SB 182 — Revises provisions relating to the staffing of health care facilities. (BDR 40-33)

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 staffingstaffingttee committee established pursuant to section 5 of this act to develop a documented staffing plan as required by NRS 449.2421.

- *SB182_R1*83rd Session (2025) – 6 – 1.Counsel Bureau for transmission to the next regular session of the Legislature.

Even-numbered year to the Director of the Legislative Counsel Bureau for transmission to the next regular session of the Legislature.

(b)(b)(1) InA ratio of one direct care nurse for each emergencytrauma unit:or critical care patient;

(1) A ratio of one direct care nurse for each trauma or critical care patient;

(4) During(I) theOne birthdirect ofcare anurse child:for each patient who is in labor;

(I) One direct care nurse for each patient who is in labor;

and (II)- If83rd theSession birth(2025) resulted– in7 multiple– children, one direct care nurse for each additional newborn child birthed by thetheone direct postpartum patient;

- *SB182_R1* – 7 – (6) During any period more than 2 hours after the birth of a child:

(d)each:) A ratio of one direct care nurse for every three patients in each:(1) Cardiac telemetry unit;

(1) Cardiac telemetry unit;

(f)each Anursery ratiofor ofwell onebabies.care direct care nurse for every six patients in each2. nursery for well babies.

2.

- 83rd Session (2025) – 8 – 3.

A hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall not include a registered nurse who does not have the principal responsibility for caring for a patient, including, without limitation, a nurse administrator or supervisor, in the calculation of any ratio for the purposes of subsection 1.1.r, in the calculation 4.

- *SB182_R1* – 8 – 4.

A hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall not include a certified nursing assistant who does not have the principal responsibility for caring for a patient in the calculation of 7.y rIn addition to any ratio forestablished thepursuant purposesto ofsubsections subsectionor 5.5, a hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall assign:

7.

In addition to any ratio established pursuant to subsections 1 or 5, a hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall assign:

(a)- 83rd Session (2025) – 9 – assignment to that unit or clinical area;ely licensed for (b) The hospital has provided orientation to the registered nurse isbefore appropriatelyassigning licensedthat forregistered assignmentnurse to that unit or clinical area;

(b) The hospital has provided orientation to the registered nurse before assigning that registered nurse to that unit or clinical area;

- *SB182_R1* – 9 – 9.

(c) Shall not be construed to prohibit a collective bargaining agreement or documented staffing plan required pursuant to NRS 449.2421 from requiring ratios which are more restrictive than thosetho10. required by this section.

10.

(d) “Step-down care” means care for patients transitioning out of the intensive care unit who require more care and attention thanthaSec. patients on a general unit.

Sec.

- 83rd Session (2025) – 10 – (c) The identity and duty hours of each certified nursing assistant and licensed practical nurse in the unit;

2.county whose population is 100,000 or more and which is licensed to have more than 70 beds shall maintain daily statistics, by unit, of mortality, morbidity, infection, accident, injury and medical errors.

As a condition for licensure, each hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall maintain daily statistics, by unit, of mortality, morbidity, infection, accident, injury and medical errors.

- *SB182_R1* – 10 – (a) Maintain all records required to be maintained by this section, for at least 7 years after the date on which the record was created;

If a hospital deviates from a documented staffing plan developed pursuant to NRS 449.2421 or the maximum ratios prescribed in section 8 of this act pursuant to subsection 1, the hospital shall, not later than 30 days after the deviation, report to the co-chairs of the nursing staffing committee established by the hospital pursuant to NRS 449.242 or, if the committee has not elected co-chairs, report to two persons appointed by the not committee to serve as liaisons during the state of emergency.

- 83rd Session (2025) – 11 – 4.

A hospital may not continue to deviate from the documented staffing plan developed pursuant to NRS 449.2421 or the maximum ratios prescribed in section 8 of this act for more than 90 days, unless the hospital first receives the approval of the nursingnur5.ng staffingAs committee.used in this section, “state of emergency” means:

5.

As used in this section, “state of emergency” means:

or - *SB182_R1* – 11 – (d) An event similar to the events described in paragraph (a), (b) and (c) which requires a hospital to utilize standards of care for crisis situations.

and (d) Report a violation of NRS 449.242 to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act to the Division.Division.ve, 2.

2.

Any facility conducted by and for the adherents of any church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend solely upon spiritual means through prayer for healing in the practice of the religion of the church or denomination, except that such a facility- shall83rd complySession with(2025) all– regulations12 relative– to sanitation and safety applicable to other facilities of a similar category.category.ation and 2.

2.

(a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and - *SB182_R1* – 12 – sections 2 to 10, inclusive, of this act, or 449A.100 to 449A.124, inclusive, and 449A.270 to 449A.286, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.the(b) Aiding, abetting or permitting the commission of any illegal act.

(b) Aiding, abetting or permitting the commission of any illegal act.

(e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or 439A.102 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and sections 2 to 10, inclusive, of this act, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required, including, without limitation, the closure or conversion of any hospital in a county whose population is 100,000 or more that is ownedown(f) byFailure to comply with the licenseeprovisions withoutof approvalNRS 441A.315 and any regulations adopted pursuant tothereto or NRS 439A.102.449.2486.

(f) Failure to comply with the provisions of NRS 441A.315 and any regulations adopted pursuant thereto or NRS 449.2486.

In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility for the dependent if, with respect- to83rd thatSession facility,(2025) – 13 – agent or employee of the licenseelicensee:nsee that operates the facility, or an agent(a) orIs employeeconvicted of violating any of the licensee:provisions of NRS 202.470;

(a) Is convicted of violating any of the provisions of NRS 202.470;

- *SB182_R1* – 13 – (b) A report of any investigation conducted with respect to the complaint;

andandt of any investigation conducted with respect to the (c) A report of any disciplinary action taken against the facility.

In addition to the payment of the amount required by NRS 449.0308, if a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act, or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

(b)- Limit83rd theSession occupancy(2025) of– the14 facility– to the number of beds occupied when the violation occurred, until it determines that the facility has corrected the violation;

(1) It determines that the facility has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations;regulat(2) Improvements are made to correct the violation.

or (2) Improvements are made to correct the violation.

If an off-campus location of a hospital fails to obtain a national provider identifier that is distinct from the national provider - *SB182_R1* – 14 – identifier used by the main campus and any other off-campus location of the hospital in violation of NRS 449.1818, the Division may impose against the hospital an administrative penalty of not more than $10,000 for each day of such failure, together with interest thereon at a rate not to exceed 10 percent per annum, in addition to any other action authorized by this chapter.

and (b) Collect court costs, reasonable attorney’s fees and other costscos4. incurred to collect the administrative penalty.

4.

Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 or subsection 2 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and sections 2 to 10, inclusive, of- this83rd act,Session 449.435(2025) to– 449.531,15 inclusive,– and chapter 449A of NRS to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards or for any other purpose authorized by the Legislature.

(1) Reports to the Board of Medical Examiners or the State Board of Osteopathic Medicine, as applicable, information relating to the conduct of a physician which may constitute grounds for initiating disciplinary action against the physician or which otherwise raises a reasonable question regarding the competence of the physician to practice medicine with reasonable skill and safety to patients;pati(2) Reports a sentinel event to the Division pursuant to NRS 439.835;

(2)[or] Reports(3) aCooperates sentinelor eventotherwise toparticipates in an investigation or proceeding conducted by the DivisionBoard pursuantof Medical Examiners, the State Board of Osteopathic Medicine or another governmental entity relating to NRSconduct 439.835;described in subparagraph (1) or (2);

[or] (3) Cooperates or otherwise participates in an investigation or proceeding conducted by the Board of Medical Examiners, the - *SB182_R1* – 15 – State Board of Osteopathic Medicine or another governmental entity relating to conduct described in subparagraph (1) or (2);

(I) Reports to his or her immediate supervisor, in writing, that he or she does not possess the knowledge, skill or experience to comply with an assignment to provide nursing services to a patient;

and (II) Refuses to provide to a patient nursing services for which, as verified by documentation in the personnel file of the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified concerning his or her competence to provide various nursing services, he or she does not possess the knowledge, skill or experience to comply with the assignment to provide- nursing83rd servicesSession to(2025) the– patient,16 unless– the refusal constitutes unprofessional conduct as set forth in chapter 632 of NRS or anyanytitutes regulations adopted pursuant thereto;

(II) Any concerns regarding patients who may be exposed to a substantial risk of harm as a result of the failure of the medical facility or any agent or employee thereof to comply with minimum professional or accreditation standards or applicable statutory or regulatory requirements;

or - *SB182_R1* – 16 – (4) Refuses to engage in conduct that would violate the duty of the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to protect patients from actual or potential harm, conduct which would violate any provision of chapter 632 of NRS or conduct which would subject the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to disciplinary action by the State Board of Nursing;

A medical facility or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the medical facility or a registered nurse, licensed practical nurse, nursingnursingical assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility because the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified has taken an action described in subsection 1.

A medical facility or any agent or employee thereof shall not prohibit, restrict or attempt to prohibit or restrict by contract, policy, procedure or any other manner the right of an employee of the - 83rd Session (2025) – 17 – medical facility or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility to take an action described in subsection 1.

4.

As used in this section:

or - *SB182_R1* – 17 – (X) Frequent changes in working hours or workdays.

(2) Does not include an action described in sub- subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action is taken in the normal course of employment or as a form of the action discipline.

Sec.- 83rd Session (2025) – 18 – 449.242 1.RS 44Except 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 nursing staffing committee .

18.

NRS 449.242 is hereby amended to read as follows:

449.242 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 nursing staffing committee .

(2) One member representing each unit of the hospital who is a certified nursing assistant who provides direct patient care on that unit, elected by the certified nursing assistants who provide direct patient care on the unit that the member will represent.

(c) One alternate member representing each unit of the hospital who is a licensed nurse or certified nursing assistant who provides direct patient care on that unit, elected by the licensed nursing staff - *SB182_R1* – 18 – and certified nursing assistants who provide direct patient care on the unit that the member represents.

Each licensed nurse and certified staffing assistantallowed whoat providesleast direct3 patientdays to vote for:t care at the hospital must be allowed(a) atThe leastregular 3member daysdescribed toin voteparagraph for:(a) of subsection who will represent his or her unit and profession;

(a) The regular member described in paragraph (a) of subsection 1 who will represent his or her unit and profession;

- 83rd Session (2025) – 19 – 4.

(a) The health care facility is not required to form a nursing staffing committee pursuant to that subsection;

andandform a nursing (b) The nursing staffing committee established pursuant to the collective bargaining agreement shall be deemed to be the nursing staffing committee established for the health care facility pursuant to subsection 1.

Each hospital that is required to establish a staffing committee pursuant to this section shall prepare a written report concerning the establishment of the staffing committee, the activities and progress of the staffing committee and a determination - *SB182_R1* – 19 – of the efficacy of the staffing committee.

As a condition of licensing, a health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall make available to the Division a written policy adopted pursuant to NRS 449.2423, a documented staffing plan and a written certification that the written policy and the documented staffing plan are adequate to meet the needs- of83rd theSession patients(2025) of– the20 health– facility is a hospital [, the] :lth care facility.

If the health care facility(a) isThe awritten hospitalpolicy [,[and the]the :documented staffing plan] must:

(a) The written policy [and the documented staffing plan] must:

and (2) Include a place where a member of a staffing committee may note any objections to the staffing plan.plan.a staffing committee 2.

2.

and - *SB182_R1* – 20 – (2) The number of certified nursing assistants required in each unit in the health care facility [;] , which must conform to the maximum ratios prescribed in section 8 of this act if the health car(b) A description of the types of patients who are treated in each unit, including, without limitation, the type of care facilityrequired isby athe hospital;patients;

(b) A description of the types of patients who are treated in each unit, including, without limitation, the type of care required by the patients;

(f)- 83rd Session (2025) – 21 – [and]) Any foreseeable changes in the size or function of each unit;

[and] (g) Protocols for adequately staffing the health care facility:

and (i) A plan for maintaining adequate staffing levels for the technical and service staff of the health care facility as necessary for the(1) Minimize or reduce the facilitypotential to:for any disruption of the physical or technical capabilities of the health care facility, for which the availability of such capabilities are necessary to safely and efficiently provide care to patients;

(1) Minimize or reduce the potential for any disruption of the physical or technical capabilities of the health care facility, for which the availability of such capabilities are necessary to safely and efficiently provide care to patients;

As a condition of licensure, a health care facility which is located in a county whose population is 100,000 or more - *SB182_R1* – 21 – and which is licensed to have more than 70 beds must adopt and disseminate to each licensed nurse and certified nursing assistant employed by the health care facility a written policy that sets forth the circumstances under which a licensed nurse or certified nursing assistant may refuse or object to a work assignment.

and (b)- File83rd anSession objection(2025) to– a22 work– assignment if the work assignment violates any provision of NRS 449.241 to 449.2428, inclusive [.] , and sections 2 to 10, inclusive, of this act.

(1) Relieve the licensed nurse or certified nursing assistant of the workwor(2) assignmentDeny asthe requested;request;

orand; (2) Deny the request;

andor (c) A process pursuant to which a licensed nurse or certified nursing assistant may exercise his or her right to refuse a work assignment if the supervisor does not approve the request to be relieved of the work assignment if:

and (3) The licensed nurse or certified nursing assistant in good faith believes that the work assignment meets the conditions establishedest4.lisFor inthe purposes of objecting to a work assignment pursuant to paragraph (b) of subsection 2, the written policy justifyingconcerning refusal.work assignments must contain:

- *SB182_R1* – 22 – 4.

For the purposes of objecting to a work assignment pursuant to paragraph (b) of subsection 2, the written policy concerning work assignments must contain:

- 83rd Session (2025) – 23 – 5.

(a) Maintain records for at least 2 years of each request to be relieved of a work assignment, each refusal of a work assignment and each objection to a work assignment that is filed with the health caresection;ility facility pursuant to the written policy adopted pursuant to this section;(b) If the health care facility has established a nursing staffing committee pursuant to NRS 449.242, provide to the nursing staffing committee:

(b) If the health care facility has established a nursing staffing committee pursuant to NRS 449.242, provide to the nursing staffing committee:

(a) A system for rating each health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds on the compliance by the facility with the provisions of this section and NRS 449.241 to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act, including, without limitation, the number of resolved and unresolved violations and the severity of those violations.

(2) Each investigation conducted by the Division pursuant to NRS 449.0307 and 449.2428 concerning a complaint that alleges a - *SB182_R1* – 23 – violation of the provisions of this section and NRS 449.241 to 449.2428, inclusive [.] , and sections 2 to 10, inclusive, of this act.

(b) Procedures by which a health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds may, not later than 30 days after an investigation or inspection, appeal a finding concerning a violation of the provisions of this section and NRS 449.241 to 449.2428, - 83rd Session (2025) – 24 – inclusive, and sections 2 to 10, inclusive, of this act or request a follow-up inspection.

(a) Thirty days after the investigation or inspection on which the star rating is based;

or the investigation or inspection on which the (b) After the completion of any follow-up inspection or the final determination of any appeal pursuant to subsection 1,  whichever is later.

1.with the provisions of NRS 449.241 to 449.2428, inclusive, andity sections 2 to 10, inclusive, of this act, including, without limitation, those provisions relating to documented staffing plans and written policies adopted pursuant to NRS 449.2421 and 449.2423 [;] , respectively;

Ensure the general compliance of the health care facility with the provisions of NRS 449.241 to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act, including, without limitation, those provisions relating to documented staffing plans and written policies adopted pursuant to NRS 449.2421 and 449.2423 [;] , respectively;

- *SB182_R1* – 24 – (a) For unannounced, random visits at a health care facility to determine whether the facility is in compliance with NRS 449.241 to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act.

(b) An accessible and confidential system pursuant to which the nursing, technical and service staff of a hospital may report the failure of the hospital to comply with the provisions of NRS 449.241- to83rd Session (2025) – 25 – this act.o 449.2428, inclusive, and sections 2 to 10, inclusive, of this(c) act.Procedures for timely investigating and resolving a report received pursuant to the system described in paragraph (b).

(c) Procedures for timely investigating and resolving a report received pursuant to the system described in paragraph (b).

and (2) Take appropriate disciplinary action pursuant to NRS 449.160 or 449.163, as appropriate, against a health care facility that is found to have violated the provisions of NRS 449.241 to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act pursuant to an investigation completed pursuant to the procedures described in this paragraph.

and (II) Employees of the medical facility who work in areas of the medical facility other than those represented on the staffing [committee,] committees, appointed by the operator of the medicalmedicaling facility.

(2) If [a staffing committee has] staffing committees have not been established for the medical facility pursuant to NRS 449.242 or sections 5 or 6 of this act or an applicable collective - *SB182_R1* – 25 – bargaining agreement, employees of the medical facility appointed by the operator of the medical facility.

(b)- Develop83rd andSession maintain(2025) a– plan26 for– the prevention of and response to workplace violence.

The plan must:must:vention of and (1) Be in writing;

(1) Be in writing;

The plan developed pursuant to paragraph (b) of subsection 1 must include, without limitation:

(1) Upon the adoption of a new plan for the prevention of workplace violence;

adoption of a new plan for the prevention of (2) Upon commencing employment and annually thereafter;

(d) Procedures for correcting hazards that increase the risk of workplace violence, including, without limitation, using engineering controls that are feasible and applicable to the medical facility and work practice controls to eliminate or minimize exposure ofofcility and employees and other providers of care to such hazards.

(f) Procedures for responding to incidents involving an active shooter and other threats of mass casualties through the use of plans - *SB182_R1* – 26 – for evacuation and sheltering that are feasible and appropriate for the medical facility.

- 83rd Session (2025) – 27 – (g) Procedures for annually assessing, in collaboration with the committee on workplace safety established pursuant to paragraph (a)Sec.(a) of subsection 1, the effectiveness of the plan.

24.

The provisions of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.

24.

The provisions of NRS 354.599 do not apply to any provisions of this act.a local government that are related to the Sec.

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