LRB-4541/1
KMS&MIM:amn
2023 - 2024 LEGISLATURE
October 12, 2023 - Introduced by Representatives Hong, Ratcliff, Shelton,
Cabrera, Joers, J. Anderson, Sinicki, Subeck, Stubbs, Palmeri, Clancy, C.
Anderson
and Ortiz-Velez, cosponsored by Senators Larson, Carpenter,
Hesselbein and L. Johnson. Referred to Committee on Health, Aging and
Long-Term Care.
AB489,1,5 1An Act to amend 111.322 (2m) (a) and 111.322 (2m) (b); and to create 50.373,
2103.035, 106.54 (10) (c) and 146.998 of the statutes; relating to: minimum
3nurse staffing ratios in hospitals, registered nurses' right to refuse a work
4assignment, prohibiting mandatory overtime for registered nurses, and
5providing a penalty.
Analysis by the Legislative Reference Bureau
This bill requires hospitals to develop and adhere to a plan for staffing
registered nurses. Under the bill, the nurse staffing plan must meet certain
standards, including being created and approved by a nurse staffing committee, the
majority of which must be registered nurses in nonsupervisory positions; reviewed
annually by the hospital; provided to the Department of Health Services annually,
by a deadline set by DHS; and posted in every unit of the hospital and on the DHS
website. The bill establishes minimum nurse-to-patient ratios that the hospital
must maintain for each unit in the hospital. Under the bill, hospitals must keep for
at least three years records of its nurse staffing ratios and actual staffing numbers.
Under the bill, a hospital that fails to provide DHS with its nurse staffing plan
by the deadline set by DHS is subject to a civil penalty of $25,000. In addition, a
hospital that fails to form a nurse staffing committee, annually review its nurse
staffing plan, annually submit its nurse staffing plan to DHS, or adhere to required
nurse-to-patient staffing ratios must submit a corrective action plan to DHS. Under
the bill, a hospital may be subject to a civil penalty of $5,000 for each day the hospital
fails to submit or comply with a corrective action plan.

In addition, the bill provides that registered nurses have the right to refuse a
work assignment if the nurse, in good faith and in the nurse's professional judgment,
finds that the nurse is unable to fulfill the assignment without compromising patient
safety or the nurse's license. The bill creates a cause of action for a nurse against a
hospital that disciplines, discharges, retaliates, discriminates, takes adverse action,
or files a complaint with a disciplinary agency against a nurse that refuses to
complete an assignment under those circumstances.
Under current law, subject to certain exceptions, an employer must pay an
employee who receives an hourly wage one and one-half times the employee's
regular rate of pay for all hours worked in excess of 40 hours per week, but current
law, with exceptions under child labor laws, does not prohibit an employer from
requiring an employee to work in excess of 40 hours per week.
This bill prohibits a hospital from requiring a registered nurse to work
overtime. Under the bill, overtime is work in excess of any of the following: 1) a
regularly scheduled predetermined shift immediately following that shift; 2) 12
hours in a 24-hour period; or 3) 40 hours in a scheduled workweek.
The prohibition on mandatory overtime under the bill does not apply in cases
in which the registered nurse is involved in an ongoing surgical procedure, the
registered nurse's presence is essential to the health and safety of a patient, the
nurse is working in a critical care unit, or a public health emergency has been
declared by the president of the United States or the governor, or during periods of
adverse weather, catastrophe, or widespread illness within the hospital.
A registered nurse who is discharged or discriminated against for refusing to
work overtime or for opposing a practice prohibited under the bill, for filing a
complaint or attempting to enforce a right provided under the bill, or for testifying
or assisting in any action or proceeding to enforce such a right may file a complaint
with the Department of Workforce Development, and DWD must process the
complaint in the same manner that employment discrimination complaints are
processed under current law.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB489,1 1Section 1. 50.373 of the statutes is created to read:
AB489,2,3 250.373 Hospital nurse staffing requirements. (1) Definitions. In this
3section:
AB489,3,3
1(a) “Direct patient care” means any direct patient contact or treatment,
2including consultation, diagnostic tests and procedures, therapeutic procedures,
3pathological analyses and reports, and any other direct medical or health services.
AB489,3,54 (b) “Nurse staffing plan” means a plan developed and provided to the
5department under sub. (2) (a).
AB489,3,66 (c) “Registered nurse” has the meaning given in s. 146.40 (1) (f).
AB489,3,9 7(2) Safe nurse staffing standards; nurse staffing plan. (a) A hospital shall
8provide to the department, by a date determined by the department, a nurse staffing
9plan for the upcoming year.
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.
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