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HOUSE BILL 138
57TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2025
INTRODUCED BY
Kathleen Cates
AN ACT
RELATING TO HEALTH; ENACTING THE HOSPITAL PATIENT SAFETY ACT;
REQUIRING HOSPITALS TO ESTABLISH HOSPITAL STAFFING COMMITTEES
FOR THE PURPOSE OF DEVELOPING HOSPITAL STAFFING PLANS TO
PRIORITIZE PATIENT SAFETY; DECLARING AN EMERGENCY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] SHORT TITLE.--This act may be cited as the
"Hospital Patient Safety Act"."
SECTION 2. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] DEFINITIONS.--As used in the Hospital
Patient Safety Act:
A. "critical care unit" means a unit that is
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established to safeguard and protect patients whose severity of
medical conditions requires continuous monitoring and complex
intervention by licensed nurses;
B. "direct care nursing staff" means nurses who are
routinely assigned to patient care and are replaced when those
nurses are absent, including:
(1) registered nurses, including registered
nurses that do not assume primary responsibility for a
patient's care but have the responsibility of consulting on
patient care;
(2) licensed practical nurses; and
(3) certified nurse assistants;
C. "direct care professional and technical staff"
means any licensed or certified member of a hospital's staff
who provides care that is within the scope of the license or
certification held by the member;
D. "hospital" means a facility offering in-patient
services, nursing, overnight care on a twenty-four-hour basis
for diagnosing, treating and providing medical, psychological
or surgical care for three or more individuals, whether the
facility is designated as a public, private for-profit, private
not-for-profit, acute care, rehabilitation, limited services,
critical access, general or specific facility;
E. "hospital unit" means a critical care unit, burn
unit, labor and delivery room, post-anesthesia service area,
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emergency department, operating room, pediatric unit, step-down
or intermediate care unit, specialty care unit, telemetry unit,
general medical care unit, subacute care unit, transitional
inpatient care unit or any other unit designation used by a
hospital;
F. "patient classification system" means a system
for establishing staffing requirements by hospital unit,
patient care requirements and shifts that includes methods to:
(1) predict the nursing care requirements of
individual patients;
(2) determine that the amount of nursing care
needed for each category of patient is validated for each unit
and for each shift;
(3) discern trends and patterns of nursing
care delivery by licensed and unlicensed staff;
(4) evaluate the accuracy of the predicted
nursing care requirements described in Paragraph (1) of this
subsection;
(5) determine staff resource allocations based
on nursing care requirements; and
(6) validate the reliability of the patient
classification system for each hospital unit and for each
shift; and
G. "service staff" includes staff who provide the
following services:
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(1) housekeeping;
(2) dietary;
(3) maintenance; or
(4) other essential services to hospital
operations."
SECTION 3. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] HOSPITAL NURSING STAFFING COMMITTEES--
ESTABLISHMENT--MEMBERSHIP--RESPONSIBILITIES.--
A. Each hospital licensed pursuant to the Public
Health Act shall establish a hospital nursing staffing
committee.
B. A hospital nursing staffing committee shall
include hospital managers and direct care nursing staff.
C. Direct care nursing staff shall comprise at
least fifty-one percent of the members of the hospital nursing
staffing committee and shall represent all hospital units when
practicable.
D. Hospital manager members of a hospital nursing
staffing committee shall include the hospital's chief financial
officer, chief nursing officers and hospital unit directors or
managers when practicable.
E. If a hospital's direct care nursing staff are
represented by an exclusive representative certified or
recognized by the hospital pursuant to the National Labor
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Relations Act or the Public Employee Bargaining Act, the
exclusive representative shall select the direct care nursing
staff members to serve on the hospital nursing staffing
committee. In the absence of an exclusive representative,
members of the direct care nursing staff shall select the
direct care nursing staff members to serve on the hospital
nursing staffing committee by affirmation or election.
F. A hospital nursing staffing committee shall have
two co-chairs. One co-chair shall be a hospital nurse manager
elected by the hospital manager members of the committee. One
co-chair shall be a direct care registered nurse elected by the
direct care nursing staff members of the committee. Both co-
chairs shall have had direct patient care experience within
three years of being elected.
G. The hospital nursing staffing committee shall
meet at least once every three months at a time and place
agreed to by the co-chairs. A majority of the members of a
hospital nursing staffing committee constitutes a quorum for
the transaction of business; provided that at least fifty-one
percent of the members present are direct care nursing staff.
All decisions of the hospital nursing staffing committee shall
be made by majority vote of the members present.
H. The hospital nursing staffing committee shall
keep written minutes of all meetings, to be approved at the
following meeting and made available in a timely manner to
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hospital staff upon request. Those minutes shall include:
(1) motions made and the outcomes of votes
taken; and
(2) a summary of discussions.
I. A hospital shall release a member of the
hospital's hospital nursing staffing committee from the
member's work assignment and ensure adequate staffing to cover
the member's work assignment. The hospital shall pay the
member the member's regular rate of pay, plus any differentials
and including overtime wages, for time spent at the hospital
nursing staffing committee meeting.
J. A hospital nursing staffing committee shall:
(1) develop a written nursing staffing plan
prioritizing patient safety; and
(2) review the plan on an ongoing basis, using
data to be provided by the hospital, including:
(a) nursing-sensitive patient outcomes;
(b) internal or external complaints from
staff or the public regarding staffing involving delays in or
the absence of the provision of direct care nursing;
(c) the aggregate hours of mandatory
overtime worked by the direct care nursing staff;
(d) the aggregate hours of voluntary
overtime worked by the direct care nursing staff;
(e) the percentage of shifts in each
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hospital unit in which staffing levels differed from staffing
levels established by the nursing staffing plan; and
(f) the number of meal breaks and rest
breaks missed by direct care nursing staff.
K. A hospital nursing staffing committee shall
develop and recertify the efficacy of the hospital's patient
classification system at least annually."
SECTION 4. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] PROFESSIONAL AND TECHNICAL STAFFING
COMMITTEE--ESTABLISHMENT--MEMBERSHIP--RESPONSIBILITIES.--
A. Each hospital licensed pursuant to the Public
Health Act shall establish a professional and technical
staffing committee.
B. A professional and technical staffing committee
shall consist of hospital managers and direct care professional
and technical staff.
C. Direct care professional and technical staff
shall comprise at least fifty-one percent of the members of a
professional and technical staffing committee. The
professional and technical staffing committee shall represent
all hospital units and a variety of job titles, when
practicable.
D. Hospital manager members of a professional and
technical staffing committee shall include the hospital's chief
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financial officer, chief nursing officers and hospital unit
directors or managers, when practicable.
E. If the direct care professional and technical
staff at a hospital are represented by an exclusive
representative certified or recognized by the hospital pursuant
to the National Labor Relations Act or the Public Employee
Bargaining Act, the exclusive representative shall select the
direct care professional and technical staff to serve on the
professional and technical staffing committee. In the absence
of an exclusive representative, members of the hospital's
direct care professional and technical staff shall select the
direct care professional and technical staff members to serve
on the professional and technical staffing committee by
affirmation or election.
F. A professional and technical staffing committee
shall have two co-chairs. One co-chair shall be a professional
and technical manager elected by the hospital manager members
of the committee and one co-chair shall be a direct care
professional and technical staff member elected by the direct
care professional and technical staff members of the committee.
Both co-chairs shall have had direct patient care experience
within three years of being elected.
G. A professional and technical staffing committee
shall meet at least once every three months at a time and place
agreed to by the two co-chairs. A majority of the members of a
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professional and technical staffing committee constitutes a
quorum for the transaction of business; provided that at least
fifty-one percent of the members present are direct care
professional and technical staff. All decisions of the
committee shall be made by majority vote of the members
present.
H. A professional and technical staffing committee
shall keep written minutes of all meetings, to be approved at
the following meeting and made available in a timely manner to
hospital staff upon request. Those minutes shall include:
(1) motions made and the outcomes of votes
taken; and
(2) a summary of discussions.
I. A hospital shall release a member of the
hospital's professional and technical staffing committee from
that member's assignment and ensure adequate staffing to cover
the member's assignment. The hospital shall pay the member the
member's regular rate of pay, including any differentials and
overtime wages, for time spent at a meeting of the professional
and technical staffing committee.
J. A professional and technical staffing committee
shall:
(1) develop a written professional and
technical staffing plan focused on prioritizing patient safety;
and
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(2) review the plan on an ongoing basis using
data to be provided by the hospital, including:
(a) patient outcomes reasonably related
to care provided by direct care professional and technical
staff;
(b) internal or external complaints from
staff or the public regarding staffing involving complaints
about delays in or the absence of the provision of professional
and technical services;
(c) the aggregate hours of mandatory
overtime worked by the direct care professional and technical
staff;
(d) the aggregate hours of voluntary
overtime worked by the direct care professional and technical
staff;
(e) the percentage of shifts in each
hospital unit in which staffing levels differed from staffing
levels established by the staffing plan; and
(f) the number of meal breaks and rest
break periods missed by direct care professional and technical
staff."
SECTION 5. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] HOSPITAL SERVICE STAFFING COMMITTEES--
ESTABLISHMENT--MEMBERSHIP--RESPONSIBILITIES.--
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A. Each hospital licensed pursuant to the Public
Health Act shall establish a hospital service staffing
committee.
B. A hospital service staffing committee shall
include hospital managers and service staff.
C. Service staff shall comprise at least fifty-one
percent of the members of a hospital service staffing committee
and represent a variety of job titles and hospital units, when
practicable.
D. Hospital manager members of a hospital service
staffing committee shall include the hospital's chief financial
officer, chief nursing officers and hospital unit directors or
managers, when practicable.
E. If the service staff at a hospital are
represented by an exclusive representative certified or
recognized by the hospital pursuant to the National Labor
Relations Act or the Public Employee Bargaining Act, the
exclusive representative shall select the service staff members
to serve on the hospital's hospital service staffing committee.
In the absence of an exclusive representative, the members of
the service staff shall select the service staff members to
serve on the hospital service staffing committee by affirmation
or election.
F. A hospital service staffing committee shall have
two co-chairs. One co-chair shall be a hospital manager
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elected by the hospital manager members of the committee. One
co-chair shall be a service staff member elected by the service
members of the committee.
G. A hospital service staffing committee shall meet
at least once every three months at a time and place agreed to
by the co-chairs. A majority of the members of a hospital
service staffing committee constitutes a quorum for the
transaction of business; provided that at least fifty-one
percent of the members present are service staff. All
decisions of the committee shall be made by majority vote of
the members present.
H. A hospital service staffing committee shall keep
written minutes of all meetings, to be approved at the
following meeting and made available to hospital staff upon
request. Those minutes shall include:
(1) motions made and the outcomes of votes
taken; and
(2) a summary of discussions.
I. A hospital shall release a member of the
hospital's hospital service staffing committee from that
member's assignment and ensure adequate staffing to cover the
member's work assignment. The hospital shall pay the member
the member's regular rate of pay, plus any differentials and
including overtime, for time spent at the meetings of the
committee.
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J. A hospital service staffing committee shall:
(1) develop a written hospital service
staffing plan prioritizing patient safety; and
(2) review the plan on an ongoing basis and
consider using data to be provided to the committee by the
hospital regarding:
(a) patient outcomes;
(b) internal or external complaints
regarding staffing involving delays in or the absence of the
provision of services;
(c) the aggregate hours of mandatory
overtime worked by the hospital's service staff;
(d) the aggregate hours of voluntary
overtime worked by the hospital's service staff;
(e) the percentage of shifts in each
hospital unit for which staffing levels differed from staffing
levels established by the hospital's staffing plan; and
(f) the number of meal breaks and rest
breaks missed by service staff."
SECTION 6. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] NURSING STAFFING PLANS.--
A. Starting on January 1, 2026 and on every January
1 and July 1 thereafter, all hospitals licensed pursuant to the
Public Health Act shall, as a condition of licensing, submit to
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the department a nursing staffing plan prioritizing patient
safety developed and approved by the hospital's hospital
nursing staffing committee. The nursing staffing plan shall
include certification that the plan is sufficient to provide
safe, adequate and appropriate health care services to patients
for the upcoming six-month period.
B. A hospital's nursing staffing plan shall be the
primary basis for the hospital's nursing staffing budget.
C. Factors to be considered in the development of a
hospital's nursing staffing plan include the following:
(1) patient census, including total numbers of
patients on each hospital unit and on each shift and patient
activity, including discharges, admissions and transfers;
(2) patient acuity levels as measured by the
hospital's patient classification system, including the
intensity of care needs and the type of care to be delivered on
each shift;
(3) nursing skill mix;
(4) the level of experience and specialty
certification or training of nursing and patient care staff;
(5) staffing guidelines adopted or published
by national nursing professional associations, specialty
nursing organizations and other health professional
organizations that prioritize patient safety; and
(6) the availability of other staff supporting
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nursing services on the unit.
D. Any portion of a nursing staffing plan that
governs psychiatric units shall be approved by a subcommittee
of the hospital nursing staffing committee consisting of direct
care nursing staff and managers who work in the psychiatric
unit.
E. Each nursing staffing plan shall establish
minimum staffing ratios to prioritize patient safety as
follows:
(1) in an emergency department:
(a) a direct care registered nurse shall
be assigned to not more than one trauma patient;
(b) the ratio of direct care registered
nurses to patients shall average no more than one-to-four over
a twelve-hour shift and a single direct care registered nurse
may not be assigned more than five patients at a time; and
(c) direct care registered nurses
assigned to trauma patients may not be taken into account in
determining the average ratio;
(2) in an intensive care unit, a direct care
registered nurse shall be assigned to no more than two
patients;
(3) in a labor and delivery unit, a direct
care registered nurse shall be assigned no more than:
(a) two patients if the patients are not
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in active labor or experiencing complications; or
(b) one patient if the patient is in
active labor or is at any stage of labor and is experiencing
complications;
(4) in a postpartum, antepartum or well-baby
nursery, a direct care registered nurse shall be assigned to no
more than six patients, counting mother and baby as separate
patients;
(5) in a mother-baby unit, a direct care
registered nurse shall be assigned to no more than eight
patients, counting mother and baby as separate patients;
(6) in an operating room, a direct care
registered nurse shall be assigned to no more than one patient;
(7) in an oncology unit, a direct care
registered nurse shall be assigned to no more than four
patients;
(8) in a post-anesthesia service unit, a
direct care registered nurse shall be assigned to no more than
two patients;
(9) in an intermediate care unit, a direct
care registered nurse shall be assigned to no more than three
patients;
(10) in a medical-surgical unit, a direct care
registered nurse shall be assigned to no more than four
patients;
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(11) in a cardiac telemetry unit, a direct
care registered nurse shall be assigned to no more than four
patients;
(12) in a pediatric unit, a direct care
registered nurse shall be assigned to no more than four
patients;
(13) in a behavioral health unit, a direct
care registered nurse shall be assigned to no more than four
patients; and
(14) in a psychiatric unit, a direct care
registered nurse shall be assigned to no more than four
patients.
F. A hospital's nursing staffing plan shall
allocate direct care nursing staff to hospital units with
adjustable patient acuity levels according to the highest
patient acuity level that exists within the hospital unit
during a shift.
G. The ratios set forth in Subsection E of this
section shall constitute the minimum number of registered and
licensed nurses and unlicensed employees involved in direct
patient care. Additional staff shall be assigned in accordance
with a documented patient classification system for determining
nursing care requirements, including the severity of the
condition; the need for specialized equipment and technology;
the complexity of clinical judgment needed to design, implement
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and evaluate the patient care plan; the ability for patient
self-care; and the type of licensure required for care.
H. A hospital shall not:
(1) assign unlicensed personnel to perform
nursing functions in lieu of a registered nurse; or
(2) allow unlicensed personnel to perform
functions under the direct clinical supervision of a registered
nurse that require a substantial amount of scientific knowledge
and technical skills, including the following functions:
(a) administration of medication;
(b) venipuncture or intravenous therapy;
(c) parenteral or tube feedings;
(d) invasive procedures, including
inserting nasogastric tubes, inserting catheters or tracheal
suctioning;
(e) assessment of patient condition;
(f) sedation, recovery and monitoring;
(g) educating a patient and that
patient's caregivers concerning the patient's health care
problems, including post-discharge care; or
(h) performance of moderate-complexity
laboratory tests.
I. This section shall not preclude any person from
performing any act or function that the person is authorized to
perform pursuant to existing statute or regulation.
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J. Hospitals licensed pursuant to the Public Health
Act shall adopt written policies and procedures for the
training and orientation of direct care nursing staff and
unlicensed employees involved in direct patient care. The
written policies and procedures for orientation of direct care
nursing staff and unlicensed employees involved in direct
patient care shall require that all temporary personnel receive
orientation and be subject to competency validation.
K. A registered nurse or an unlicensed employee
involved in direct patient care shall not be assigned to a
nursing unit or clinical area unless that nurse or unlicensed
employee has:
(1) received orientation in that clinical area
sufficient to provide competent care to patients in that area;
and
(2) demonstrated current competence in
providing care in that area.
L. In case of conflict between this section and any
statute or rule defining the scope of nursing practice, the
scope of practice provisions shall control.
M. Each hospital shall post its approved nursing
staffing plan in publicly accessible areas of the hospital and
on the hospital's website. Each hospital shall make the
nursing staffing plan accessible to staff in either written or
electronic form."
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SECTION 7. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] HOSPITAL PROFESSIONAL AND TECHNICAL
STAFFING PLANS.--
A. Starting on January 1, 2026 and on every January
1 and July 1 thereafter, all hospitals licensed pursuant to the
Public Health Act shall, as a condition of licensing, submit to
the department a professional and technical staffing plan
prioritizing patient safety that has been developed and
approved by the hospital's professional and technical staffing
committee. A professional and technical staffing plan shall
include a written certification that the plan is sufficient to
provide safe, adequate and appropriate health care services to
patients for the upcoming six-month period.
B. A professional and technical staffing plan shall
be developed to ensure that the hospital is staffed
sufficiently to meet the health care needs of the hospital's
patients. The professional and technical staffing plan shall
be consistent with the hospital's approved nursing staffing
plan and hospital service staffing plan.
C. A hospital's professional and technical staffing
plan shall be the primary basis for the hospital's professional
and technical staffing budget.
D. Factors to be considered in the development of a
professional and technical staffing plan include the following:
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(1) patient census, including total numbers of
patients on each hospital unit and on each shift and patient
activity, including discharges, admissions and transfers;
(2) patient acuity levels as measured by the
hospital's patient classification system, including the
intensity of care needs and the type of care to be delivered on
each shift;
(3) applicable national staffing standards;
(4) the size and square footage of the
hospital;
(5) policies to ensure patient access to care;
and
(6) feedback received from staff during
committee meetings.
E. A hospital shall post its approved professional
and technical staffing plan in publicly accessible areas of the
hospital and on the hospital's website. Each hospital shall
make the hospital's professional and technical staffing plan
accessible to staff in either written or electronic form."
SECTION 8. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] HOSPITAL SERVICE STAFFING PLANS.--
A. Starting on January 1, 2026 and on every January
1 and July 1 thereafter, all hospitals licensed pursuant to the
Public Health Act shall, as a condition of licensure, submit to
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the department a hospital service staffing plan that has been
developed and approved by the hospital's hospital service
staffing committee. The hospital service staffing plan shall
include a written certification that the plan is sufficient to
provide adequate and appropriate delivery of health care
services to patients for the upcoming six-month period.
B. A hospital service staffing plan shall be
developed to ensure that the hospital is staffed sufficiently
to meet the health care needs of the hospital's patients. The
hospital service staffing plan shall be consistent with the
hospital's approved nursing staffing plan and approved
professional and technical staffing plan.
C. Factors to be considered in the development of a
hospital service staffing plan include the following:
(1) patient census, including total numbers of
patients on each hospital unit and on each shift and patient
activity, including discharges, admissions and transfers;
(2) patient acuity levels as measured by the
hospital's patient classification system, including the
intensity of care needs and the type of care to be delivered on
each shift;
(3) applicable national staffing standards;
(4) the size and square footage of the
hospital;
(5) policies to ensure patient access to care;
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and
(6) feedback received from staff during
committee meetings.
D. A hospital shall post its approved hospital
service staffing plan in publicly accessible areas of the
hospital and on the hospital's website. Each hospital shall
make the hospital's hospital service staffing plan accessible
to staff in either written or electronic form."
SECTION 9. A new section of Chapter 24 NMSA 1978 is
enacted to read:
"[NEW MATERIAL] DEPARTMENT PROMULGATION OF RULES TO
ESTABLISH A PROCESS FOR REPORTING, INVESTIGATING AND REMEDYING
VIOLATIONS OF THE HOSPITAL PATIENT SAFETY ACT, INCLUDING THE
IMPOSITION OF PENALTIES--GRANTING WAIVERS FOR CERTAIN
HOSPITALS.--
A. The department shall, no later than January 1,
2026, promulgate rules that establish a process for reporting,
investigating and remedying violations of the Hospital Patient
Safety Act, including the imposition of penalties.
B. A hospital shall not be required to follow any
staffing plan in the event of:
(1) a national or state emergency requiring
the implementation of a facility disaster plan;
(2) sudden and unforeseen adverse weather
conditions; or
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(3) an infectious disease epidemic suffered by
hospital staff.
C. In the event of an emergency circumstance not
described in Subsection B of this section, either co-chair of
any staffing committee may specify a time and place to meet to
review and potentially modify the committee's approved staffing
plan in response to the emergency circumstance.
D. The department may grant waivers to rural or
critical access hospitals for compliance with the Hospital
Patient Safety Act if the hospital is able to document
reasonable efforts to obtain adequate staff."
SECTION 10. EMERGENCY.--It is necessary for the public
peace, health and safety that this act take effect immediately.
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