3rd Session, 43rd Legislature

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Bill 28

THE HEALTH SYSTEM GOVERNANCE AND ACCOUNTABILITY AMENDMENT ACT (NURSE-TO-PATIENT RATIOS)

(Assented to                                         )

HIS MAJESTY, by and with the advice and consent of the Legislative Assembly of Manitoba, enacts as follows:

C.C.S.M. c. H26.5 amended

1   The Health System Governance and Accountability Act is amended by this Act.

2   Subsection 1(1) is amended by adding the following definitions:

"compliance plan for nurse-to-patient ratios" means a nurse-to-patient ratio compliance plan required under section 24.1 or 54; (« plan de conformité relatif aux ratios infirmier-malade »)

"nurse-to-patient ratio" means a nurse-to-patient ratio referred to in subsection 3(3.1); (« ratio infirmier-malade »)

3   The following is added after subsection 3(3):

Standards for minimum nurse-to-patient ratio

3(3.1)   A prescribed standard under subsection (3) may establish a ratio of the minimum number of nurses to patients that a health authority, health care organization or health corporation, or other person in receipt of payments or funding from a health authority, must comply with in providing health services.

4   The centred heading "STRATEGIC AND OPERATIONAL PLANS" is added before section 24.

5   The following is added after section 24 and before the centred heading that follows it:

NURSE-TO-PATIENT RATIOS

Compliance plan for nurse-to-patient ratios

24.1(1)   A health authority must prepare a compliance plan for nurse-to-patient ratios and submit the plan to the minister within the time specified by the minister.

Required protocols

24.1(2)   The compliance plan must set out protocols that the authority will follow if the authority is unable to comply with a nurse-to-patient ratio when providing health services.

Minister may require changes

24.1(3)   The minister may, at any time and by providing written direction to an authority, require the authority to make changes to its plan within the time specified by the minister, and the authority must comply with the minister's direction.

6(1)   Subsection 54(1) is amended

(a) in clause (b), by adding ", including any nurse-to-patient ratios that apply" at the end; and

(b) by adding the following after clause (b):

(b.0.1) shall, if it receives operational funding from a health authority, ensure that it prepares a compliance plan for nurse-to-patient ratios that is acceptable to the authority;

6(2)   The following is added after subsection 54(1):

Required protocols

54(1.1)   A compliance plan prepared under clause (1)(b.0.1) by a health care organization, health corporation or other person must set out protocols that the organization, corporation or other person will follow if it is unable to comply with a nurse-to-patient ratio when providing health services.

Authority must file nurse-to-patient ratio plans with minister

54(1.2)   A health authority must, on determining that a compliance plan prepared under clause (1)(b.0.1) is acceptable, submit the plan to the minister.

Minister may require changes

54(1.3)   The minister may, at any time and by providing written direction, require a health care organization, health corporation or other person in receipt of payments or funding from a health authority to make changes to its plan within the time specified by the minister, and the health care organization, health corporation or other person must comply with the minister's direction.

7   The following is added after section 55:

Implementation committee — nurse-to-patient ratios

55.1(1)   The minister must establish an implementation committee for nurse-to-patient ratios.

Role of committee

55.1(2)   The committee is to advise and make recommendations to the minister respecting

(a) priority areas in which nurse-to-patient ratios are to be established;

(b) appropriate nurse-to-patient ratios, including circumstances where variations in a ratio may be appropriate; and

(c) any other matter relating to nurse-to-patient ratios on which the minister seeks the committee's advice.

Definition of "operator"

55.2(1)   In this section, "operator" means a health authority, health care organization or health corporation, or other person in receipt of payments or funding from a health authority.

Reporting on nurse-to-patient ratio

55.2(2)   An operator who is unable to comply with a nurse-to-patient ratio when providing health services must report the non-compliance to the minister.

Content

55.2(3)   The report must

(a) specify the date, time and place that the non-compliance occurred;

(b) provide the reasons for the non-compliance; and

(c) contain any other information as the minister requires.

Form and timing of report

55.2(4)   An operator must, for each three-month period beginning on January 1, April 1, July 1 or October 1 in a year, submit the reports prepared under this section in a form and manner approved by the minister.

8   Section 60 is amended by renumbering it as subsection 60(1) and adding the following as subsections 60(2) and (3):

Content of nurse-to-patient ratio regulation

60(2)   A prescribed standard that establishes a nurse-to-patient ratio may

(a) for the purpose of determining a ratio, specify

(i) a unit, program or type of health services that is subject to the ratio,

(ii) the manner in which the number of patients or other persons who are in a unit or program or who are provided health services is to be determined, including by reference to the number of patients or persons, their acuity levels or any other prescribed criteria,

(iii) the nursing positions to be included, which must be based on the number of nursing positions that are assigned to the unit or program or to provide the health services, and

(iv) the qualification or training required for a nurse to be eligible to be counted when calculating a ratio;

(b) calculate the ratio in reference to

(i) a specified number or a numerical range of nursing positions in relation to patients or other persons who are in a unit or program or are provided with the health services, or

(ii) the amount of time within a period in which care must be available to a patient or other person;

(c) provide for a variation in the ratio based on the following:

(i) the time of day, the day of the week or the day of the year,

(ii) the facility or the size or layout of the facility,

(iii) the availability of other health care providers and health care aides to provide services, including health services other than reserved acts, in the facility that would normally be provided by nurses,

(iv) any other prescribed criteria;

(d) specify circumstances in which the ratio does not apply, such as a public health emergency or an event that results in the sudden influx of patients beyond normal expectations;

(e) address any other matter that the minister considers necessary or advisable in respect of nurse-to-patient ratios.

Limit on interpretation

60(3)   A regulation establishing a nurse-to-patient ratio must not be interpreted as establishing a maximum number of nurses that may be assigned to a unit or program or to provide the health services.

9   The following is added after section 61 as part of Part 5:

No rights, remedies

61.1(1)   A nurse-to-patient ratio does not affect or create rights or remedies under any other enactment or the common law or equity.

No cause of action, proceeding

61.1(2)   A failure to comply with a nurse-to-patient ratio does not give rise to a cause of action or other claim or to a proceeding in any court or before any body or person having the power to make decisions under an enactment.

Coming into force

10   This Act comes into force on a day to be fixed by proclamation.