S.B. 182
- *SB182*
SENATE BILL NO. 182–SENATOR NGUYEN
PREFILED FEBRUARY 3, 2025
____________
Referred to Committee on Health and Human Services
SUMMARY—Revises provisions relating to the staffing of health
care facilities. (BDR 40-33)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§§ 5, 6, 8, 19)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
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
health care facilities to report and publish 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 1
or more (currently Clark and Washoe Counties) to establish a staffing committee, 2
which must consist, in part, of certain nurses who are on the staff of the hospital. 3
(NRS 449.242) Existing law requires a hospital and certain other health care 4
facilities in such counties to develop a documented staffing plan which must 5
include certain items, such as the number of nurses required in each unit of the 6
hospital and protocols for adequately staffing the hospital upon the occurrence of 7
certain events. (NRS 449.2421) If the health care facility is a hospital, existing law 8
requires the staffing committee established for the hospital to develop the staffing 9
plan. (NRS 442.242) Sections 5 and 6 of this bill require each hospital that is 10
required to establish a staffing committee for nurses to additionally establish a 11
technical staffing committee and a service staffing committee, respectively, to 12
represent the technical and service workers of the hospital. Sections 18-20 of this 13
– 2 –
- *SB182*
bill make conforming changes to refer to existing staffing committees for nurses as 14
“nursing staffing committees.” Sections 5, 6 and 18 require the technical staffing 15
committee, the service staffing committee and the nursing staffing committee to 16
collaborate to develop the documented staffing plan for the hospital. Section 19 17
requires a documented staffing plan to contain certain provisions relating to the 18
adequate staffing of technical and service workers. Section 23 of this bill requires a 19
hospital that has established a technical staffing committee and a service staffing 20
committee to include the members of those committees on the hospital’s committee 21
on workplace safety, which performs certain duties relating to the prevention of 22
workplace violence at the hospital. (NRS 618.7312) 23
Existing law requires each hospital that is required to establish a nursing 24
staffing committee to report annually to the Legislature concerning the 25
establishment of the nursing staffing committee, the activities and progress of the 26
nursing staffing committee and a determination of the efficacy of the nursing 27
staffing committee. (NRS 449.242) Sections 7 and 18 of this bill require that report 28
to additionally include such information for the technical staffing committee and 29
the service staffing committee. 30
Section 8 of this bill establishes the maximum ratios for the number of patients 31
that may be assigned to a direct care nurse at one time in certain hospitals in a 32
county whose population is 100,000 or more (currently Clark and Washoe 33
Counties). The ratios established by section 8 vary based on the unit of the hospital 34
to which a direct care nurse is assigned. Section 8 also establishes the maximum 35
ratios for the number of patients that may be assigned to a certified nursing 36
assistant, in any unit, in certain hospitals in a county whose population is 100,000 37
or more (currently Clark and Washoe Counties), at one time. Section 19 requires 38
the documented staffing plan of a hospital to provide for staffing in accordance 39
with the maximum ratios of patients to direct care nurses established by section 8. 40
Section 19 also requires such a documented staffing plan to provide for additional 41
compensation for nurses who perform certain duties. Section 9 of this bill requires 42
a hospital to maintain certain records containing information relevant for measuring 43
the compliance of the hospital with the nurse-to-patient ratios established by 44
section 8. 45
Sections 12 and 13 of this bill authorize the Division of Public and Behavioral 46
Health of the Department of Health and Human Services to discipline a health care 47
facility that fails to comply with the requirements of this bill in the same manner as 48
violations of other requirements governing health care facilities. Section 22 of this 49
bill requires the Division to establish: (1) procedures for random visits to health 50
care facilities to ensure compliance with the requirements of this bill, where 51
applicable, and certain other requirements governing the staffing of health care 52
facilities; (2) an accessible and confidential system that allows certain staff of a 53
health care facility to report a violation of those requirements; and (3) procedures 54
for timely investigating and resolving such a report. Section 10 of this bill 55
additionally authorizes the Labor Commissioner to take certain actions to ensure 56
that a health care facility complies with the requirements of this bill, where 57
applicable, and certain other requirements relating to the staffing of health care 58
facilities. Section 15 of this bill prohibits a health care facility from retaliating 59
against an employee of the facility for reporting a violation to the Division or the 60
Labor Commissioner. 61
Existing law requires the establishment of a system for rating certain health 62
care facilities located in a county whose population is 100,000 or more on their 63
compliance with requirements governing staffing. (NRS 449.2425) Section 21 of 64
this bill requires the Division to assign a new rating to a facility after an inspection 65
or investigation conducted pursuant to section 22. 66
Sections 2-4 of this bill define certain terms relating to the staffing of health 67
care facilities, and section 17 of this bill establishes the applicability of those 68
– 3 –
- *SB182*
definitions. Sections 11 and 16 of this bill make conforming changes relating to the 69
applicability and enforcement of sections 2-10. 70
Existing law requires the operator of a facility for skilled nursing to 71
conspicuously post his or her license to operate the facility and certain information 72
relating to the management of the facility. (NRS 449.184) Section 14 of this bill 73
additionally requires a skilled nursing facility to post on the Internet website of the 74
facility and submit to the Division a monthly report concerning the ratio of licensed 75
nurses to patients at the facility for skilled nursing. 76
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 1
thereto the provisions set forth as sections 2 to 10, inclusive, of this 2
act. 3
Sec. 2. “Direct care nurse” means a licensed nurse who has 4
principal responsibility to oversee or carry out medical regimens 5
or nursing care for one or more patients. 6
Sec. 3. “Service staff” means the staff of a health care 7
facility who: 8
1. Interact directly with patients or with other staff; 9
2. Do not provide medical care or related services to patients; 10
and 11
3. Are not a part of the technical staff of the health care 12
facility. 13
Sec. 4. “Technical staff” means the staff of a health care 14
facility whose primary job duties relate to servicing medical 15
equipment and machinery, providing information technology 16
support services or performing other duties which involve 17
technical skills and which are not related to the direct provision of 18
medical care to patients. 19
Sec. 5. 1. Except as otherwise provided in subsection 4, 20
each hospital located in a county whose population is 100,000 or 21
more and which is licensed to have more than 70 beds shall 22
establish a technical staffing committee. Each technical staffing 23
committee established pursuant to this subsection must consist of: 24
(a) Not less than one-half of the total members of the technical 25
staffing committee from the technical staff of the hospital. The 26
members described in this paragraph must consist of one member 27
representing each division of the technical staff of the hospital, 28
elected by the members of the technical staff within that division. 29
(b) Not less than one-half of the total members of the technical 30
staffing committee from the managers of the technical staff of the 31
hospital, appointed by the administration of the hospital. 32
– 4 –
- *SB182*
(c) One alternate member representing each division of the 1
technical staff of the hospital, elected by the members of the 2
technical staff within that division. 3
2. Each time a new technical staffing committee is formed 4
pursuant to subsection 1, the administration of the hospital shall 5
hold an election to select the members described in paragraphs (a) 6
and (c) of subsection 1. Each member of the technical staff at the 7
hospital must be allowed at least 3 days to vote for: 8
(a) The regular member described in paragraph (a) of 9
subsection 1; and 10
(b) The alternate member described in paragraph (c) of 11
subsection 1. 12
3. If a vacancy occurs in a position on a staffing committee 13
described in paragraph (a) or (c) of subsection 1, a new regular or 14
alternate member, as applicable, must be elected in the same 15
manner as his or her predecessor. 16
4. If a technical staffing committee is established for a 17
hospital described in subsection 1 through collective bargaining 18
with an employee organization representing the technical staff of 19
the hospital: 20
(a) The hospital is not required to form a technical staffing 21
committee pursuant to that subsection; and 22
(b) The technical staffing committee established pursuant to 23
the collective bargaining agreement shall be deemed to be the 24
technical staffing committee established for the hospital pursuant 25
to subsection 1. 26
5. A technical staffing committee established pursuant to 27
subsection 1 shall collaborate with the nursing staffing committee 28
established pursuant to NRS 449.242 and the service staffing 29
committee established pursuant to section 6 of this act to develop a 30
documented staffing plan as required by NRS 449.2421. 31
6. The technical staffing committee of a hospital shall meet at 32
least quarterly. 33
Sec. 6. 1. Except as otherwise provided in subsection 4, 34
each hospital located in a county whose population is 100,000 or 35
more and which is licensed to have more than 70 beds shall 36
establish a service staffing committee. Each service staffing 37
committee established pursuant to this subsection must consist of: 38
(a) Not less than one-half of the total members of the service 39
staffing committee from the service staff of the hospital. The 40
members described in this paragraph must consist of one member 41
representing each division of the service staff of the hospital, 42
elected by the members of the service staff within that division. 43
– 5 –
- *SB182*
(b) Not less than one-half of the total members of the service 1
staffing committee from the managers of the service staff 2
appointed by the administration of the hospital. 3
(c) One alternate member representing each division of the 4
service staff of the hospital, elected by the members of the service 5
staff within that division. 6
2. Each time a new service staffing committee is formed 7
pursuant to subsection 1, the administration of the hospital shall 8
hold an election to select the members described in paragraphs (a) 9
and (c) of subsection 1. Each member of the service staff at the 10
hospital must be allowed at least 3 days to vote for: 11
(a) The regular member described in paragraph (a) of 12
subsection 1; and 13
(b) The alternate member described in paragraph (c) of 14
subsection 1. 15
3. If a vacancy occurs in a position on a service staffing 16
committee described in paragraph (a) or (c) of subsection 1, a new 17
regular or alternate member, as applicable, must be elected in the 18
same manner as his or her predecessor. 19
4. If a service staffing committee is established for a hospital 20
described in subsection 1 through collective bargaining with an 21
employee organization representing the service staff of the 22
hospital: 23
(a) The hospital is not required to form a service staffing 24
committee pursuant to that subsection; and 25
(b) The service staffing committee established pursuant to the 26
collective bargaining agreement shall be deemed to be the service 27
staffing committee established for the hospital pursuant to 28
subsection 1. 29
5. A service staffing committee established pursuant to 30
subsection 1 shall collaborate with the nursing staffing committee 31
established pursuant to NRS 449.242 and the technical staffing 32
committee established pursuant to section 5 of this act to develop a 33
documented staffing plan as required by NRS 449.2421. 34
6. The service staffing committee of a hospital shall meet at 35
least quarterly. 36
Sec. 7. Each hospital located in a county whose population is 37
100,000 or more and which is licensed to have more than 70 beds 38
shall prepare a written report concerning the establishment of the 39
technical staffing committee pursuant to section 5 of this act, the 40
service staffing committee pursuant to section 6 of this act and 41
the nursing staffing committee pursuant to NRS 449.242, the 42
activities and progress of those staffing committees and a 43
determination of the efficacy of those staffing committees. The 44
hospital shall submit the report on or before December 31 of each: 45
– 6 –
- *SB182*
1. Even-numbered year to the Director of the Legislative 1
Counsel Bureau for transmission to the next regular session of the 2
Legislature. 3
2. Odd-numbered year to the Director of the Legislative 4
Counsel Bureau for transmission to the Joint Interim Standing 5
Committee on Health and Human Services. 6
Sec. 8. 1. The ratios for the maximum number of patients 7
that may be assigned to a direct care nurse in a hospital located in 8
a county whose population is 100,000 or more and which is 9
licensed to have more than 70 beds are: 10
(a) A ratio of one direct care nurse to one patient in each: 11
(1) Operating room; or 12
(2) Critical care unit. 13
(b) In each emergency unit: 14
(1) A ratio of one direct care nurse for each trauma patient; 15
(2) An average ratio of one direct care nurse for every four 16
patients over each 12-hour shift, excluding direct care nurses 17
described in subparagraph (1); and 18
(3) A ratio of one direct care nurse for every five patients at 19
any time. 20
(c) In each labor and delivery unit, a ratio of: 21
(1) One direct care nurse for each patient who is: 22
(I) In active labor; or 23
(II) In any stage of labor and is experiencing 24
complications relating to the pregnancy; and 25
(2) One direct care nurse for every two patients not 26
described in subparagraph (1). 27
(d) A ratio of one direct care nurse for every two patients in 28
each: 29
(1) Burn unit; 30
(2) Intensive care unit; or 31
(3) Postanesthesia unit. 32
(e) A ratio of one direct care nurse for every three patients in 33
each: 34
(1) Cardiac telemetry unit; or 35
(2) Intermediate care unit. 36
(f) A ratio of one direct care nurse for every four patients in 37
each: 38
(1) Ambulatory care unit; 39
(2) Oncology unit; 40
(3) Pediatric unit; 41
(4) Medical-surgical unit; 42
(5) Pre-surgical unit; or 43
(6) Psychiatric unit. 44
– 7 –
- *SB182*
(g) A ratio of one direct care nurse for every five patients in 1
each rehabilitation unit. 2
(h) A ratio of one direct care nurse for every six patients in 3
each: 4
(1) Antepartum unit; 5
(2) Postpartum unit; or 6
(3) Nursery for well babies. 7
(i) A ratio of one direct care nurse for every eight patients in 8
each mother-baby unit. 9
(j) Such other ratios, as prescribed by regulation of the Board, 10
for any units not otherwise identified in this subsection. 11
2. A hospital shall count a mother and her child as separate 12
patients when calculating any ratio for the purposes of 13
subsection 1. 14
3. A hospital shall not include a licensed nurse who does not 15
have the principal responsibility for caring for a patient, 16
including, without limitation, a nurse administrator or supervisor, 17
in the calculation of any ratio for the purposes of subsection 1. 18
4. A hospital shall adjust its staff as necessary to reflect the 19
need for additional direct care nurses to ensure that each unit 20
within the hospital is adequately staffed in accordance with the 21
requirements of subsection 1, including, without limitation, when 22
a direct care nurse takes a meal or rest break. 23
5. A hospital that includes certified nursing assistants in the 24
nursing staff of the hospital shall include in its documented 25
staffing plan the following ratios for the maximum number of 26
patients that may be assigned to a certified nursing assistant: 27
(a) During the hours of 6 a.m. until 8 p.m., a ratio of one 28
certified nursing assistant for every seven patients in any unit. 29
(b) During the hours of 8:01 p.m., until 5:59 a.m., a ratio of 30
one certified nursing assistant for every 11 patients in any unit. 31
6. A hospital may only assign a licensed nurse to a unit or a 32
clinical area and include the licensed nurse in the count of 33
assigned nursing staff for the purposes of compliance with 34
subsection 1 if: 35
(a) The licensed nurse is appropriately licensed for assignment 36
to that unit or clinical area; 37
(b) The hospital has provided orientation to the licensed nurse 38
before assigning that licensed nurse to that unit or clinical area; 39
and 40
(c) The hospital has verified that the licensed nurse is capable 41
of providing competent nursing care to the patients in that unit or 42
clinical area. 43
7. As used in this section: 44
– 8 –
- *SB182*
(a) “Intensive care unit” means a unit that provides care to 1
critically ill patients who require advanced treatments such as 2
mechanical ventilation, vasoactive infusions, continuous renal 3
replacement treatment or frequent assessment or monitoring. 4
(b) “Intermediate care unit” means a unit that provides 5
progressive care, intensive specialty care or step-down care. 6
(c) “Progressive care” means care provided to patients who 7
need more monitoring and assessment than patients on a general 8
unit but whose conditions are not so unstable that care in an 9
intensive care unit is required. 10
(d) “Step-down care” means care for patients transitioning out 11
of the intensive care unit who require more care and attention 12
than patients on a general unit. 13
Sec. 9. 1. As a condition for licensure, each hospital 14
located in a county whose population is 100,000 or more and 15
which is licensed to have more than 70 beds shall maintain 16
accurate daily records showing for each unit: 17
(a) The number of patients admitted, released and present in 18
the unit; 19
(b) The identity and duty hours of each direct care nurse in the 20
unit; 21
(c) The identity and duty hours of each certified nursing 22
assistant in the unit; and 23
(d) Any meal or rest break missed by each direct care nurse in 24
the unit. 25
2. As a condition for licensure, each hospital located in a 26
county whose population is 100,000 or more and which is licensed 27
to have more than 70 beds shall maintain daily statistics, by unit, 28
of mortality, morbidity, infection, accident, injury and medical 29
errors. 30
3. A hospital located in a county whose population is 100,000 31
or more and which is licensed to have more than 70 beds shall: 32
(a) Maintain all records required to be maintained by this 33
section, for at least 7 years after the date on which the record was 34
created; and 35
(b) Make all records required to be maintained by this section 36
available for inspection upon the request of the Division or the 37
Labor Commissioner. 38
4. On or before the last day of each month, a hospital located 39
in a county whose population is 100,000 or more and which is 40
licensed to have more than 70 beds shall transmit the content of 41
any records created pursuant to this section during the 42
immediately preceding month to the Division, in a format to be 43
determined by the Division. 44
– 9 –
- *SB182*
Sec. 10. 1. The Labor Commissioner shall collaborate with 1
the Division to ensure compliance with the provisions of NRS 2
449.242 to 449.2428, inclusive, and sections 2 to 10, inclusive, of 3
this act. The Labor Commissioner may: 4
(a) Inspect a health care facility to assess compliance with 5
NRS 449.242 to 449.2428, inclusive, and sections 2 to 10, 6
inclusive, of this act; 7
(b) Investigate an alleged violation of NRS 449.242 to 8
449.2428, inclusive, and sections 2 to 10, inclusive, of this act or 9
assist the Division with such an investigation; and 10
(c) Report a violation of NRS 449.242 to 449.2428, inclusive, 11
and sections 2 to 10, inclusive, of this act to the Division. 12
2. Upon receiving from the Labor Commissioner pursuant to 13
paragraph (c) of subsection 1 a report that a health care facility 14
has violated NRS 449.242 to 449.2428, inclusive, and sections 2 to 15
10, inclusive, of this act, the Division shall initiate disciplinary 16
proceedings against the health care facility. 17
Sec. 11. NRS 449.0301 is hereby amended to read as follows: 18
449.0301 The provisions of NRS 449.029 to 449.2428, 19
inclusive, and sections 2 to 10, inclusive, of this act, do not apply 20
to: 21
1. Any facility conducted by and for the adherents of any 22
church or religious denomination for the purpose of providing 23
facilities for the care and treatment of the sick who depend solely 24
upon spiritual means through prayer for healing in the practice of 25
the religion of the church or denomination, except that such a 26
facility shall comply with all regulations relative to sanitation and 27
safety applicable to other facilities of a similar category. 28
2. Foster homes as defined in NRS 424.014. 29
3. Any medical facility, facility for the dependent or facility 30
which is otherwise required by the regulations adopted by the Board 31
pursuant to NRS 449.0303 to be licensed that is operated and 32
maintained by the United States Government or an agency thereof. 33
Sec. 12. NRS 449.160 is hereby amended to read as follows: 34
449.160 1. The Division may deny an application for a 35
license or may suspend or revoke any license issued under the 36
provisions of NRS 449.029 to 449.2428, inclusive, and sections 2 to 37
10, inclusive, of this act upon any of the following grounds: 38
(a) Violation by the applicant or the licensee of any of the 39
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 40
sections 2 to 10, inclusive, of this act, or 449A.100 to 449A.124, 41
inclusive, and 449A.270 to 449A.286, inclusive, or of any other law 42
of this State or of the standards, rules and regulations adopted 43
thereunder. 44
– 10 –
- *SB182*
(b) Aiding, abetting or permitting the commission of any illegal 1
act. 2
(c) Conduct inimical to the public health, morals, welfare and 3
safety of the people of the State of Nevada in the maintenance and 4
operation of the premises for which a license is issued. 5
(d) Conduct or practice detrimental to the health or safety of the 6
occupants or employees of the facility. 7
(e) Failure of the applicant to obtain written approval from the 8
Director of the Department of Health and Human Services as 9
required by NRS 439A.100 or 439A.102 or as provided in any 10
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 11
and sections 2 to 10, inclusive, of this act, and 449.435 to 449.531, 12
inclusive, and chapter 449A of NRS if such approval is required, 13
including, without limitation, the closure or conversion of any 14
hospital in a county whose population is 100,000 or more that is 15
owned by the licensee without approval pursuant to NRS 439A.102. 16
(f) Failure to comply with the provisions of NRS 441A.315 and 17
any regulations adopted pursuant thereto or NRS 449.2486. 18
(g) Violation of the provisions of NRS 458.112. 19
(h) Failure to comply with the provisions of NRS 449A.170 to 20
449A.192, inclusive, and any regulation adopted pursuant thereto. 21
(i) Violation of the provisions of NRS 629.260. 22
2. In addition to the provisions of subsection 1, the Division 23
may revoke a license to operate a facility for the dependent if, with 24
respect to that facility, the licensee that operates the facility, or an 25
agent or employee of the licensee: 26
(a) Is convicted of violating any of the provisions of 27
NRS 202.470; 28
(b) Is ordered to but fails to abate a nuisance pursuant to NRS 29
244.360, 244.3603 or 268.4124; or 30
(c) Is ordered by the appropriate governmental agency to correct 31
a violation of a building, safety or health code or regulation but fails 32
to correct the violation. 33
3. The Division shall maintain a log of any complaints that it 34
receives relating to activities for which the Division may revoke the 35
license to operate a facility for the dependent pursuant to subsection 36
2. The Division shall provide to a facility for the care of adults 37
during the day: 38
(a) A summary of a complaint against the facility if the 39
investigation of the complaint by the Division either substantiates 40
the complaint or is inconclusive; 41
(b) A report of any investigation conducted with respect to the 42
complaint; and 43
(c) A report of any disciplinary action taken against the facility. 44
– 11 –
- *SB182*
The facility shall make the information available to the public 1
pursuant to NRS 449.2486. 2
4. On or before February 1 of each odd-numbered year, the 3
Division shall submit to the Director of the Legislative Counsel 4
Bureau a written report setting forth, for the previous biennium: 5
(a) Any complaints included in the log maintained by the 6
Division pursuant to subsection 3; and 7
(b) Any disciplinary actions taken by the Division pursuant to 8
subsection 2. 9
Sec. 13. NRS 449.163 is hereby amended to read as follows: 10
449.163 1. In addition to the payment of the amount required 11
by NRS 449.0308, if a medical facility, facility for the dependent or 12
facility which is required by the regulations adopted by the Board 13
pursuant to NRS 449.0303 to be licensed violates any provision 14
related to its licensure, including any provision of NRS 439B.410 or 15
449.029 to 449.2428, inclusive, and sections 2 to 10, inclusive, of 16
this act, or any condition, standard or regulation adopted by the 17
Board, the Division, in accordance with the regulations adopted 18
pursuant to NRS 449.165, may: 19
(a) Prohibit the facility from admitting any patient until it 20
determines that the facility has corrected the violation; 21
(b) Limit the occupancy of the facility to the number of beds 22
occupied when the violation occurred, until it determines that the 23
facility has corrected the violation; 24
(c) If the license of the facility limits the occupancy of the 25
facility and the facility has exceeded the approved occupancy, 26
require the facility, at its own expense, to move patients to another 27
facility that is licensed; 28
(d) Except where a greater penalty is authorized by subsection 2, 29
impose an administrative penalty of not more than $5,000 per day 30
for each violation, together with interest thereon at a rate not to 31
exceed 10 percent per annum; and 32
(e) Appoint temporary management to oversee the operation of 33
the facility and to ensure the health and safety of the patients of the 34
facility, until: 35
(1) It determines that the facility has corrected the violation 36
and has management which is capable of ensuring continued 37
compliance with the applicable statutes, conditions, standards and 38
regulations; or 39
(2) Improvements are made to correct the violation. 40
2. If an off-campus location of a hospital fails to obtain a 41
national provider identifier that is distinct from the national provider 42
identifier used by the main campus and any other off-campus 43
location of the hospital in violation of NRS 449.1818, the Division 44
may impose against the hospital an administrative penalty of not 45
– 12 –
- *SB182*
more than $10,000 for each day of such failure, together with 1
interest thereon at a rate not to exceed 10 percent per annum, in 2
addition to any other action authorized by this chapter. 3
3. If the facility fails to pay any administrative penalty imposed 4
pursuant to paragraph (d) of subsection 1 or subsection 2, the 5
Division may: 6
(a) Suspend the license of the facility until the administrative 7
penalty is paid; and 8
(b) Collect court costs, reasonable attorney’s fees and other 9
costs incurred to collect the administrative penalty. 10
4. The Division may require any facility that violates any 11
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 12
sections 2 to 10, inclusive, of this act or any condition, standard or 13
regulation adopted by the Board to make any improvements 14
necessary to correct the violation. 15
5. Any money collected as administrative penalties pursuant to 16
paragraph (d) of subsection 1 or subsection 2 must be accounted for 17
separately and used to administer and carry out the provisions of 18
NRS 449.001 to 449.430, inclusive, and sections 2 to 10, inclusive, 19
of this act, 449.435 to 449.531, inclusive, and chapter 449A of NRS 20
to protect the health, safety, well-being and property of the patients 21
and residents of facilities in accordance with applicable state and 22
federal standards or for any other purpose authorized by the 23
Legislature. 24
Sec. 14. NRS 449.184 is hereby amended to read as follows: 25
449.184 1. A person who operates a residential facility for 26
groups shall: 27
(a) Post his or her license to operate the residential facility for 28
groups; 29
(b) Post the rates for services provided by the residential facility 30
for groups; and 31
(c) Post contact information for the administrator and the 32
designated representative of the owner or operator of the facility, 33
in a conspicuous place in the residential facility for groups. 34
2. A person who operates a facility for intermediate care or 35
facility for skilled nursing shall: 36
(a) Post his or her license to operate the facility; 37
(b) Post the organizational structure of the management of the 38
facility; and 39
(c) Post contact information for the administrator and the 40
designated representative of the owner or operator of the facility, 41
in a conspicuous place in the facility for intermediate care or 42
facility for skilled nursing. 43
3. Except as otherwise provided in subsection 4, on or before 44
the last day of each month, a facility for skilled nursing shall post 45
– 13 –
- *SB182*
on an Internet website maintained by the facility for skilled 1
nursing and submit to the Division the average ratios of licensed 2
nurses for each patient at the facility during the immediately 3
preceding month and the immediately preceding 12 months. 4
4. If a facility for skilled nursing does not maintain an 5
Internet website, the facility for skilled nursing shall make the 6
information described in subsection 3 available to any person 7
upon request at all times in lieu of posting on an Internet website. 8
5. As used in this section, “licensed nurse” means a person 9
licensed pursuant to chapter 632 of NRS to practice nursing, 10
including, without limitation, a licensed practical nurse. The term 11
does not include a certified nursing assistant or a medication 12
aide - certified. 13
Sec. 15. NRS 449.205 is hereby amended to read as follows: 14
449.205 1. A medical facility or any agent or employee 15
thereof shall not retaliate or discriminate unfairly against: 16
(a) An employee of the medical facility or a person acting on 17
behalf of the employee who in good faith: 18
(1) Reports to the Board of Medical Examiners or the State 19
Board of Osteopathic Medicine, as applicable, information relating 20
to the conduct of a physician which may constitute grounds for 21
initiating disciplinary action against the physician or which 22
otherwise raises a reasonable question regarding the competence of 23
the physician to practice medicine with reasonable skill and safety 24
to patients; 25
(2) Reports a sentinel event to the Division pursuant to NRS 26
439.835; [or] 27
(3) Cooperates or otherwise participates in an investigation 28
or proceeding conducted by the Board of Medical Examiners, the 29
State Board of Osteopathic Medicine or another governmental entity 30
relating to conduct described in subparagraph (1) or (2); or 31
(4) Reports to the Division or the Labor Commissioner any 32
information concerning a potential or actual violation of the 33
provisions of NRS 449.242 to 449.2428, inclusive, and sections 2 34
to 10, inclusive, of this act; 35
(b) A registered nurse, licensed practical nurse, nursing assistant 36
or medication aide - certified who is employed by or contracts to 37
provide nursing services for the medical facility and who: 38
(1) In accordance with the policy, if any, established by the 39
medical facility: 40
(I) Reports to his or her immediate supervisor, in writing, 41
that he or she does not possess the knowledge, skill or experience to 42
comply with an assignment to provide nursing services to a patient; 43
and 44
– 14 –
- *SB182*
(II) Refuses to provide to a patient nursing services for 1
which, as verified by documentation in the personnel file of the 2
registered nurse, licensed practical nurse, nursing assistant or 3
medication aide - certified concerning his or her competence to 4
provide various nursing services, he or she does not possess the 5
knowledge, skill or experience to comply with the assignment to 6
provide nursing services to the patient, unless the refusal constitutes 7
unprofessional conduct as set forth in chapter 632 of NRS or any 8
regulations adopted pursuant thereto; 9
(2) In accordance with a policy adopted pursuant to NRS 10
449.2423, requests to be relieved of, refuses or objects to a work 11
assignment; 12
(3) In good faith, reports to the medical facility, the Board of 13
Medical Examiners, the State Board of Osteopathic Medicine, the 14
State Board of Nursing, the Legislature or any committee thereof or 15
any other governmental entity: 16
(I) Any information concerning the willful conduct of 17
another registered nurse, licensed practical nurse, nursing assistant 18
or medication aide - certified which violates any provision of 19
chapter 632 of NRS or which is required to be reported to the State 20
Board of Nursing; 21
(II) Any concerns regarding patients who may be exposed 22
to a substantial risk of harm as a result of the failure of the medical 23
facility or any agent or employee thereof to comply with minimum 24
professional or accreditation standards or applicable statutory or 25
regulatory requirements; or 26
(III) Any other concerns regarding the medical facility, 27
the agents and employees thereof or any situation that reasonably 28
could result in harm to patients; or 29
(4) Refuses to engage in conduct that would violate the duty 30
of the registered nurse, licensed practical nurse, nursing assistant or 31
medication aide - certified to protect patients from actual or 32
potential harm, conduct which would violate any provision of 33
chapter 632 of NRS or conduct which would subject the registered 34
nurse, licensed practical nurse, nursing assistant or medication aide - 35
certified to disciplinary action by the State Board of Nursing; or 36
(c) An employee or other provider of care who takes an action 37
described in subsection 3 of NRS 618.7315. 38
2. A medical facility or any agent or employee thereof shall not 39
retaliate or discriminate unfairly against an employee of the medical 40
facility or a registered nurse, licensed practical nurse, nursing 41
assistant or medication aide - certified who is employed by or 42
contracts to provide nursing services for the medical facility because 43
the employee, registered nurse, licensed practical nurse, nursing 44
– 15 –
- *SB182*
assistant or medication aide - certified has taken an action described 1
in subsection 1. 2
3. A medical facility or any agent or employee thereof shall not 3
prohibit, restrict or attempt to prohibit or restrict by contract, policy, 4
procedure or any other manner the right of an employee of the 5
medical facility or a registered nurse, licensed practical nurse, 6
nursing assistant or medication aide - certified who is employed by 7
or contracts to provide nursing services for the medical facility to 8
take an action described in subsection 1. 9
4. As used in this section: 10
(a) “Good faith” means honesty in fact in the reporting of the 11
information or in the cooperation in the investigation concerned. 12
(b) “Physician” means a person licensed to practice medicine 13
pursuant to chapter 630 or 633 of NRS. 14
(c) “Retaliate or discriminate”: 15
(1) Includes, without limitation, any of the following actions 16
if taken solely because the employee, registered nurse, licensed 17
practical nurse, nursing assistant or medication aide - certified took 18
an action described in subsection 1: 19
(I) Frequent or undesirable changes in the location where 20
the person works; 21
(II) Frequent or undesirable transfers or reassignments; 22
(III) The issuance of letters of reprimand, letters of 23
admonition or evaluations of poor performance; 24
(IV) A demotion; 25
(V) A reduction in pay; 26
(VI) The denial of a promotion; 27
(VII) A suspension; 28
(VIII) A dismissal; 29
(IX) A transfer; or 30
(X) Frequent changes in working hours or workdays. 31
(2) Does not include an action described in sub-32
subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action 33
is taken in the normal course of employment or as a form of 34
discipline. 35
Sec. 16. NRS 449.240 is hereby amended to read as follows: 36
449.240 The district attorney of the county in which the facility 37
is located shall, upon application by the Division, institute and 38
conduct the prosecution of any action for violation of any provisions 39
of NRS 449.029 to 449.245, inclusive [.] and sections 2 to 10, 40
inclusive, of this act. 41
Sec. 17. NRS 449.241 is hereby amended to read as follows: 42
449.241 As used in NRS 449.241 to 449.2428, inclusive, and 43
sections 2 to 10, inclusive, of this act, unless the context otherwise 44
requires, the words and terms defined in NRS 449.2413 to 45
– 16 –
- *SB182*
449.2418, inclusive, and sections 2, 3 and 4 of this act have the 1
meanings ascribed to them in those sections. 2
Sec. 18. NRS 449.242 is hereby amended to read as follows: 3
449.242 1. Except as otherwise provided in subsection 4, 4
each hospital located in a county whose population is 100,000 or 5
more and which is licensed to have more than 70 beds shall 6
establish a nursing staffing committee . [to develop a written policy 7
as required pursuant to NRS 449.2423 and a documented staffing 8
plan as required pursuant to NRS 449.2421.] Each nursing staffing 9
committee established pursuant to this subsection must consist of: 10
(a) Not less than one-half of the total regular members of the 11
nursing staffing committee from the licensed nursing staff and 12
certified nursing assistants who are providing direct patient care at 13
the hospital. The members described in this paragraph must consist 14
of: 15
(1) One member representing each unit of the hospital who is 16
a licensed nurse who provides direct patient care on that unit, 17
elected by the licensed nursing staff who provide direct patient care 18
on the unit that the member will represent. 19
(2) One member representing each unit of the hospital who is 20
a certified nursing assistant who provides direct patient care on that 21
unit, elected by the certified nursing assistants who provide direct 22
patient care on the unit that the member will represent. 23
(b) Not less than one-half of the total regular members of the 24
nursing staffing committee appointed by the administration of the 25
hospital. 26
(c) One alternate member representing each unit of the hospital 27
who is a licensed nurse or certified nursing assistant who provides 28
direct patient care on that unit, elected by the licensed nursing staff 29
and certified nursing assistants who provide direct patient care on 30
the unit that the member represents. 31
2. Each time a new nursing staffing committee is formed 32
pursuant to subsection 1, the administration of the hospital shall 33
hold an election to select the members described in paragraphs (a) 34
and (c) of subsection 1. Each licensed nurse and certified staffing 35
assistant who provides direct patient care at the hospital must be 36
allowed at least 3 days to vote for: 37
(a) The regular member described in paragraph (a) of subsection 38
1 who will represent his or her unit and profession; and 39
(b) The alternate member described in paragraph (c) of 40
subsection 1 who will represent his or her unit. 41
3. If a vacancy occurs in a position on a nursing staffing 42
committee described in paragraph (a) or (c) of subsection 1, a new 43
regular or alternate member, as applicable, must be elected in the 44
same manner as his or her predecessor. 45
– 17 –
- *SB182*
4. If a nursing staffing committee is established for a health 1
care facility described in subsection 1 through collective bargaining 2
with an employee organization representing the licensed nursing 3
staff and certified nursing assistants of the health care facility: 4
(a) The health care facility is not required to form a nursing 5
staffing committee pursuant to that subsection; and 6
(b) The nursing staffing committee established pursuant to the 7
collective bargaining agreement shall be deemed to be the nursing 8
staffing committee established for the health care facility pursuant to 9
subsection 1. 10
5. In developing the written policy and the staffing plan, the 11
nursing staffing committee shall consider, without limitation, the 12
information received pursuant to paragraph (b) of subsection 5 of 13
NRS 449.2423 regarding requests to be relieved of a work 14
assignment, refusals of a work assignment and objections to a work 15
assignment. 16
6. The nursing staffing committee shall: 17
(a) Collaborate with the technical staffing committee 18
established pursuant to section 5 of this act and the service 19
staffing committee established pursuant to section 6 of this act to 20
develop a documented staffing plan as required by NRS 449.2421; 21
and 22
(b) Develop a written policy as required by NRS 449.2423. 23
7. The nursing staffing committee of a hospital shall meet at 24
least quarterly. 25
[7. Each hospital that is required to establish a staffing 26
committee pursuant to this section shall prepare a written report 27
concerning the establishment of the staffing committee, the 28
activities and progress of the staffing committee and a determination 29
of the efficacy of the staffing committee. The hospital shall submit 30
the report on or before December 31 of each: 31
(a) Even-numbered year to the Director of the Legislative 32
Counsel Bureau for transmission to the next regular session of the 33
Legislature. 34
(b) Odd-numbered year to the Joint Interim Standing Committee 35
on Health and Human Services.] 36
Sec. 19. NRS 449.2421 is hereby amended to read as follows: 37
449.2421 1. As a condition of licensing, a health care facility 38
located in a county whose population is 100,000 or more and which 39
is licensed to have more than 70 beds shall make available to the 40
Division a written policy adopted pursuant to NRS 449.2423, a 41
documented staffing plan and a written certification that the written 42
policy and the documented staffing plan are adequate to meet the 43
needs of the patients of the health care facility. If the health care 44
facility is a hospital [, the] : 45
– 18 –
- *SB182*
(a) The written policy [and the documented staffing plan] must: 1
[(a)] (1) Be signed by each member of the nursing staffing 2
committee of the hospital established pursuant to NRS 449.242 to 3
indicate that the member has received a copy of the written policy 4
[and the staffing plan] and, if applicable, actively participated in the 5
development of the written policy ; [and the staffing plan;] and 6
[(b)] (2) Include a place where a member of the nursing staffing 7
committee may note any objections to the written policy . [or the 8
staffing plan.] 9
(b) The documented staffing plan must: 10
(1) Be signed by each member of the staffing committees of 11
the hospital established pursuant to NRS 449.242 and sections 5 12
and 6 of this act to indicate that the member has received a copy of 13
the staffing plan and, if applicable, actively participated in the 14
development of the staffing plan; and 15
(2) Include a place where a member of a staffing committee 16
may note any objections to the staffing plan. 17
2. The documented staffing plan must include, without 18
limitation: 19
(a) A detailed written plan setting forth: 20
(1) The number, skill mix and classification of licensed 21
nurses required in each unit in the health care facility, which must 22
[take] : 23
(I) Take into account the experience of the clinical and 24
nonclinical support staff with whom the licensed nurses collaborate, 25
supervise or otherwise delegate assignments; and 26
(II) If the health care facility is a hospital, conform to 27
the maximum ratios prescribed in section 8 of this act; and 28
(2) The number of certified nursing assistants required in 29
each unit in the health care facility [;] , which must conform to the 30
maximum ratios prescribed in section 8 of this act if the health 31
care facility is a hospital; 32
(b) A description of the types of patients who are treated in each 33
unit, including, without limitation, the type of care required by the 34
patients; 35
(c) A description of the activities in each unit, including, without 36
limitation, discharges, transfers and admissions; 37
(d) A description of the size and geography of each unit; 38
(e) A description of any specialized equipment and technology 39
available for each unit; 40
(f) Any foreseeable changes in the size or function of each unit; 41
[and] 42
(g) Protocols for adequately staffing the health care facility: 43
– 19 –
- *SB182*
(1) In the event of an emergency, including, without 1
limitation, mass casualties and a significant change in the acuity or 2
number of patients; 3
(2) If applicable, in circumstances when a significant number 4
of patients are diverted from another facility; and 5
(3) If a licensed nurse or certified nursing assistant is absent 6
or refuses a work assignment pursuant to NRS 449.2423 [.] ; 7
(h) If the health care facility is a hospital, policies to provide 8
additional compensation for licensed nurses who: 9
(1) Are assigned to float between units; 10
(2) Perform duties that involve unusual hazards; or 11
(3) Serve as preceptors; and 12
(i) A plan for maintaining adequate staffing levels for the 13
technical and service staff of the health care facility as necessary 14
for the facility to: 15
(1) Minimize or reduce the potential for any disruption of 16
the physical or technical capabilities of the health care facility, for 17
which the availability of such capabilities are necessary to safely 18
and efficiently provide care to patients; and 19
(2) Ensure the efficient admission of patients and the timely 20
administration of care to patients. 21
3. A documented staffing plan must provide sufficient 22
flexibility to allow for adjustments based upon changes in a unit of 23
the health care facility. 24
4. The health care facility shall ensure that it is staffed in 25
accordance with the documented staffing plan. 26
Sec. 20. NRS 449.2423 is hereby amended to read as follows: 27
449.2423 1. As a condition of licensure, a health care facility 28
which is located in a county whose population is 100,000 or more 29
and which is licensed to have more than 70 beds must adopt and 30
disseminate to each licensed nurse and certified nursing assistant 31
employed by the health care facility a written policy that sets forth 32
the circumstances under which a licensed nurse or certified nursing 33
assistant may refuse or object to a work assignment. 34
2. The written policy concerning work assignments must, at a 35
minimum, allow a licensed nurse or certified nursing assistant to: 36
(a) Refuse a work assignment for any reason for refusal set forth 37
in paragraph (b) of subsection 1 of NRS 449.205; and 38
(b) File an objection to a work assignment if the work 39
assignment violates any provision of NRS 449.241 to 449.2428, 40
inclusive [.] , and sections 2 to 10, inclusive, of this act. 41
3. For the purposes of refusing a work assignment pursuant to 42
paragraph (a) of subsection 2, the written policy concerning work 43
assignments must contain: 44
– 20 –
- *SB182*
(a) Reasonable requirements for prior notice to the supervisor of 1
the licensed nurse or certified nursing assistant of the request by the 2
licensed nurse or certified nursing assistant to be relieved of the 3
work assignment, including, without limitation, the reasons 4
supporting the request; 5
(b) Reasonable requirements which provide, if feasible, an 6
opportunity for the supervisor to review a request by the licensed 7
nurse or certified nursing assistant to be relieved of the work 8
assignment, including any specific conditions supporting the 9
request, and based upon that review: 10
(1) Relieve the licensed nurse or certified nursing assistant of 11
the work assignment as requested; or 12
(2) Deny the request; and 13
(c) A process pursuant to which a licensed nurse or certified 14
nursing assistant may exercise his or her right to refuse a work 15
assignment if the supervisor does not approve the request to be 16
relieved of the work assignment if: 17
(1) The supervisor failed to approve the request without 18
proposing a remedy or, if a remedy is proposed, the proposed 19
remedy would be inadequate or untimely; 20
(2) The process for filing a complaint with the Division or 21
any other appropriate regulatory entity, including any investigation 22
that would be required, would be untimely to address the concerns 23
of the licensed nurse or certified nursing assistant in refusing a work 24
assignment; and 25
(3) The licensed nurse or certified nursing assistant in good 26
faith believes that the work assignment meets the conditions 27
established in the written policy justifying refusal. 28
4. For the purposes of objecting to a work assignment pursuant 29
to paragraph (b) of subsection 2, the written policy concerning work 30
assignments must contain: 31
(a) A process for a licensed nurse or certified nursing assistant 32
to file an objection with the health care facility, but still accept the 33
work assignment despite the objection; and 34
(b) A requirement that the health care facility respond to the 35
objection as soon as practicable, but not later than 45 days after 36
receiving the objection. 37
5. The health care facility shall: 38
(a) Maintain records for at least 2 years of each request to be 39
relieved of a work assignment, each refusal of a work assignment 40
and each objection to a work assignment that is filed with the health 41
care facility pursuant to the written policy adopted pursuant to this 42
section; 43
– 21 –
- *SB182*
(b) If the health care facility has established a nursing staffing 1
committee pursuant to NRS 449.242, provide to the nursing staffing 2
committee: 3
(1) The number of requests to be relieved of a work 4
assignment and refusals of a work assignment made by a licensed 5
nurse or a certified nursing assistant at the health care facility 6
pursuant to this section; 7
(2) The number of objections to a work assignment filed by a 8
licensed nurse or a certified nursing assistant at the health care 9
facility pursuant to this section; and 10
(3) An explanation of how the health care facility addressed 11
the requests, refusals and objections; and 12
(c) Ensure that the health care facility complies with the written 13
policy adopted pursuant to this section. 14
Sec. 21. NRS 449.2425 is hereby amended to read as follows: 15
449.2425 1. The Division shall adopt regulations 16
establishing: 17
(a) A system for rating each health care facility located in a 18
county whose population is 100,000 or more and which is licensed 19
to have more than 70 beds on the compliance by the facility with the 20
provisions of this section and NRS 449.241 to 449.2428, inclusive, 21
and sections 2 to 10, inclusive, of this act, including, without 22
limitation, the number of resolved and unresolved violations and the 23
severity of those violations. The rating system must provide for the 24
assignment of a star rating of not more than five stars and not less 25
than one star to each such facility after: 26
(1) Each inspection conducted by the Division pursuant to 27
NRS 449.132 [;] and 449.2428. 28
(2) Each investigation conducted by the Division pursuant to 29
NRS 449.0307 and 449.2428 concerning a complaint that alleges a 30
violation of the provisions of this section and NRS 449.241 to 31
449.2428, inclusive [.] , and sections 2 to 10, inclusive, of this act. 32
(b) Procedures by which a health care facility located in a 33
county whose population is 100,000 or more and which is licensed 34
to have more than 70 beds may, not later than 30 days after an 35
investigation or inspection, appeal a finding concerning a violation 36
of the provisions of this section and NRS 449.241 to 449.2428, 37
inclusive, and sections 2 to 10, inclusive, of this act or request a 38
follow-up inspection. 39
2. A star rating assigned pursuant to subsection 1 becomes 40
final: 41
(a) Thirty days after the investigation or inspection on which the 42
star rating is based; or 43
– 22 –
- *SB182*
(b) After the completion of any follow-up inspection or the final 1
determination of any appeal pursuant to subsection 1, 2
whichever is later. 3
3. Not later than 5 days after a star rating becomes final 4
pursuant to subsection 2, the Division shall post on an Internet 5
website maintained by the Division a report which must include: 6
(a) The final star rating assigned to the facility pursuant to 7
subsection 1; and 8
(b) A report of each unresolved violation of an applicable statute 9
or regulation and all proposed actions to correct the violation. 10
4. A health care facility located in a county whose population 11
is 100,000 or more and which is licensed to have more than 70 beds 12
shall post the final star rating assigned to the facility pursuant to 13
subsection 1 after the most recent investigation or inspection in a 14
conspicuous place near each entrance to the facility that is regularly 15
used by the public and, if the facility maintains an Internet website 16
that is accessible to the public, on that Internet website. 17
Sec. 22. NRS 449.2428 is hereby amended to read as follows: 18
449.2428 For each health care facility which is located in a 19
county whose population is 100,000 or more and which is licensed 20
to have more than 70 beds, the Division shall: 21
1. Ensure the general compliance of the health care facility 22
with the provisions of NRS 449.241 to 449.2428, inclusive, and 23
sections 2 to 10, inclusive, of this act, including, without limitation, 24
those provisions relating to documented staffing plans and written 25
policies adopted pursuant to NRS 449.2421 and 449.2423 [;] , 26
respectively; and 27
2. Adopt such regulations as are necessary or appropriate to 28
carry out the provisions of this section. The regulations must 29
provide: 30
(a) For unannounced, random visits at a health care facility to 31
determine whether the facility is in compliance with NRS 449.241 32
to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act. 33
(b) An accessible and confidential system pursuant to which 34
the nursing, technical and service staff of a hospital may report 35
the failure of a health care facility to comply with the provisions of 36
NRS 449.241 to 449.2428, inclusive, and sections 2 to 10, 37
inclusive, of this act. 38
(c) Procedures for timely investigating and resolving a report 39
received pursuant to the system described in paragraph (b). The 40
procedures must include, without limitation, a requirement that 41
the Division: 42
(1) Investigate and resolve a report within 7 business days 43
after receiving the report, unless the applicable circumstances of 44
an investigation require additional time; and 45
– 23 –
- *SB182*
(2) Take appropriate disciplinary action pursuant to NRS 1
449.160 or 449.163, as appropriate, against a health care facility 2
that is found to have violated the provisions of NRS 449.241 to 3
449.2428, inclusive, and sections 2 to 10, inclusive, of this act 4
pursuant to an investigation completed pursuant to the procedures 5
described in this paragraph. 6
(d) A systematic means for investigating and correcting 7
violations of any provision of NRS 449.241 to 449.2428, inclusive, 8
and sections 2 to 10, inclusive, of this act. 9
Sec. 23. NRS 618.7312 is hereby amended to read as follows: 10
618.7312 1. A medical facility shall: 11
(a) Establish a committee on workplace safety, which must 12
consist of: 13
(1) If [a] staffing [committee has] committees have been 14
established for the medical facility pursuant to NRS 449.242 and 15
sections 5 and 6 of this act or an applicable collective bargaining 16
agreement: 17
(I) The members of [the] each staffing committee; and 18
(II) Employees of the medical facility who work in areas 19
of the medical facility other than those represented on the staffing 20
[committee,] committees, appointed by the operator of the medical 21
facility. 22
(2) If [a staffing committee has] staffing committees have 23
not been established for the medical facility pursuant to NRS 24
449.242 or sections 5 or 6 of this act or an applicable collective 25
bargaining agreement, employees of the medical facility appointed 26
by the operator of the medical facility. Such employees must 27
include, without limitation, employees who work in all major areas 28
of the medical facility. 29
(b) Develop and maintain a plan for the prevention of and 30
response to workplace violence. The plan must: 31
(1) Be in writing; 32
(2) Be in effect at all times; 33
(3) Be available to be viewed by each employee of the 34
medical facility or other provider of care at the medical facility at all 35
times; 36
(4) Be specific for each unit, area and location maintained by 37
the medical facility; and 38
(5) Be developed in collaboration with the committee on 39
workplace safety established pursuant to paragraph (a). 40
2. The plan developed pursuant to paragraph (b) of subsection 41
1 must include, without limitation: 42
(a) A requirement that all employees of the medical facility and 43
other providers of care at the medical facility receive the training 44
– 24 –
- *SB182*
described in NRS 618.7313 concerning the prevention of workplace 1
violence: 2
(1) Upon the adoption of a new plan for the prevention of 3
workplace violence; 4
(2) Upon commencing employment and annually thereafter; 5
(3) Upon commencing new job duties in a new location of 6
the medical facility or a new assignment in a new location of the 7
medical facility; and 8
(4) When a previously unrecognized hazard is identified or 9
there is a material change in the facility requiring a change to the 10
plan. 11
(b) Procedures that meet the requirements of NRS 618.7314 for 12
responding to and investigating incidents of workplace violence. 13
(c) Procedures that meet the requirements of the regulations 14
adopted pursuant to NRS 618.7317 for assessing and responding to 15
situations that create the potential for workplace violence. 16
(d) Procedures for correcting hazards that increase the risk of 17
workplace violence, including, without limitation, using engineering 18
controls that are feasible and applicable to the medical facility and 19
work practice controls to eliminate or minimize exposure of 20
employees and other providers of care to such hazards. 21
(e) Procedures for obtaining assistance from security guards or 22
public safety agencies when appropriate. 23
(f) Procedures for responding to incidents involving an active 24
shooter and other threats of mass casualties through the use of plans 25
for evacuation and sheltering that are feasible and appropriate for 26
the medical facility. 27
(g) Procedures for annually assessing, in collaboration with the 28
committee on workplace safety established pursuant to paragraph 29
(a) of subsection 1, the effectiveness of the plan. 30
Sec. 24. The provisions of NRS 354.599 do not apply to any 31
additional expenses of a local government that are related to the 32
provisions of this act. 33
Sec. 25. The provisions of subsection 1 of NRS 218D.380 do 34
not apply to any provision of this act which adds or revises a 35
requirement to submit a report to the Legislature. 36
Sec. 26. 1. This section becomes effective upon passage and 37
approval. 38
2. Sections 1 to 25, inclusive, of this act become effective: 39
(a) Upon passage and approval for the purpose of adopting any 40
regulations and performing any other preparatory administrative 41
tasks that are necessary to carry out the provisions of this act; and 42
(b) On October 1, 2025, for all other purposes. 43
H