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110-19 Quality care close to home. j^SPRING VALLEY HOSPITAL,,. MEDICAL CENTER The Valley ' Health System' October 23,2018 Legislative Committee on Healthcare To Whom It May Concern: Pursuant to Chapter 449 of the Nevada Revised Statuses, Spring Valley Hospital Medical Center, a 358 bed licensed hospital in Clark County, Nevada is enclosed the required elements of the bill. The hospital established a Staffing Committee on August 27,2009 and prepared a policy outlining the establishment, activities and progress, and measurement of efficacy of the Committee. We added a certified nursing assistant to the committee on September, 2013. Enclosed is the Committee Report describing the activities and resolutions of issues brought forward which determines the efficacy of the Committee. The Committee consists of not less than one-half of its total members from the licensed nursing staff as well as a certified nursing assistant and another half of those appointed by Administration. Thank you for your review of the enclosed report. Sincerely, Patricia Gilliano, MSN/MBA CNO Chief Nursing Office cc: Leonard Freehof, CEO Attachment Staffing Committee Report Staffing Plans Policy 5400 South Rainbow Boulevard • Las Vegas, Nevada 89118 Telephone (702) 853-3000* Facsimile (702) 853-3340 STAFFING COMMITTEE REPORT HOSPITAL NAME: Spring Valley Hospital Medical Center 5400 South Rainbow Blvd. Las Vegas, NV 89118 TITLE OF INDIVIDUAL RESPONSIBLE FOR COMMITTEE Chief Nursing Officer TELEPHONE NUMBER: (702)853-3332 DATE COMMITTEE WAS INITIATED: August 27, 2009 MEMBERS IN ATTENDANCE: Sign-in sheetson site COMMITTEE MEMBERS: Consists of Registered Nurses, Imaging technician, Emergency Room technician, Certified Nurse Aides, Unit Coordinators, Administration Coordinator COMMITTEE ACTIVITIES: The Staffing Committee has been set up in accordance to SB 362. Forthe year 2018, the Committee • Discussed methods of improving patient care • Analyzed Staffing Despite Objection Forms (SDO) • Considered the number of refusals and objections to work assignments, reviewing the why and examining trends • Reviewed the timeliness of response to licensed nurse/certified nurse aide requests • Considered patient load issues • Examined issues related to floating staff to other areas • Reviewed staffing plan • Continued quality initiatives related to nursing care • Discussed relevant hospital updates • Maintained recognition and reward for staff o DAISY Award o STAR Awards MEETING SCHEDULE: The Staffing Committee is scheduled to meet quarterly the first week of the month as noted on Ecalendar with invites out to all members for the 2pm meeting. STAFFING COMMITTEE EFFICACY: The Staffing Committee established on August 27, 2009 has been effective in reviewing and resolving issues in a collaborative manner. U sing data presented through SB482 and Staffing Despite Objection (SDO) Forms, initiatives have been put in place to assist with patient load and staffing. Certified Nurse Aides have been cross-trained as Unit Coordinators, and mid-shift Certified Nurse Aides were implemented to supplement staffing during the busiest part of the day. To improve employee morale, recognition boards have been placed on each department to help expand awareness and employee engagement. A Coffee Shop has been opened in the hospital lobby to improve the patient and staff experience. SIGNATURE OF RESPONSIBLE PARTY: Patti Gilliano MSN/MBA CNO Chief Nursing Officer SIGNATURE OF STAFF MEMBER OF COMMITTEE: SIGNATURE OF STAFF MEMBER OF COMMITTEE: POLICY Title: Refusal to Work Assignment Location: Spring Valley Policy Number: Page: 1 of 4 Department of Document Owner: NURSE ADMIN Original Effective Date: 10/2013 Last Review Date: 3/2018 Last Revision Date: Section: Clinical Practice (HW)- General Nursing I. SCOPE: Nurse Division II. PURPOSE: To provide a systematic method for reviewing the circumstances under which a licensed nurse or certified nursing assistant may refuse a work assignment. III. POLICY: It is the policy of Spring Valley Hospital Medical Center that: A. A licensed nurse or Certified Nursing Assistant (CNA) refusing an assignment will communicate specific conditions concerning the request in the following manner: • Will report to his or her immediate supervisor or person in charge, in writing, that he or she does not possess the knowledge, skill or experience to comply with an assignment to provide nursing services to a patient as defined in NRS 449.205 Section 1, Subsection 1(b), as verified by documentation in the personnel file of the licensed nurse or CNA - concerning his or her competence to provide various nursing services to the patient, unless the refusal constitutes unprofessional conduct as set forth in Chapter 632 of NRS or any regulations adopted pursuant thereto. • Will provide prior notice to the immediate supervisor or person in charge of the licensed nurse or CNA prior to accepting an assignment. • If a licensed nurse or CNA is assigned a position or task for which he/she feels unqualified or unsuited, he/she should immediately express such concerns to the immediate supervisor or person in charge. • The immediate supervisor will assess options and then seek to remedy the situation. • If no possible alternatives are identified, the immediate supervisor, or person in charge will contact his/her Manager/Director. • The Manager/Director will review the written request and attempt to resolve the situation utilizing available resources he/she determines appropriate • All refusals filed will be reviewed by the staffing committee at the quarterly meeting to determine trending . Policy Title: Refusal to Work Assignment Page: 2 of 4 B. The supervisor may approve or deny the request • Approval of request The licensed nurse/CNA will be relieved of his/her assignment • Denial of request If the supervisor fails to approve the request without proposing a remedy, or a remedy is proposed but inadequate or untimely, the licensed nurse or CNA can file a formal complaint with the Health Division within (21) business days of the refusal if the licensed nurse/CNA feel, in good faith, the refusal meets the condition of the written policy for refusal of assignment. The supervisor, Manager or Director has (14) days to investigate and provide a written response to the licensed nurse/CNA. A copy of the investigation will be submitted to the Staffing Committee. The refusal will be reviewed by the Staffing Committee members quarterly and a written response will be provided to the licensed nurse or CNA. C. The facility shall: • Maintain records for at least two years of each request to be relieved of a work assignment, and refusals of a work assignment made by a licensed nurse or CNA. • The facility shall provide to the staffing committee the number of requests to be relieved from work, refusals of a work assignment and objections to a work assignment. • The facility shall provide to the staffing committee an explanation of how the requests, refusal and objections were addressed. • Ensure compliance with the written policy. D. The facility shall not retaliate or discriminate unfairly against employees and certain other person’s as defined in NRS 449.205. Policy Title: Refusal to Work Assignment Page: 3 of 4 Refusal of Work Assignment Form Instructions: A licensed nurse or Certified Nursing Assistant (CNA) refusing a work assignment is encouraged to communicate this concern in the following manner: A. Report in writing to his or her immediate supervisor or person in charge, that he or she does not possess the knowledge, skill or experience to comply with an assignment to provide nursing services to a patient as defined in NRS 449.205, Section 1, Subsection 1(b). This would be verified by documentation in the personnel file of the licensed nurse or CNA – concerning his or her competence to provide various nursing services to the patient, unless the refusal constitutes unprofessional conduct as set for in NAC 632.890, or any regulations adopted pursuant thereto. B. Will provide notice, prior to accepting an assignment, to the immediate supervisor or person in charge of the licensed nurse or CNA at the time of the objection. C. If a licensed nurse or CNA is assigned a position or task for which he/she feels unqualified or unsuited, he or she should immediately express such concerns to the immediate supervisor or person in charge. D. The immediate supervisor or person in charge will assess options and then seek to remedy the situation to relieve the licensed nurse or CNA from their work assignment E. If no possible alternatives are identified, the immediate supervisor or person in charge will contact his or her immediate supervisor on duty. F. Documentation of the “Refusal of Work Assignment” will be submitted to the staffing committee for review G. The nursing supervisor will review the written request and attempt to resolve the situation utilizing available resources he/she determines appropriate. H. If the nursing supervisor fails to approve the request without proposing a remedy, or a remedy is proposed but inadequate or untimely, the licensed nurse or CNA can file a formal complaint with the Health Division within 21 business days from the date of refusal, if the licensed nurse or CNA feel, in good faith, the refusal meets the condition of the written policy for refusal of assignment. Timeframe for Action Nurse or CNA Supervisor Staffing Committee Timeline At time of objection 14 Days Quarterly Action File Complaint with NSHD, Investigate Review and examine complete Refusal of Work trends for Assignment Form with effectiveness and copy to Supervisor and quality improvement Staffing Committee Await response Respond to Nurse/CNA Respond to Nurse/CNA Policy Title: Refusal to Work Assignment Page: 4 of 4 Refusal of Work Assignment Form I, a licensed nurse/CNA at (Name) (Hospital) on , _, hereby refuse to the assignment as: (Shift) (Date) o charge nurse o licensed nurse o Certified Nursing Assistant o other In my professional opinion, the situation described here is not adequate to meet the needs of the patients assigned to me at this time.

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