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.

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 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.