As Introduced

136th General Assembly

Regular Session H. B. No. 521

2025-2026

To amend sections 3333.28, 3722.01, 4723.489, 4730.203, and 4772.092; to enact sections 3333.27, 3722.21, 3722.22, 3722.23, 3722.24, 3722.25, 3722.26, 3722.27, 3722.28, 3722.29, 3722.30, 3722.31, 3722.32, 3722.33, 3722.34, 3722.35, 3722.36, 3722.37, 3722.38, 3722.39, and 3722.40; and to repeal sections 3727.50, 3727.51, 3727.52, 3727.53, 3727.54, 3727.55, 3727.56, and 3727.57 of the Revised Code to require hospitals to establish and comply with registered nurse staffing plans that protect patient safety, to create the Nursing Student Loan-to-Grant Program, to make an appropriation, and to name this act the Ohio Nurse Workforce and Safe Patient Act.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3333.28, 3722.01, 4723.489, 4730.203, and 4772.092 be amended and sections 3333.27, 3722.21, 3722.22, 3722.23, 3722.24, 3722.25, 3722.26, 3722.27, 3722.28, 3722.29, 3722.30, 3722.31, 3722.32, 3722.33, 3722.34, 3722.35, 3722.36, 3722.37, 3722.38, 3722.39, and 3722.40 of the Revised Code be enacted to read as follows:

Sec. 3333.27. (A) The nursing student loan-to-grant program is created in the department of higher education. The chancellor of higher education shall administer the program in accordance with this section.

Under the program, a nursing student enrolled in a prelicensure nursing education program for registered nurses that is approved under section 4723.06 of the Revised Code may apply to be awarded an amount that is conditioned on the student's agreement to fulfill a five-year service obligation. Until an award recipient completes the service obligation, the total amount received shall be considered a loan subject to repayment. Once the service obligation is completed, the amount shall be considered a grant and is no longer subject to repayment.

(B) The service obligation required by the program may be fulfilled by doing any of the following:

(1) Practicing as a direct-care registered nurse in a hospital licensed under Chapter 3722. of the Revised Code;

(2) Practicing as a direct-care registered nurse in a nursing home or residential care facility, as defined in section 3721.01 of the Revised Code;

(3) Serving in this state as a faculty member in a prelicensure nursing education program for registered nurses that is approved under section 4723.06 of the Revised Code.

(C) The chancellor shall establish an application form to be used and procedures to be followed by a nursing student seeking financial assistance through the program. An applicant shall certify that the applicant will make a good faith effort to obtain the license and to secure the employment necessary to begin fulfilling the program's service obligation as soon as practicable following completion of the highest level of education being sought.

The chancellor shall review each application received. If the chancellor determines that an applicant is eligible and there are sufficient funds, the chancellor shall award to the applicant the amount authorized by division (D) of this section.

(D) All of the following apply with respect to an applicant's eligibility and the amount that may be received under the program:

(1) An applicant may submit only one application each year.

(2) If an application is approved, the amount awarded shall not exceed three thousand dollars.

(3) An award recipient may apply for additional awards in subsequent years, with each additional award not to exceed three thousand dollars.

(4) The maximum number of awards an individual may receive is four.

(E) The chancellor shall establish procedures for determining whether the recipient of an award under the program is making a good faith effort to begin fulfilling the recipient's service obligation as soon as practicable following completion of the highest level of education being sought. If the chancellor determines that a good faith effort is not being made, the chancellor shall seek repayment under the procedures described in division (F) of this section.

The chancellor shall establish procedures for monitoring the progress of a recipient who has commenced the employment necessary to fulfill the recipient's service obligation. If the chancellor determines that the recipient has failed to fulfill the service obligation, the chancellor shall seek repayment under the procedures described in division (F) of this section.

(F) The chancellor shall seek repayment of any amount awarded under this section that remains a loan because the chancellor has determined that the recipient failed to fulfill the recipient's service obligation. On request of the chancellor, the attorney general shall bring and prosecute to judgment a civil action to collect any amount that is subject to repayment and remains unpaid.

(G) The nursing student loan-to-grant fund is created in the state treasury. The fund shall consist of all money appropriated to the fund by the general assembly. The chancellor shall use the money in the fund only for purposes of awarding amounts under the nursing student loan-to-grant program.

Sec. 3333.28. (A) The chancellor of higher education shall establish the nurse education assistance program, the purpose of which shall be to make loans to students enrolled in prelicensure ~~nurse~~ nursing education programs ~~at institutions~~ approved by the board of nursing under section 4723.06 of the Revised Code and postlicensure ~~nurse~~ nursing education programs approved by the chancellor under section 3333.04 of the Revised Code or offered by an institution holding a certificate of authorization issued under Chapter 1713. of the Revised Code. The board of nursing shall assist the chancellor in administering the program.

(B) There is hereby created in the state treasury the nurse education assistance fund, which shall consist of all money transferred to it pursuant to ~~section~~ sections 3722.36 and 4743.05 of the Revised Code. The money in the fund shall be used by the chancellor ~~for~~ in accordance with both of the following:

(1) For loans made under division (A) of this section ~~and for~~;

(2) For expenses of administering the ~~loan~~ program, subject to both of the following:

(a) Of the money transferred pursuant to section 3722.36 of the Revised Code, no part shall be used for administrative expenses.

(b) Of the money transferred pursuant to section 4743.05 of the Revised Code, the amount used for administrative expenses shall not exceed the amount that would have been used if no money had been transferred pursuant to section 3722.36 of the Revised Code.

(C) Between July 1, 2005, and January 1, 2012, the chancellor shall distribute money in the nurse education assistance fund in the following manner:

(1)(a) Fifty per cent of available funds shall be awarded as loans to registered nurses enrolled in postlicensure ~~nurse~~ nursing education programs described in division (A) of this section. To be eligible for a loan, the applicant shall provide the chancellor with a letter of intent to practice as a faculty member at a prelicensure or postlicensure program for nursing in this state upon completion of the applicant's academic program.

(b) If the borrower of a loan under division (C)(1)(a) of this section secures employment as a faculty member of an approved nursing education program in this state within six months following graduation from an approved ~~nurse~~ nursing education program, the chancellor may forgive the principal and interest of the student's loans received under division (C)(1)(a) of this section at a rate of twenty-five per cent per year, for a maximum of four years, for each year in which the borrower is so employed. A deferment of the service obligation, and other conditions regarding the forgiveness of loans may be granted as provided by the rules adopted under division (D)(7) of this section.

(c) Loans awarded under division (C)(1)(a) of this section shall be awarded on the basis of the student's expected family contribution, with preference given to those applicants with the lowest expected family contribution. However, the chancellor may consider other factors the chancellor determines relevant in ranking the applications.

(d) Each loan awarded to a student under division (C)(1)(a) of this section shall be not less than five thousand dollars per year.

(2) Twenty-five per cent of available funds shall be awarded to students enrolled in prelicensure ~~nurse~~ nursing education programs for registered nurses, as defined in section 4723.01 of the Revised Code.

(3) Twenty-five per cent of available funds shall be awarded to students enrolled in ~~nurse~~ nursing education programs as determined by the chancellor, with preference given to programs aimed at increasing enrollment in an area of need.

After January 1, 2012, the chancellor shall determine the manner in which to distribute loans under this section.

(D) Subject to the requirements specified in division (C) of this section, the chancellor shall adopt rules in accordance with Chapter 119. of the Revised Code establishing:

(1) Eligibility criteria for receipt of a loan;

(2) Loan application procedures;

(3) The amounts in which loans may be made and the total amount that may be loaned to an individual;

(4) The total amount of loans that can be made each year;

(5) The percentage of the money in the fund that must remain in the fund at all times as a fund balance;

(6) Interest and principal repayment schedules;

(7) Conditions under which a portion of principal and interest obligations incurred by an individual under the program will be forgiven;

(8) Conditions under which all or a portion of the principal and interest obligations incurred by an individual who is deployed on active duty outside of the state or who is the spouse of a person deployed on active duty outside of the state may be deferred or forgiven.

(9) Ways that the program may be used to encourage individuals who are members of minority groups to enter the nursing profession;

(10) Any other matters incidental to the operation of the program.

(E) The obligation to repay a portion of the principal and interest on a loan made under this section shall be forgiven if the recipient of the loan meets the criteria for forgiveness established by division (C)(1)(b) of this section, in the case of loans awarded under division (C)(1)(a) of this section, or by the chancellor under the rule adopted under division (D)(7) of this section, in the case of other loans awarded under this section.

(F) The obligation to repay all or a portion of the principal and interest on a loan made under this section may be deferred or forgiven if the recipient of the loan meets the criteria for deferment or forgiveness established by the chancellor under the rule adopted under division (D)(8) of this section.

(G) The receipt of a loan under this section shall not affect a student's eligibility for assistance, or the amount of that assistance, granted under section 3333.122, 3333.22, 3333.26, 5910.03, 5910.032, or 5919.34 of the Revised Code, but the rules of the chancellor may provide for taking assistance received under those sections into consideration when determining a student's eligibility for a loan under this section.

(H) As used in this section, "active duty" means active duty pursuant to an executive order of the president of the United States, an act of the congress of the United States, or section 5919.29 or 5923.21 of the Revised Code.

Sec. 3722.01. As used in this chapter:

(A) "Children's hospital" means either of the following:

(1) A hospital that provides general pediatric medical and surgical care in which at least seventy-five per cent of annual inpatient discharges for the preceding two calendar years were individuals less than eighteen years of age;

(2) A distinct portion of a hospital that provides general pediatric medical and surgical care, has a total of at least one hundred fifty pediatric special care and pediatric acute care beds, and in which at least seventy-five per cent of annual inpatient discharges for the preceding two calendar years were individuals less than eighteen years of age.

(B) "Health care service" means any of the following:

(1) Pediatric intensive care;

(2) Solid organ and bone marrow transplantation;

(3) Stem cell harvesting and reinfusion;

(4) Cardiac catheterization;

(5) Open heart surgery;

(6) Operation of linear accelerators;

(7) Operation of cobalt radiation therapy units;

(8) Operation of gamma knives.

(C) "Hospital" means an institution or facility that provides inpatient medical or surgical services for a continuous period longer than twenty-four hours. "Hospital" includes a children's hospital.

(D) "Political subdivision" means a county, township, municipal corporation, or other body corporate and politic responsible for governmental activities in a geographic area smaller than that of the state.

(E) "Registered nurse" has the same meaning as in section 4723.01 of the Revised Code.

(F) "State university" has the same meaning as in section 3345.12 of the Revised Code.

Sec. 3722.21. (A) Notwithstanding any conflicting provision of this chapter or any other provision of the Revised Code, but subject to division (B) of this section, sections 3722.22 to 3722.40 of the Revised Code apply to all hospitals and portions of hospitals that use registered nurses to provide the type of patient care described in sections 3722.22 to 3722.40 of the Revised Code, including both of the following:

(1) Inpatient facilities and units licensed by the department of behavioral health under section 5119.33 of the Revised Code;

(2) Hospitals registered under section 3701.07 of the Revised Code as long-term acute care hospitals.

(B) Sections 3722.22 to 3722.40 of the Revised Code do not apply to any of the following:

(1) Hospitals managed by the department of behavioral health under Chapter 5119. of the Revised Code;

(2) Freestanding inpatient rehabilitation facilities licensed by the department of health under section 3702.30 of the Revised Code;

(3) Freestanding birthing centers licensed by the department of health under section 3702.30 of the Revised Code.

Sec. 3722.22. (A) A hospital shall develop a nurse staffing plan that provides adequate, appropriate, and quality delivery of health care services and protects patient safety. The hospital's plan shall address all recommendations the hospital receives from its nurse staffing committee created under section 3722.23 of the Revised Code.

Once a proposed plan has been developed, the hospital shall submit the proposal to its nurse staffing committee for review. If the committee recommends revisions, the hospital shall revise the proposed plan accordingly. This process shall continue until the committee has granted its approval of the plan.

When the hospital is notified that its nurse staffing committee has approved the proposed plan, the hospital shall implement the plan in whole and continue to comply with all of the plan's provisions. Any proposal to update or otherwise revise the plan is subject to the same procedures that applied to the development and approval of the original plan.

The hospital shall post a copy of its approved nurse staffing plan on a publicly accessible area of the internet web site maintained by the hospital. In addition, the hospital shall submit a copy of the plan to the director of health.

(B) If a hospital is in operation on the effective date of this section, the hospital's initial nurse staffing plan shall be developed and implemented not later than one year after the effective date of this section. If a hospital begins operation after the effective date of this section, the hospital's initial nurse staffing plan shall be developed and implemented as soon as practicable, as determined by the director of health.

Sec. 3722.23. (A) Each hospital shall establish and maintain a nurse staffing committee. The membership of the committee is subject to all of the following:

(1) At least sixty per cent of the membership shall consist of direct care registered nurses, with at least one registered nurse serving as a member from each of the hospital's patient care units. These members shall be elected by their peers.

(2) If there is a collective bargaining agreement covering the nurses employed by the hospital, the membership shall include nurses who are appointed by the labor organization, as defined in section 3517.01 of the Revised Code, that represents the nurses covered by that agreement.

(3) All or part of the remainder of the membership shall consist of a meaningful representation of direct care staff who serve in positions that are not considered management positions. These members shall be elected by their peers.

(B) The committee shall meet at intervals it considers necessary to fulfill its responsibilities. Attending a meeting of the committee as a member or otherwise fulfilling the duties of membership shall be considered by the hospital as part of a member's regularly scheduled hours of work for any pay period.

(C) For purposes of the hospital's nurse staffing plan required by section 3722.22 of the Revised Code, the committee shall do all of the following:

(1) Prepare and submit recommendations for development of the plan;

(2) Review the hospital's proposed plan and make recommendations for revisions as the committee considers necessary;

(3) Approve the hospital's proposed plan once the committee determines that the plan complies with all of the committee's recommendations;

(4) Consider any proposed updates or other revisions to an approved plan by using the same process that applied to its consideration of the original plan.

(D) In addition to its duties under division (C) of this section, the committee may prepare and submit recommendations to the hospital on any other matter it considers relevant to the staffing, patient safety, and other provisions of sections 3722.21 to 3722.40 of the Revised Code.

Sec. 3722.24. (A) Except as provided in sections 3722.25 and 3722.26 of the Revised Code, at all times during each working shift within a particular patient care unit of a hospital, the hospital shall assign a direct care registered nurse to not more than the number of patients identified under division (B) of this section for that unit. The resulting nurse-to-patient ratios shall be implemented as mandatory minimum staffing requirements, but these minimum requirements do not preclude a hospital from electing to implement more stringent staffing requirements.

(B) For purposes of division (A) of this section, all of the following apply with respect to the maximum number of patients who may be assigned to a direct care registered nurse:

(1) One patient in either of the following:

(a) A trauma emergency unit;

(b) An operating room unit, as long as there is at least one other person assigned to serve at the same time as an operating room assistant.

(2) Two patients in a critical care unit, including a unit with any of the following designations: neonatal intensive care, emergency critical care, intensive care, labor and delivery, coronary care, acute respiratory care, postanesthesia care, or burn care;

(3) Three patients in either of the following:

(a) A unit with any of the following designations: emergency department care, pediatric care, step-down care, telemetry care, or antepartum care;

(b) A combined unit for labor, delivery, and postpartum care.

(4) Four patients in either of the following:

(a) A unit with any of the following designations: medical-surgical care, intermediate care, or acute psychiatric care;

(b) Any other specialty care unit not specified in division (B)(4)(a) of this section.

(5) Five patients in either of the following:

(a) A rehabilitation unit;

(b) A skilled nursing unit, including a unit that has beds registered under section 3701.07 of the Revised Code as skilled nursing beds, long-term care beds, or special skilled nursing beds.

(6) Six patients in either of the following:

(a) A postpartum care unit, with each mother and infant being counted as a separate patient;

(b) A unit designated as a well-baby nursery.

(7) In the case of a hospital unit that is not identified in divisions (B)(1) to (6) of this section, the number of patients designated by the director of health.

(C) The direct care registered nurse-to-patient staffing ratios that result from the requirements of divisions (A) and (B) of this section shall be implemented by a hospital as soon as practicable, as determined by the director of health, subject to both of the following time frames in the case of a hospital that is in operation on the effective date of this section:

(1) Except as provided in division (C)(2) of this section, the staffing ratios apply beginning on the date that is two years after the effective date of this section.

(2) If the hospital is located in a rural area, as identified by the director, the staffing ratios apply beginning on the date that is four years after the effective date of this section.

Sec. 3722.25. (A) The director of health may establish direct care registered nurse-to-patient staffing ratios that are more stringent than the nurse-to-patient staffing ratios identified in section 3722.24 of the Revised Code, if both of the following are the case:

(1) The director has determined that the more stringent staffing ratios are necessary to protect patient safety.

(2) The director has consulted with both the hospital and the registered nurses affected by the more stringent staffing ratios.

(B) If staffing ratios are established under this section, the affected hospital shall comply with the staffing ratios in accordance with the same time frames that apply to the hospital under division (C) of section 3722.24 of the Revised Code.

Sec. 3722.26. (A) Subject to division (B) of this section, a hospital is not required to comply with the direct care registered nurse-to-patient staffing ratios identified in section 3722.24 or any more stringent ratios established under section 3722.25 of the Revised Code during any public health emergency that applies within this state and has been declared by an officer of this state or the federal government.

(B)(1) If a hospital proposes to deviate from the nurse-to-patient staffing ratios because of a public health emergency, the hospital shall submit the proposal to its nurse staffing committee created under section 3722.23 of the Revised Code. The committee shall review the proposed deviation. If the committee approves the deviation, the hospital may implement the deviation accordingly.

(2) Once a deviation is approved by the committee, the hospital shall do both of the following:

(a) Submit information to the director of health identifying the deviation, the reason for it, and the period during which it will be in effect;

(b) Not later than ten days after the hospital implements the deviation, post the same information described in division (B)(2)(a) of this section on a publicly accessible area of the internet web site maintained by the hospital.

Sec. 3722.27. In assigning registered nurses to a particular hospital unit as part of implementing the direct care registered nurse-to-patient staffing ratios identified in section 3722.24 and established under section 3722.25 of the Revised Code, a hospital is subject to all of the following:

(A) The hospital shall not assign a registered nurse to a patient care unit unless the nurse has received an orientation that is sufficient to provide competent care in that unit and has demonstrated competence in providing care for that unit. This division applies to all registered nurses who may be assigned to a unit, including nurses provided to the hospital by temporary staffing agencies and nurses who relieve other nurses during breaks, meals, and other routine or expected absences from the unit.

(B) The hospital shall not include, as part of meeting the staffing requirements, any registered nurse who is serving in an administrative or supervisory position, including a nurse who is serving as a charge nurse.

(C) The hospital shall not attempt to meet the staffing requirements by calculating averages of the number of patients in a unit or the number of registered nurses assigned to the unit during any particular working shift or over any other period of time.

(D) The hospital shall not use video monitors or any other electronic means of observing a patient as a means of meeting the staffing requirements.

(E) The hospital shall not impose mandatory overtime on any registered nurse as a means of meeting the staffing requirements.

Sec. 3722.28. In providing patient care as part of implementing the direct care registered nurse-to-patient staffing ratios identified in section 3722.24 and established under section 3722.25 of the Revised Code, a hospital is subject to all of the following:

(A) The hospital shall not use video monitors or any other electronic means of observing a patient as a substitute for the direct observation that is necessary for a registered nurse to conduct proper patient assessments.

(B) The hospital shall not place a patient for care in a particular unit unless the staffing ratios that apply to the unit are sufficient to meet the level of intensity, type of care, and individual needs of that patient.

(C) If the hospital provides care in a unit with adjustable patient acuity levels, the hospital shall use the staffing ratio that applies to the highest patient acuity level that exists within the unit during a working shift.

(D) If an assessment of a patient's acuity level and nursing care plan demonstrates that the patient's care requires staffing that is more stringent than the ratios that would otherwise apply, the hospital shall provide additional direct care registered nurses, licensed practical nurses, and other personnel in accordance with the assessment.

Sec. 3722.29. (A) In each of its patient care units, a hospital shall post a uniform notice that explains the requirements of sections 3722.21 to 3722.40 of the Revised Code. For each working shift in a unit, the hospital shall include with the uniform notice a posting of both of the following:

(1) A description of the direct care registered nurse-to-patient staffing ratio that applies to the unit;

(2) The actual number and titles of the direct care registered nurses who are assigned during the shift.

(B) The uniform notice and shift-specific information shall be prepared in a manner prescribed by the director of health. The notice and information shall be posted in an area of the unit that is visible, conspicuous, and accessible to the hospital's staff, its patients, and the public.

Sec. 3722.30. (A) A hospital shall develop a system to document the manner in which it meets the requirements of sections 3722.21 to 3722.40 of the Revised Code. In accordance with the system, the hospital shall maintain records of each of the following for not less than three years:

(1) A copy of each notice posted under section 3722.29 of the Revised Code;

(2) The actual staffing levels that occurred in each patient care unit of the hospital during each working shift;

(3) Information certifying whether each direct care registered nurse assigned to a unit received rest and meal breaks during a working shift and the identities of the individuals who relieved the nurses during the breaks.

(B) On request, the records maintained under this section shall be made available to any of the following:

(1) The director of health;

(2) Any registered nurse or the nurse's exclusive representative, as defined in section 4117.01 of the Revised Code;

(3) Any member of the general public.

Sec. 3722.31. With respect to each patient admitted to a hospital for care in an inpatient unit, the hospital shall provide the patient or the patient's representative with the telephone number of the toll-free patient safety telephone line made available to the public by the department of health under section 3701.91 of the Revised Code. The patient or the patient's representative may use the telephone number to do either or both of the following:

(A) Seek information regarding the nurse staffing requirements and other provisions of sections 3722.21 to 3722.40 of the Revised Code;

(B) Make reports of inadequate staffing or care at the hospital.

Sec. 3722.32. (A) With respect to staffing within a hospital and its patient care units, a registered nurse may object to or refuse to participate in any activity, policy, practice, assignment, or task if the nurse reasonably believes any of the following:

(1) That the hospital is not complying with its mandatory minimum nurse-to-patient staffing ratios or is otherwise violating sections 3722.21 to 3722.40 of the Revised Code;

(2) That the activity, policy, practice, assignment, or task poses a risk to patient safety;

(3) That the nurse is not prepared by education, training, or experience to participate, and that doing so would compromise patient safety or subject the nurse to disciplinary action by the board of nursing.

(B) If a registered nurse in good faith exercises the authority granted by division (A) of this section, the hospital shall not take any retaliatory action against the nurse, including any of following:

(1) Imposing discipline involving the nurse's employment with the hospital, including a reduction in the number of hours available for work, reassignment to a different position or shift, or termination of employment;

(2) Filing a complaint or report against the nurse with the board of nursing.

(C) If a violation of division (B) of this section occurs, the registered nurse may submit a complaint against the hospital under section 3722.37 of the Revised Code. In addition to any disciplinary actions taken against the hospital by the director of health under section 3722.36 of the Revised Code as a result of the complaint and subsequent investigation, the registered nurse has a cause of action against the hospital for committing the violation.

Sec. 3722.33. (A) The director of health shall conduct audits of a hospital to determine both of the following:

(1) Whether the hospital is implementing its staffing plan in accordance with sections 3722.21 to 3722.40 of the Revised Code;

(2) Whether the hospital is maintaining records in accordance with section 3722.30 of the Revised Code.

(B) The director shall conduct at least one audit of a hospital every six months. The director may conduct other audits at any time the director considers necessary for proper enforcement of sections 3722.21 to 3722.40 of the Revised Code.

Sec. 3722.34. No hospital shall knowingly do any of the following:

(A) Fail to develop and implement a staffing plan in accordance with section 3722.22 of the Revised Code;

(B) Except as provided in section 3722.26 of the Revised Code, fail to comply with the staffing plan once it has been implemented;

Sec. 3722.35. The director of health shall investigate alleged violations of section 3722.34 of the Revised Code, including allegations that arise from complaints received under section 3722.37 of the Revised Code.

An investigation may be conducted with or without giving advance notice to the hospital that is the subject of the investigation. In either case, the hospital shall grant access to the hospital's facilities and records as considered necessary by the director.

Sec. 3722.36. (A) If the director of health determines through an investigation conducted under section 3722.35 of the Revise Code or through any other means that a hospital is in violation of section 3722.34 of the Revised Code, the director shall require the hospital to establish a corrective action plan and submit the plan to the director. The plan is subject to approval by the director. On the director's request, the plan shall be revised accordingly.

(B)(1) If a violation of section 3722.34 of the Revised Code is not resolved by the hospital's corrective action plan established under division (A) of this section, the director shall impose a fine pursuant to an adjudication under Chapter 119. of the Revised Code. The following fines apply:

(a) In the case of a fine that is imposed on the hospital as a business entity, the amount of the fine for a first offense shall be twenty-five thousand dollars; for each subsequent offense, the amount of the fine shall be fifty thousand dollars.

(b) In the case of a fine that is imposed on an individual who is employed by the hospital, the amount of the fine shall be twenty thousand dollars for each offense.

(2) On the director's request, the attorney general shall bring and prosecute to judgment a civil action to collect any fine imposed under division (B)(1) of this section that remains unpaid.

(C) All fines collected under division (B) of this section shall be deposited into the state treasury to the credit of the nurse education assistance fund created under section 3333.28 of the Revised Code and used only as described in division (B)(1) of that section.

Sec. 3722.37. The director of health shall establish procedures under which a registered nurse, a hospital patient, or any other person may file a complaint with the director alleging that a hospital has violated section 3722.34 of the Revised Code. On receipt of a complaint, the director shall conduct an investigation as provided in section 3722.35 of the Revised Code.

Sec. 3722.38. With respect to the requirements, rights, and remedies established under sections 3722.21 to 3722.40 of the Revised Code, all of the following apply:

(A) A hospital shall not discriminate or retaliate in any manner against a registered nurse, hospital patient, or any other person who, in good faith, files a complaint under section 3722.37 of the Revised Code, presents a grievance to the hospital regarding the staffing within the hospital's patient care units, or otherwise demonstrates opposition to any hospital policy, practice, or action that is in violation of sections 3722.21 to 3722.40 of the Revised Code.

(B) A hospital shall not interfere with, restrain, or prohibit a person's exercise of, or attempt to exercise, any of the rights conferred by sections 3722.21 to 3722.40 of the Revised Code.

(C) A hospital shall not establish policies that, directly or indirectly, discourage a registered nurse or any other person from disclosing information as authorized by sections 3722.21 to 3722.40 of the Revised Code.

(D) A hospital shall not intimidate a registered nurse or any other person who makes public statements regarding hospital staffing.

Sec. 3722.39. (A) With respect to the practice of registered nursing, particularly in relation to a hospital's nurse staffing plan implemented under section 3722.22 of the Revised Code, the general assembly recognizes all of the following:

(1) All registered nurses have a duty and right to act based on their professional judgment and in accordance with the statutes and rules that apply to their practice.

(2) All registered nurses have the duty and right to provide care in the exclusive interests of their patients.

(3) All registered nurses have the duty and right to act as advocates for their patients.

(B) In recognizing the matters described in division (A) of this section, the general assembly finds that a registered nurse, before the nurse may accept a patient assignment, is responsible for determining all of the following:

(1) Whether the nurse has the necessary professional knowledge, judgment, skills, and ability to care for the patient;

(2) Whether the nurse is competent to provide the required care;

(3) Whether accepting the assignment would create harm for either the patient or the nurse.

Sec. 3722.40. As a means of increasing transparency and accountability regarding hospital nurse staffing plans implemented under section 3722.22 of the Revised Code, both of the following apply:

(A) On a semi-annual basis, each hospital shall prepare and make publicly available a report that includes a description of the hospital's staffing levels in relation to its nurse staffing plan, a description of any deviations from the plan that occurred under section 3722.26 of the Revised Code, and a summary of each meeting held by the hospital's nurse staffing committee under section 3722.23 of the Revised Code.

(B) The department of health shall maintain an internet web site dashboard that displays information regarding the extent to which hospitals are in compliance with their nurse staffing plans and all other provisions that apply to hospitals under sections 3722.21 to 3722.40 of the Revised Code. The dashboard may be included as a part of the department's general web site, but regardless of whether it is included in this manner or maintained separately, the dashboard shall be made accessible to the public.

Sec. 4723.489. A person not otherwise authorized to administer drugs may administer a drug to a specified patient if all of the following conditions are met:

(A) The authority to administer the drug is delegated to the person by an advanced practice registered nurse who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner and holds a license issued under section 4723.42 of the Revised Code.

(B) The drug is not listed in the formulary established in rules adopted under section 4723.50 of the Revised Code, is not a controlled substance, and is not to be administered intravenously.

(1) A hospital inpatient care unit~~, as defined in section 3727.50 of the Revised Code~~; a

(2) A hospital emergency department or a freestanding emergency department; ~~or an~~

(3) An ambulatory surgical facility~~, as defined in~~ licensed under section 3702.30 of the Revised Code.

(D) The person has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person's employer the knowledge, skills, and ability to administer the drug safely.

(E) The person's employer has given the advanced practice registered nurse access to documentation, in written or electronic form, showing that the person has met the conditions specified in division (D) of this section.

(F) The advanced practice registered nurse is physically present at the location where the drug is administered.

Sec. 4730.203. (A) Acting pursuant to a supervision agreement, a physician assistant may delegate performance of a task to implement a patient's plan of care or, if the conditions in division (C) of this section are met, may delegate administration of a drug. Subject to division (D) of section 4730.03 of the Revised Code, delegation may be to any person. The physician assistant must be physically present at the location where the task is performed or the drug administered.

(B) Prior to delegating a task or administration of a drug, a physician assistant shall determine that the task or drug is appropriate for the patient and the person to whom the delegation is to be made may safely perform the task or administer the drug.

(1) The physician assistant has been granted physician-delegated prescriptive authority and is authorized to prescribe the drug.

(2) The drug is not a controlled substance.

(3) The drug will not be administered intravenously.

(4) The drug will not be administered in a any of the following locations:

(a) A hospital inpatient care unit~~, as defined in section 3727.50 of the Revised Code~~; a

(b) A hospital emergency department; or a freestanding emergency department; ~~or an~~

(D) A person not otherwise authorized to administer a drug or perform a specific task may do so in accordance with a physician assistant's delegation under this section.

Sec. 4772.092. (A) Acting pursuant to a supervision agreement, a certified mental health assistant may delegate performance of a task to implement a patient's plan of care or, if the conditions in division (C) of this section are met, may delegate administration of a drug. Subject to division (D) of section 4772.03 of the Revised Code, delegation may be to any person. The certified mental health assistant must be physically present at the location where the task is performed or the drug administered.

(B) Prior to delegating a task or administration of a drug, a certified mental health assistant shall determine that the task or drug is appropriate for the patient and the person to whom the delegation is to be made may safely perform the task or administer the drug.

(C) A certified mental health assistant may delegate administration of a drug only if all of the following conditions are met:

(1) The certified mental health assistant has been granted physician-delegated prescriptive authority by the physician supervising the certified mental health assistant and is authorized to prescribe the drug.

(2) The drug is not a controlled substance.

(3) The drug will not be administered intravenously.

(4) The drug will not be administered in a any of the following:

(a) A hospital inpatient care unit~~, as defined in section 3727.50 of the Revised Code~~; a

(b) A hospital emergency department; or a freestanding emergency department; ~~or an~~

(D) A person not otherwise authorized to administer a drug or perform a specific task may do so in accordance with a certified mental health assistant's delegation under this section.

Section 2. That existing sections 3333.28, 3722.01, 4723.489, 4730.203, and 4772.092 of the Revised Code are hereby repealed.

Section 3. That sections 3727.50, 3727.51, 3727.52, 3727.53, 3727.54, 3727.55, 3727.56, and 3727.57 of the Revised Code are hereby repealed.

Section 4. Not later than one year after the effective date of this section, the Director of Health, in consultation with the Board of Nursing and the Department of Higher Education, shall prepare a report containing recommendations for ensuring that sufficient numbers of nurses are available in this state to meet the hospital nurse staffing requirements established under sections 3722.21 to 3722.40 of the Revised Code. On completion of the report, the Director shall submit copies to the General Assembly in accordance with section 101.68 of the Revised Code.

Section 5. All items in this act are hereby appropriated as designated out of any moneys in the state treasury to the credit of the designated fund. For all operating appropriations made in this act, those in the first column are for fiscal year 2026 and those in the second column are for fiscal year 2027. The operating appropriations made in this act are in addition to any other operating appropriations made for these fiscal years.

Section 6.

	1	2	3	4	5
A	BOR DEPARTMENT OF HIGHER EDUCATION
B	Dedicated Purpose Fund Group
C	5BA1	235683	Nursing Student Loan-to-Grant Program	$10,000,000	$10,000,000
D	TOTAL DPF Dedicated Purpose Fund Group			$10,000,000	$10,000,000
E	TOTAL ALL BUDGET FUND GROUPS			$10,000,000	$10,000,000

NURSING STUDENT LOAN-TO-GRANT PROGRAM

The foregoing appropriation item 235683, Nursing Student Loan-to-Grant Program, shall be used by the Chancellor of Higher Education to support the Nursing Student Loan-to-Grant Program pursuant to section 3333.27 of the Revised Code.

An amount equal to the unexpended, unencumbered balance of the foregoing appropriation item 235683, Nursing Student Loan-to-Grant Program, at the end of fiscal year 2026 is hereby reappropriated for the same purpose in fiscal year 2027.

Section 7. Within the limits set forth in this act, the Director of Budget and Management shall establish accounts indicating the source and amount of funds for each appropriation made in this act, and shall determine the manner in which appropriation accounts shall be maintained. Expenditures from operating appropriations contained in this act shall be accounted for as though made in, and are subject to all applicable provisions of, H.B. 96 of the 136th General Assembly.

Section 8. On the effective date of this section, or as soon as possible thereafter, the Director of Budget and Management shall transfer $20,000,000 cash from the General Revenue Fund to the Nursing Student Loan-to-Grant Fund (Fund 5BA1).

Section 9. This act shall be known as the Ohio Nurse Workforce and Safe Patient Act.