,2524 (e) A hospital's nurse staffing plan shall be approved by a majority vote of the
25members of the hospital's nurse staffing committee under sub. (3).
AB489,5,2
1(f) A hospital, in collaboration with its nurse staffing committee, shall
2implement to the best of its ability the nurse staffing plan.
AB489,5,83 (g) If staffing falls below the levels proposed in the nurse staffing plan for the
4previous reporting period, a hospital shall include, in its nurse staffing plan for the
5subsequent reporting period, a description of any differences between the staffing
6levels described in the previous staffing plan and the actual staffing levels for each
7patient care unit and any actions the hospital intends to take to address the
8differences or adjust staffing levels in future staffing plans.
AB489,5,109 (h) A hospital shall post its nurse staffing plan on each unit of the hospital in
10a location that is visible, conspicuous, and accessible to staff, patients, and the public.
AB489,5,1211 (i) The department shall post each hospital's nurse staffing plan on the
12department's website.
AB489,5,17 13(3) Nurse staffing committee. (a) A hospital shall maintain a nurse staffing
14committee to assist in the preparation of its nurse staffing plan. The majority of the
15nurse staffing committee members shall be nonsupervisory registered nurses who
16are employed by the hospital and whose primary responsibility is to provide direct
17patient care.
AB489,5,2118 (b) In a hospital in which registered nurses providing direct patient care are
19included in a collective bargaining unit established under ch. 111, the representative
20of the collective bargaining unit shall select the registered nurse members of the
21nurse staffing committee, subject to the requirements under par. (a).
AB489,6,2 22(4) Nurse staffing records. (a) A hospital shall maintain accurate records of
23the actual ratios of registered nurses providing direct patient care to patients in each
24unit of the hospital during each shift for at least 3 years. The records must include
25the number of patients in each unit during each shift and the number of registered

1nurses assigned to provide direct patient care to each patient in each unit during
2each shift.
AB489,6,53 (b) A hospital shall make the records under par. (a) available to the department
4and, upon request, to hospital staff, to a collective bargaining representative of
5hospital staff, to patients, and to the public.
AB489,6,7 6(5) Complaints. A hospital employee, patient, or member of the public may file
7a complaint with the department to report any suspected violation of subs. (2) to (4).
AB489,6,13 8(6) Hospital failure to comply with nurse staffing plan and reporting
9requirements; corrective action; penalties.
(a) Nurse staffing plan deadline;
10penalty.
The department shall review each nurse staffing plan provided by a hospital
11under sub. (2) (a) to ensure it is received by the date determined by the department
12under sub. (2) (a). A hospital that fails to submit a nurse staffing plan by the date
13determined by the department under sub. (2) (a) shall forfeit $25,000.
AB489,6,1814 (b) Corrective plan of action; penalty. 1. The department shall investigate a
15complaint received under sub. (5) that is accompanied with documented evidence of
16a hospital's failure to establish a nurse staffing committee, conduct an annual review
17of a nurse staffing plan, submit a nurse staffing plan on an annual basis, or meet the
18nurse staffing levels provided under sub. (2) (d) in violation of sub. (2), (3), or (4).
AB489,6,2219 2. If, after an investigation, the department determines a violation has
20occurred, the department shall present its findings to the hospital and require the
21hospital to submit a corrective plan of action within 45 days from the time the
22department presented its findings to the hospital.
AB489,7,423 3. If a hospital fails to submit or follow a corrective plan of action, the hospital
24may be required to forfeit $5,000 for each day that the hospital fails to submit or
25follow the corrective plan of action. The forfeitures under this subdivision shall

1accrue until the hospital submits and follows for 90 days a corrective plan of action
2that has been approved by the department. If the hospital follows the corrective plan
3of action for 90 days, the department may reduce the forfeiture amount accrued
4under this subdivision.
AB489,7,75 (c) Posting violations. The department shall post on its website a report of
6violations of subs. (2) to (4) and maintain for public inspection records of any civil
7penalties and administrative actions imposed on hospitals under this subsection.
AB489,2 8Section 2. 103.035 of the statutes is created to read:
AB489,7,10 9103.035 Mandatory overtime for registered nurses in hospitals
10prohibited; exceptions.
(1) Definitions. In this section:
AB489,7,1111 (a) “Hospital” has the meaning given in s. 50.33 (2) .
AB489,7,1212 (b) “Overtime” means any of the following:
AB489,7,1513 1. Time worked in excess of a regularly scheduled daily work shift that has been
14determined and agreed to before the performance of the work, immediately following
15the regularly scheduled daily work shift.
AB489,7,1616 2. Time worked in excess of 12 hours in a 24-hour period.
AB489,7,1717 3. Time worked in excess of 40 hours in a previously determined workweek.
AB489,7,1818 (c) “Registered nurse” has the meaning given in s. 146.40 (1) (f).
AB489,7,20 19(2) Mandatory overtime prohibited. (a) Except as provided in par. (b), no
20hospital may require a registered nurse to work overtime.
AB489,7,2221 (b) A hospital may require a registered nurse to work overtime only in one of
22the following instances:
AB489,7,2523 1. The hospital has determined that the safety of a patient requires that a
24registered nurse work overtime and the hospital has found that no reasonable
25alternative exists.
AB489,8,2
12. The registered nurse is working in an ongoing surgical procedure at the time
2the hospital requires the nurse to work overtime.
AB489,8,43 3. The registered nurse is working in a critical care unit and is required to work
4overtime until the nurse is relieved by another scheduled registered nurse.
AB489,8,75 4. During any time that the president of the United States declares a public
6health emergency under 50 USC 1621 that affects the region of this state in which
7the hospital is located.
AB489,8,98 5. During any time that the governor declares a public health emergency under
9s. 323.10 that affects the region of this state in which the hospital is located.
AB489,8,1110 6. During any time of adverse weather conditions, catastrophe, or widespread
11illness within the hospital.
AB489,8,14 12(3) Voluntary coverage. Before requiring a registered nurse to work overtime
13under sub. (2) (b), the hospital shall make a good faith effort to have those work hours
14covered on a voluntary basis.
AB489,8,20 15(4) Right to refuse mandatory overtime. A registered nurse may refuse to
16work overtime if the nurse believes in good faith that the hospital has not made a
17good faith effort to fill the work hours covered by the overtime mandate. A hospital
18may not discharge, retaliate, or discriminate in promotion, in compensation, or in the
19terms, conditions, or privileges of employment against the registered nurse for
20refusing to work the overtime.
AB489,9,3 21(5) Enforcement. A registered nurse who is discharged, retaliated, or
22discriminated against in violation of sub. (4) may file a complaint with the
23department, and the department shall process the complaint in the same manner
24that employment discrimination complaints are processed under s. 111.39. If the
25department finds that a hospital has violated sub. (4), the department may order the

1hospital to take such action under s. 111.39 as will effectuate the purpose of this
2section. Section 111.322 (2m) applies to discharge or other discriminatory acts
3arising in connection with any proceeding under this subsection.
AB489,3 4Section 3. 106.54 (10) (c) of the statutes is created to read:
AB489,9,75 106.54 (10) (c) The division shall receive complaints under s. 103.035 (5) and
6shall process the complaints in the same manner as employment discrimination
7complaints are processed under s. 111.39.
AB489,4 8Section 4. 111.322 (2m) (a) of the statutes is amended to read:
AB489,9,129 111.322 (2m) (a) The individual files a complaint or attempts to enforce any
10right under s. 103.02, 103.035, 103.10, 103.11, 103.13, 103.28, 103.32, 103.34,
11103.455, 104.12, 109.03, 109.07, 109.075, 146.997, 146.998, or 995.55, or ss. 101.58
12to 101.599 or 103.64 to 103.82.
AB489,5 13Section 5. 111.322 (2m) (b) of the statutes is amended to read:
AB489,9,1714 111.322 (2m) (b) The individual testifies or assists in any action or proceeding
15held under or to enforce any right under s. 103.02, 103.035, 103.10, 103.11, 103.13,
16103.28, 103.32, 103.34, 103.455, 104.12, 109.03, 109.07, 109.075, 146.997, 146.998,
17or 995.55, or ss. 101.58 to 101.599 or 103.64 to 103.82.
AB489,6 18Section 6. 146.998 of the statutes is created to read:
AB489,9,20 19146.998 Nurse rights regarding safe nursing standards; cause of
20action.
(1) Definitions. In this section:
AB489,9,2121 (a) “Hospital” has the meaning given in s. 50.33 (2).
AB489,9,2222 (b) “Registered nurse” has the meaning given in s. 146.40 (1) (f).
AB489,9,25 23(2) Right to refuse. A registered nurse may object to or refuse to participate
24in an activity, policy, practice, assignment, or task if, in good faith and in the
25registered nurse's professional judgment, the registered nurse is not prepared by

1education, training, or experience to fulfill the activity, policy, practice, assignment,
2or task without compromising the safety of a patient or jeopardizing the registered
3nurse's license. A registered nurse's professional judgment under this subsection
4shall be based upon the registered nurse's application of knowledge, expertise, and
5experience in conducting a comprehensive nursing assessment of a patient and
6making independent decisions about patient care in accordance with state law and
7administrative rules, including the need for additional staff.
AB489,10,10 8(3) Disciplinary action prohibited. A hospital may not do any of the following
9in response to a registered nurse's refusal to participate in an activity, policy,
10practice, assignment, or task under this section:
AB489,10,1411 (a) Discharge, retaliate, or discriminate against, or otherwise subject the
12registered nurse to an adverse action with respect to any aspect of the registered
13nurse's employment, including actions related to promotion, compensation, or terms,
14conditions, or privileges of employment.
AB489,10,1615 (b) File a complaint or report against a registered nurse with a state
16professional disciplinary entity.
AB489,10,23 17(4) Cause of action. A registered nurse or the collective bargaining
18representative or legal representative of a nurse who has been discharged,
19retaliated, or discriminated against, subjected to an adverse action, or the subject of
20a complaint or report filed with a state professional disciplinary entity in violation
21of sub. (3) may bring a cause of action against the hospital that violated sub. (3). A
22registered nurse who prevails in a cause of action under this subsection is entitled
23to at least one of the following:
AB489,10,2424 (a) Reinstatement.
AB489,10,2525 (b) Reimbursement of lost wages, compensation, and benefits.
AB489,11,1
1(c) Reasonable attorney fees, notwithstanding s. 814.04 (1).
AB489,11,22 (d) Court costs.
AB489,11,33 (e) Any other reasonable damages.
AB489,7 4Section 7. Initial applicability.
AB489,11,95 (1) Collective bargaining agreements. This act first applies to a registered
6nurse, as defined in s. 146.40 (1) (f), who is affected by a collective bargaining
7agreement that contains provisions inconsistent with this act on the day on which
8the collective bargaining agreement expires or is extended, modified, or renewed,
9whichever occurs first.
AB489,8 10Section 8. Effective dates. This act takes effect on the day after publication,
11except as follows:
AB489,11,1312 (1) Nurse staffing records. The treatment of s. 50.373 (4) takes effect on the
13first day of the 4th month beginning after publication.
AB489,11,1414 (End)
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