Nurse Staffing

Page Updated: Oct. 10, 2024

CHA Advocacy Principle: Promote rational regulations to ensure staff resources are focused on patient care.

What Has Been Completed:

Origin: House Bill (HB) 22-1401 builds on the work from the past two years to update the nursing section of the Chapter 4 regulations governing hospital and nurse staffing and address “hospital readiness” for pandemic response.

Background: On April 19, 2023, the Board of Health finalized three rules implementing HB22-1401. Per the finalized rules, hospitals are required to: 

• • Establish a nurse staffing committee that is required to create, implement, and evaluate a nurse staffing plan and to receive, track, and resolve complaints and receive feedback from direct-care nurses and other staff;
  • Submit its nurse staffing plan to CDPHE on an annual basis;
  • Evaluate its nurse staffing plan on a quarterly basis and, based on complaint and recommendations of patients and staff, revise the nurse staffing plan accordingly;
  • Prepare a quarterly report containing the details of the evaluation;
  • Update emergency management plans annually and as often as necessary, as circumstances warrant, and include specific provisions to maximize staffed-bed capacity and appropriate utilization of hospital beds to the extent necessary for a public health emergency;
  • Assign direct care providers only to a nursing unit or clinical area of a hospital that the provider is properly trained in;
  • Continue to report hospital bed capacity on a biweekly basis (Tuesdays and Fridays) in EMResource; and
  • Report on communicable diseases and related events to CDPHE and local public health agencies.

As a reminder, hospitals are required to submit an annual report of their nurse staffing plans to CDPHE as part of Chapter 4 standards. This submission is a requirement due at the time of the license renewal process. The required form can be found with the documents and instructions needed to complete the facility’s license renewal application. Additionally, the form can be found on the CDPHE website.   

Information for Critical Access Hospitals (CAHs): Facilities that have 25 inpatient beds or fewer and are federally certified, or undergoing federal certification, under 42 CFR 485.600, et seq., as critical access hospitals shall meet Chapter 4 requirements, except that the staffing qualifications, level of staffing, hours of operation, and quality management requirements shall not exceed the requirements established in the aforementioned federal regulations.

Per HB 22-1401, a hospital with fewer than 25 beds does not have to include in its emergency plan a demonstrated ability to surge to 125% after a statewide emergency (Section 25-3-128(6), et seq., C.R.S.).

Dates of Notice:

Resources: 

• • CHA September 2024 Regulatory Update Call – recording linked here (Passcode: #*^!4tid), slides linked here
  • Nurse Staffing Plan Submission Portal
  • Nurse Staffing Plan Annual Report Table of Contents Requirements
  • Health Facilities Complaint Process – File a Complaint
  • CDPHE slides for CHA’s Regulatory Update deep dive
  • Finalized Rules:
    • • 6 CCR 1009-5, outlining hospital bed reporting;
      • 6 CCR 1011-1, Chapter 4, General Hospitals, outlining requirements for hospital nurse staffing committees, nurse staffing plans, and emergency management plans;
      • 6 CCR 1011-1, Chapter 2, General Licensure Standards, establishing regulations regarding infection control and prevention practices in licensed health facilities; and
      • 6 CCR 1009-1, Epidemic and Communicable Disease Control, outlining communicable diseases and related events reporting.
  • CDPHE Link to Receive HB 22-1401 Information
  • CHA HB 22-1401 Issue Brief
  • CHA Staffed-Bed Hardship Waiver
  • CHA Chapter 4 Webpage
  • CHA Chapter 4 Webinar Recording

CHA Staff Contact: Megan Axelrod, CHA senior director, regulatory policy and federal affairs, [email protected].