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HOUSE BILL 72
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Eleanor Chávez
AN ACT
RELATING TO HEALTH CARE; REQUIRING THE HEALTH CARE AUTHORITY TO
PROMULGATE AND ENFORCE MINIMUM NURSING STAFF-TO-PATIENT RATIOS
IN LICENSED HOSPITALS; CREATING THE STAFFING ADVISORY
COMMITTEE; REQUIRING LICENSED HOSPITALS TO DEVELOP AND
IMPLEMENT POLICIES AND PROCEDURES; PROVIDING ADMINISTRATIVE
PENALTIES; DECLARING AN EMERGENCY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the Health Care Code is
enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--DEFINITIONS.--As
used in Sections 1 through 5 of this 2025 act:
A. "critical care unit" means a unit that is
established to treat patients whose severity of medical
conditions require continuous monitoring and complex
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intervention by licensed nurses;
B. "hospital" means any public, private for-profit
or not-for-profit acute care, rehabilitation, limited services,
critical access, general or specific facility offering
inpatient services, nursing and overnight care seven days per
week on a twenty-four-hour basis that is capable of treating no
fewer than three patients for the purposes of diagnosing,
treating and providing medical, psychological or surgical care
for physical or mental illness, disease, injury, rehabilitative
conditions and pregnancies; and
C. "hospital unit" includes critical care units,
burn units, labor and delivery rooms, post-anesthesia service
areas, emergency departments, operating rooms, pediatric units,
step-down or intermediate care units, specialty care units,
telemetry units, general medical care units, subacute care
units and transitional inpatient care units."
SECTION 2. A new section of the Health Care Code is
enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--STAFFING
ADVISORY COMMITTEE--CREATION--ORGANIZATION.--
A. The "staffing advisory committee" is created for
the purpose of advising the authority on matters related to
nurse staffing as provided in this 2025 act. The committee
consists of eleven members that reflect a geographic
representation of the state, appointed by the authority as
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follows:
(1) two members shall be private hospital
administrators or chief nursing officers;
(2) two members shall be public hospital
administrators or chief nursing officers;
(3) two members shall be nonmanagerial and
nonsupervisory employees of private hospitals involved in
direct patient care;
(4) two members shall be nonmanagerial and
nonsupervisory employees of public hospitals involved in direct
patient care;
(5) two members shall represent labor
organizations representing employees in public or private
hospitals; and
(6) one nonvoting advisory member shall
represent the authority.
B. The members of the staffing advisory committee
shall serve for terms of four years and no more than three
terms. A member appointed by the committee to fill a vacancy
shall serve the remainder of the term.
C. Term-length conditions for voting members
appointed to the staffing advisory committee are:
(1) for initial appointments, four members
shall serve for four-year terms, three members shall serve for
three-year terms, two members shall serve for two-year terms
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and one member shall serve for a one-year term;
(2) for regular appointments after the initial
appointments, four-year terms;
(3) for a vacancy appointment, the balance of
the term; and
(4) a committee member shall continue to serve
on the committee until a replacement is appointed.
D. The staffing advisory committee shall elect
annually a chair and other officers as the committee determines
to be necessary.
E. The staffing advisory committee shall meet at a
frequency necessary for the committee to advise and provide
data for the authority to use in promulgating rules pursuant to
Section 3 of this 2025 act.
F. A majority of the staffing advisory committee
members currently serving constitutes a quorum.
G. The authority may remove from office a member of
the staffing advisory committee for neglect of duties."
SECTION 3. A new section of the Health Care Code is
enacted to read:
"[NEW MATERIAL] HOSPITALS--LICENSED NURSE-TO-PATIENT
RATIOS--AUTHORITY--COMMITTEE--POWERS AND DUTIES.--
A. The authority, with the advice of the staffing
advisory committee, may:
(1) ensure that staffing ratios promulgated by
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the authority are maintained by a hospital;
(2) waive staffing ratios for rural general
acute care hospitals as needed to increase operational
efficiency; provided that doing so would not jeopardize the
health, safety and well-being of patients; and
(3) seek injunctive relief for violations of
this 2025 act.
B. By July 1, 2026, the authority, with the advice
of the staffing advisory committee, shall hold hearings and
promulgate rules regarding:
(1) minimum, specific and numerical staffing
ratios for hospitals licensed by the authority pursuant to the
Health Care Code, which shall include:
(a) licensed nurse-to-patient ratios by
licensed nurse classification and hospital unit; and
(b) unlicensed employee-to-patient
ratios by unlicensed classification and hospital unit for
unlicensed employees involved in direct patient care;
(2) rural general acute care hospital staffing
needs; provided that the ratios promulgated pursuant to
Paragraph (1) of this subsection may be adjusted to accommodate
these needs;
(3) emergency department staffing, which shall
include the ratios provided pursuant to Paragraph (1) of this
subsection but shall distinguish between regularly scheduled
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core staff licensed nurses and additional licensed nurses
required to treat critical care patients; and
(4) the documented patient classification
systems to be used by hospitals in determining nursing care
requirements, including the:
(a) severity of the illness to be
treated;
(b) need for specialized equipment and
technology;
(c) complexity of clinical judgment
needed to design, implement and evaluate the patient care plan
and the ability for self-care; and
(d) licensure of the personnel required
for care.
C. The rules promulgated by the authority pursuant
to Subsection B of this section shall not replace existing
nurse-to-patient ratios and unlicensed employee-to-patient
ratios that may exist as provided by rule or existing state or
federal law as of the effective date of this 2025 act.
D. The authority, in consultation with the staffing
advisory committee, shall:
(1) review the rules adopted pursuant to
Subsection B of this section after five years following the
adoption of the rules; and
(2) report proposed rules to the legislature
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prior to promulgation."
SECTION 4. A new section of the Health Care Code is
enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--HOSPITAL
POLICIES AND PROCEDURES--TRAINING.--
A. A hospital shall:
(1) employ staff to meet the staffing ratios
established by the authority, which shall be the minimum number
of registered and licensed nurses and unlicensed employees
involved in direct patient care; and
(2) adopt written policies and procedures for
nursing staff and unlicensed employees involved in direct
patient care and temporary personnel, which shall require:
(a) training and orientation for
providing direct patient care;
(b) orientation for registered nurses
and unlicensed employees sufficient to provide competent care
to patients in a nursing unit or clinical area prior to
assigning the registered nurse or unlicensed employees to those
areas; provided that the registered nurse or unlicensed
employee also demonstrates competency in providing care in the
assigned area; and
(c) temporary personnel orientation and
competency evaluation.
B. A hospital may employ additional staff in
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accordance with a documented patient classification system.
C. A hospital shall not:
(1) assign unlicensed personnel to perform
nursing functions in lieu of a registered nurse; or
(2) allow unlicensed personnel under the
direct clinical supervision of a registered nurse to perform
functions that require a substantial amount of scientific
knowledge and technical skills, including:
(a) administration of medication;
(b) venipuncture or intravenous therapy;
(c) parenteral or tube feedings;
(d) invasive procedures, including
inserting nasogastric tubes, inserting catheters and tracheal
suctioning;
(e) assessment of the condition of a
patient;
(f) educating patients and their
families concerning the patient's health care problems,
including post-discharge care; and
(g) moderate complexity laboratory
tests.
D. All hospitals shall adopt written policies and
procedures for training and orientation of nursing staff and
unlicensed employees involved in direct patient care. No
registered nurse or unlicensed employee involved in direct
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patient care shall be assigned to a nursing unit or clinical
area unless that nurse or unlicensed employee involved in
direct patient care has first received orientation in that
clinical area sufficient to provide competent care to patients
in that area and has demonstrated current competence in
providing care in that area. The written policies and
procedures for orientation of nursing staff and unlicensed
employees involved in direct patient care shall require that
all temporary personnel shall receive orientation and be
subject to competency validation.
E. Nothing in this section precludes a licensed or
registered nurse from working within that person's scope of
practice."
SECTION 5. A new section of the Health Care Code is
enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--VIOLATION--
ENFORCEMENT--REMEDIES.--
A. A hospital shall not deviate from any staffing
ratios established by the authority pursuant to this 2025 act
more than six times during a rolling thirty-day period. The
unit manager shall notify the staffing advisory committee and
the authority no later than ten days after each deviation.
Each subsequent deviation during the thirty-day period
constitutes a separate violation.
B. The authority shall, no later than July 1, 2026,
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adopt rules that establish a process for investigating and
remedying any violation of hospital staffing requirements. The
rules shall specify reporting requirements for deviations
consistent with this section and allow for the acceptance,
investigation and resolution of complaints from hospital staff,
exclusive representatives of hospital staff or members of the
public.
C. If the authority determines, whether through a
complaint process, hospital reporting or the authority's own
independent investigation, that a hospital has engaged in a
violation of staffing requirements, the authority shall:
(1) issue a warning for the first violation in
a four-year period;
(2) impose a civil penalty of one thousand
seven hundred fifty dollars ($1,750) for the second violation
of the same provision in a four-year period;
(3) impose a civil penalty of two thousand
five hundred dollars ($2,500) for the third violation of the
same provision in a four-year period; and
(4) impose a civil penalty of five thousand
dollars ($5,000) for the fourth and subsequent violations of
the same provision in a four-year period.
D. If the authority finds that a hospital has
committed multiple violations of the staffing ratio
requirements of a similar nature, it shall require the hospital
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to submit a corrective action plan for approval. If a hospital
does not follow the corrective action plan approved by the
authority, the hospital shall be fined fifty thousand dollars
($50,000) every thirty days until the hospital complies.
E. The requirements of this section or any rules
adopted pursuant to this 2025 act may be enforced by a civil
action brought by any interested person or organization for
injunctive relief to enforce the provisions of this section or
any rules adopted hereunder. In the event such a suit is at
least partially successful, the court may award the interested
person or organization litigation costs and reasonable attorney
fees.
F. A hospital is not required to follow the
staffing ratios established by the authority 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
(3) an infectious disease epidemic suffered by
hospital staff.
G. The authority may grant waivers to rural or
critical access hospitals for portions of this 2025 act if the
hospital is able to document reasonable efforts to obtain
adequate staff."
SECTION 6. EMERGENCY.--It is necessary for the public
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peace, health and safety that this act take effect immediately.
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