SB182 - Revises provisions relating to the staffing of health care facilities. (BDR 40-33)

- 83rd Session (2025) Senate Bill No. 182–Senator Nguyen CHAPTER.......... AN ACT relating to health care; requiring certain hospitals to establish staffing committees for technical and service staff; establishing requirements governing the staffing of certain health care facilities; requiring certain hospitals to keep certain records relating to staffing; requiring certain hospitals to report certain information relating to staffing; prohibiting certain health care facilities from taking certain retaliatory actions; providing for certain actions to investigate and correct certain violations relating to staffing; providing administrative penalties; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires certain hospitals in a county whose population is 100,000 or more (currently Clark and Washoe Counties) to establish a staffing committee, which must consist, in part, of certain nurses who are on the staff of the hospital. (NRS 449.242) Existing law requires a hospital and certain other health care facilities in such counties to develop a documented staffing plan which must include certain items, such as the number of nurses required in each unit of the hospital and protocols for adequately staffing the hospital upon the occurrence of certain events. (NRS 449.2421) If the health care facility is a hospital, existing law requires the staffing committee established for the hospital to develop the staffing plan. (NRS 442.242) Sections 5 and 6 of this bill require each hospital that is required to establish a staffing committee for nurses to additionally establish a technical staffing committee and a service staffing committee, respectively, to represent the technical and service workers of the hospital. Sections 18-20 of this bill make conforming changes to refer to existing staffing committees for nurses as “nursing staffing committees.” Sections 5, 6 and 18 require the technical staffing committee, the service staffing committee and the nursing staffing committee to collaborate to develop the documented staffing plan for the hospital. Section 19 requires a documented staffing plan to contain certain provisions relating to the adequate staffing of technical and service workers. Section 23 of this bill requires a hospital that has established a technical staffing committee and a service staffing committee to include the members of those committees on the hospital’s committee on workplace safety, which performs certain duties relating to the prevention of workplace violence at the hospital. (NRS 618.7312) Existing law requires each hospital that is required to establish a nursing staffing committee to report annually to the Legislature concerning the establishment of the nursing staffing committee, the activities and progress of the nursing staffing committee and a determination of the efficacy of the nursing staffing committee. (NRS 449.242) Sections 7 and 18 of this bill require that report to additionally include such information for the technical staffing committee and the service staffing committee. Section 8 of this bill establishes the maximum ratios for the number of patients that may be assigned to a direct care nurse at one time in certain hospitals in a county whose population is 100,000 or more (currently Clark and Washoe Counties). The ratios established by section 8 vary based on the unit of the hospital to which a direct care nurse is assigned. Section 8 also establishes certain other – 2 – - 83rd Session (2025) staffing requirements for certain hospitals in a county whose population is 100,000 or more (currently Clark and Washoe Counties), including maximum ratios for the number of patients that may be assigned to a certified nursing assistant, in any unit, at one time. Section 19 requires the documented staffing plan of a hospital to provide for staffing in accordance with the maximum ratios of patients to direct care nurses established by section 8. Section 19 also requires such a documented staffing plan to provide for additional compensation for nurses who perform certain duties. Section 9 of this bill requires a hospital to maintain certain records containing information relevant for measuring the compliance of the hospital with the nurse-to-patient ratios established by section 8. Section 9.5 of this bill authorizes hospitals which are required to establish a nursing staffing committee and adhere to the maximum ratios prescribed in section 8 to deviate from those maximum ratios and the documented staffing plan of the hospital during a state of emergency. Section 9.5 establishes certain procedures that must be followed by the hospital and the nursing staffing committee upon such a deviation. Sections 12 and 13 of this bill authorize the Division of Public and Behavioral Health of the Department of Health and Human Services to discipline a health care facility that fails to comply with the requirements of this bill in the same manner as violations of other requirements governing health care facilities. Section 22 of this bill requires the Division to establish: (1) procedures for random visits to health care facilities to ensure compliance with the requirements of this bill, where applicable, and certain other requirements governing the staffing of health care facilities; (2) an accessible and confidential system that allows certain staff of a health care facility to report a violation of those requirements; and (3) procedures for timely investigating and resolving such a report. Section 10 of this bill additionally authorizes the Labor Commissioner to take certain actions to ensure that a health care facility complies with the requirements of this bill, where applicable, and certain other requirements relating to the staffing of health care facilities. Section 15 of this bill prohibits a health care facility from retaliating against an employee of the facility for reporting a violation to the Division or the Labor Commissioner. Existing law requires the establishment of a system for rating certain health care facilities located in a county whose population is 100,000 or more on their compliance with requirements governing staffing. (NRS 449.2425) Section 21 of this bill requires the Division to assign a new rating to a facility after an inspection or investigation conducted pursuant to section 22. Sections 2-4 of this bill define certain terms relating to the staffing of health care facilities, and section 17 of this bill establishes the applicability of those definitions. Sections 11 and 16 of this bill make conforming changes relating to the applicability and enforcement of sections 2-10. – 3 – - 83rd Session (2025) EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 449 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 10, inclusive, of this act. Sec. 2. “Direct care nurse” means a registered nurse who is assigned the principal responsibility to oversee or carry out medical regimens or nursing care, in person and in a hands-on capacity, for one or more patients. Sec. 3. “Service staff” means the staff of a health care facility who: 1. Interact directly with patients or with other staff; 2. Do not provide medical care or related services to patients; and 3. Are not a part of the technical staff of the health care facility. Sec. 4. “Technical staff” means the staff of a health care facility whose primary job duties relate to servicing medical equipment and machinery, providing information technology support services or performing other duties which involve technical skills and which are not related to the direct provision of medical care to patients. Sec. 5. 1. Except as otherwise provided in subsection 4, each hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall establish a technical staffing committee. Each technical staffing committee established pursuant to this subsection must consist of: (a) Not less than one-half of the total members of the technical staffing committee from the technical staff of the hospital. The members described in this paragraph must consist of one member representing each division of the technical staff of the hospital, elected by the members of the technical staff within that division. (b) Not less than one-half of the total members of the technical staffing committee from the managers of the technical staff of the hospital, appointed by the administration of the hospital. (c) One alternate member representing each division of the technical staff of the hospital, elected by the members of the technical staff within that division. 2. Each time a new technical staffing committee is formed pursuant to subsection 1, the administration of the hospital shall – 4 – - 83rd Session (2025) hold an election to select the members described in paragraphs (a) and (c) of subsection 1. Each member of the technical staff at the hospital must be allowed at least 3 days to vote for: (a) The regular member described in paragraph (a) of subsection 1; and (b) The alternate member described in paragraph (c) of subsection 1. 3. If a vacancy occurs in a position on a staffing committee described in paragraph (a) or (c) of subsection 1, a new regular or alternate member, as applicable, must be elected in the same manner as his or her predecessor. 4. If a technical staffing committee is established for a hospital described in subsection 1 through collective bargaining with an employee organization representing the technical staff of the hospital: (a) The hospital is not required to form a technical staffing committee pursuant to that subsection; and (b) The technical staffing committee established pursuant to the collective bargaining agreement shall be deemed to be the technical staffing committee established for the hospital pursuant to subsection 1. 5. A technical staffing committee established pursuant to subsection 1 shall collaborate with the nursing staffing committee established pursuant to NRS 449.242 and the service staffing committee established pursuant to section 6 of this act to develop a documented staffing plan as required by NRS 449.2421. 6. The technical staffing committee of a hospital shall meet at least quarterly. Sec. 6. 1. Except as otherwise provided in subsection 4, each hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall establish a service staffing committee. Each service staffing committee established pursuant to this subsection must consist of: (a) Not less than one-half of the total members of the service staffing committee from the service staff of the hospital. The members described in this paragraph must consist of one member representing each division of the service staff of the hospital, elected by the members of the service staff within that division. (b) Not less than one-half of the total members of the service staffing committee from the managers of the service staff appointed by the administration of the hospital. – 5 – - 83rd Session (2025) (c) One alternate member representing each division of the service staff of the hospital, elected by the members of the service staff within that division. 2. Each time a new service staffing committee is formed pursuant to subsection 1, the administration of the hospital shall hold an election to select the members described in paragraphs (a) and (c) of subsection 1. Each member of the service staff at the hospital must be allowed at least 3 days to vote for: (a) The regular member described in paragraph (a) of subsection 1; and (b) The alternate member described in paragraph (c) of subsection 1. 3. If a vacancy occurs in a position on a service staffing committee described in paragraph (a) or (c) of subsection 1, a new regular or alternate member, as applicable, must be elected in the same manner as his or her predecessor. 4. If a service staffing committee is established for a hospital described in subsection 1 through collective bargaining with an employee organization representing the service staff of the hospital: (a) The hospital is not required to form a service staffing committee pursuant to that subsection; and (b) The service staffing committee established pursuant to the collective bargaining agreement shall be deemed to be the service staffing committee established for the hospital pursuant to subsection 1. 5. A service staffing committee established pursuant to subsection 1 shall collaborate with the nursing staffing committee established pursuant to NRS 449.242 and the technical staffing committee established pursuant to section 5 of this act to develop a documented staffing plan as required by NRS 449.2421. 6. The service staffing committee of a hospital shall meet at least quarterly. Sec. 7. Each hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall prepare a written report concerning the establishment of the technical staffing committee pursuant to section 5 of this act, the service staffing committee pursuant to section 6 of this act and the nursing staffing committee pursuant to NRS 449.242, the activities and progress of those staffing committees and a determination of the efficacy of those staffing committees. The hospital shall submit the report on or before December 31 of each: – 6 – - 83rd Session (2025) 1. Even-numbered year to the Director of the Legislative Counsel Bureau for transmission to the next regular session of the Legislature. 2. Odd-numbered year to the Director of the Legislative Counsel Bureau for transmission to the Joint Interim Standing Committee on Health and Human Services. Sec. 8. 1. The ratios for the maximum number of patients that may be assigned to a direct care nurse in a hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds are: (a) A ratio of one direct care nurse to one patient in each: (1) Operating room; (2) Critical care unit; (3) Intensive care unit; (4) Postanesthesia unit; or (5) Unit where a patient receives conscious sedation, as defined in NRS 449.436. (b) In each emergency unit: (1) A ratio of one direct care nurse for each trauma or critical care patient; and (2) A ratio [Text truncated for display. Full text available on LegiScan.]