OH HB637

Establishes mandatory minimum direct-care registered nurse-to-patient staffing ratios for hospital units, ranging from 1:1 (operating rooms, critical care) to 1:5 (rehabilitation, skilled nursing units).

Requires hospitals to establish hospital-wide nursing care committees with at least 50% direct-care registered nurses to develop written nursing services staffing plans based on evidence-based standards and patient acuity.

Prohibits hospitals from averaging staffing ratios over time, imposing mandatory overtime to meet ratios, using video monitoring as a substitute for direct patient observation, or retaliating against nurses who refuse unsafe assignments.

Grants registered nurses the right to refuse assignments if they lack competency or if the assignment violates staffing ratio requirements, with protections against discharge, retaliation, demotion, or board complaints.

Imposes fines up to $25,000 per violation plus up to $10,000 per nursing unit shift for non-compliance, and allows nurses to sue hospitals for violations with remedies including reinstatement, back pay, and attorney fees.