SECTION 1. Chapter 111 of the General Laws is hereby amended by inserting after Section 231 the following section:

Section 231A. To ensure a stable, diverse workforce of nurses for citizens of the Commonwealth wherever they may be receiving health services, ensure safe patient care, and avoid complications and preventable hospital readmissions, the department shall commission, in consultation with the health policy commission, at least three independent studies designed to determine: (1) the makeup of the current licensed nursing workforce, including, but not limited to: its diversity, skill mix, specialization, classification, work hours, education and student debt burden; (2) estimated licensed nurses required to meet the health care needs for the citizens of the commonwealth from now through the year 2050, with attention to graduation rates, nurse recruitment and retention, turnover, attrition by leaving the profession and attrition by retirement; (3) workplace injuries and quality of work life; (4) data on the current direct care staffing plan for all units for all shifts in each acute care hospital and the actual staffing of all units for all shifts in each acute care hospital; (5) best practice for maximum nurse-to-patient limits for direct care licensed nurses in acute care hospitals for each type of unit, taking into account the ability to adjust such limits based on the acuity of the patients cared for, and excluding the limits established under section 231 of chapter 111 of the General Laws; and (6) the cost and timing to establish maximum limits, including implementation costs, cost savings associated with such limits and the impact on patient outcomes. The studies’ design and implementation shall include a review of current best available research, data on current hospital practices including staffing plans for each unit and be done in consultation with core stakeholders, including, but not limited to, the Massachusetts Nurses Association (MNA), Massachusetts Health and Hospital Association (MHA), and the respective professional associations of the various specialty areas of nursing for each unit, excluding the limits established under section 231 of chapter 111 of the General Laws , to develop research specific to Massachusetts. Such research studies shall include longitudinal design analysis over a minimum of ten years to determine patterns among nurse-sensitive outcomes, reviewing not less than 5 of the nurse sensitive outcomes that are the most empirically associated with nurse staffing by specialty in all Massachusetts acute care hospitals.

The studies shall be completed no later than January 1, 2022 and released to the public no later than 12 months from the commencement of each study. The department shall subsequently develop a plan and timeframe to implement the best practice limits as well as other recommendations established in the study including patient and public awareness and enforcement mechanisms, including, but not limited to, the ability to assess fines for non-compliance.