EXEMPT
(Reprinted with amendments adopted on April 21, 2025)
FIRST REPRINT S.B. 182
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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
hospitals to report certain information relating to staffing;
prohibiting certain health care facilities from taking
certain retaliatory actions; providing for certain actions to
investigate and correct certain violations relating to
staffing; providing administrative penalties; and providing
other matters properly relating thereto.
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
bill make conforming changes to refer to existing staffing committees for nurses as 14
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“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 certain other 35
staffing requirements for certain hospitals in a county whose population is 100,000 36
or more (currently Clark and Washoe Counties), including maximum ratios for the 37
number of patients that may be assigned to a certified nursing assistant, in any unit, 38
at one time. Section 19 requires the documented staffing plan of a hospital to 39
provide for staffing in accordance with the maximum ratios of patients to direct 40
care nurses established by section 8. Section 19 also requires such a documented 41
staffing plan to provide for additional compensation for nurses who perform certain 42
duties. Section 9 of this bill requires a hospital to maintain certain records 43
containing information relevant for measuring the compliance of the hospital with 44
the nurse-to-patient ratios established by section 8. 45
Section 9.5 of this bill authorizes hospitals which are required to establish a 46
nursing staffing committee and adhere to the maximum ratios prescribed in section 47
8 to deviate from those maximum ratios and the documented staffing plan of the 48
hospital during a state of emergency. Section 9.5 establishes certain procedures that 49
must be followed by the hospital and the nursing staffing committee upon such a 50
deviation. 51
Sections 12 and 13 of this bill authorize the Division of Public and Behavioral 52
Health of the Department of Health and Human Services to discipline a health care 53
facility that fails to comply with the requirements of this bill in the same manner as 54
violations of other requirements governing health care facilities. Section 22 of this 55
bill requires the Division to establish: (1) procedures for random visits to health 56
care facilities to ensure compliance with the requirements of this bill, where 57
applicable, and certain other requirements governing the staffing of health care 58
facilities; (2) an accessible and confidential system that allows certain staff of a 59
health care facility to report a violation of those requirements; and (3) procedures 60
for timely investigating and resolving such a report. Section 10 of this bill 61
additionally authorizes the Labor Commissioner to take certain actions to ensure 62
that a health care facility complies with the requirements of this bill, where 63
applicable, and certain other requirements relating to the staffing of health care 64
facilities. Section 15 of this bill prohibits a health care facility from retaliating 65
against an employee of the facility for reporting a violation to the Division or the 66
Labor Commissioner. 67
Existing law requires the establishment of a system for rating certain health 68
care facilities located in a county whose population is 100,000 or more on their 69
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compliance with requirements governing staffing. (NRS 449.2425) Section 21 of 70
this bill requires the Division to assign a new rating to a facility after an inspection 71
or investigation conducted pursuant to section 22. 72
Sections 2-4 of this bill define certain terms relating to the staffing of health 73
care facilities, and section 17 of this bill establishes the applicability of those 74
definitions. Sections 11 and 16 of this bill make conforming changes relating to the 75
applicability and enforcement of sections 2-10. 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 registered nurse who is 4
assigned the principal responsibility to oversee or carry out 5
medical regimens or nursing care, in person and in a hands-on 6
capacity, for one or more patients. 7
Sec. 3. “Service staff” means the staff of a health care 8
facility who: 9
1. Interact directly with patients or with other staff; 10
2. Do not provide medical care or related services to patients; 11
and 12
3. Are not a part of the technical staff of the health care 13
facility. 14
Sec. 4. “Technical staff” means the staff of a health care 15
facility whose primary job duties relate to servicing medical 16
equipment and machinery, providing information technology 17
support services or performing other duties which involve 18
technical skills and which are not related to the direct provision of 19
medical care to patients. 20
Sec. 5. 1. Except as otherwise provided in subsection 4, 21
each hospital located in a county whose population is 100,000 or 22
more and which is licensed to have more than 70 beds shall 23
establish a technical staffing committee. Each technical staffing 24
committee established pursuant to this subsection must consist of: 25
(a) Not less than one-half of the total members of the technical 26
staffing committee from the technical staff of the hospital. The 27
members described in this paragraph must consist of one member 28
representing each division of the technical staff of the hospital, 29
elected by the members of the technical staff within that division. 30
(b) Not less than one-half of the total members of the technical 31
staffing committee from the managers of the technical staff of the 32
hospital, appointed by the administration of the hospital. 33
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(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
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(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
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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; 12
(2) Critical care unit; 13
(3) Intensive care unit; 14
(4) Postanesthesia unit; or 15
(5) Unit where a patient receives conscious sedation, as 16
defined in NRS 449.436. 17
(b) In each emergency unit: 18
(1) A ratio of one direct care nurse for each trauma or 19
critical care patient; and 20
(2) A ratio of one direct care nurse for every three patients 21
not described in subparagraph (1). 22
(c) In each labor and delivery, antepartum, postpartum, 23
mother-baby or nursery unit, other than a nursery for well babies, 24
a ratio of: 25
(1) One direct care nurse for each patient who is: 26
(I) In active labor; or 27
(II) In any stage of labor and is experiencing 28
complications relating to the pregnancy; 29
(2) One direct care nurse for every two antepartum patients 30
requiring continuous antepartum fetal monitoring; 31
(3) One direct care nurse for every three antepartum 32
patients not described in subparagraph (1) or (2); 33
(4) During the birth of a child: 34
(I) One direct care nurse for each patient who is in 35
labor; and 36
(II) One additional direct care nurse for each newborn 37
child, whose sole responsibility is to care for the particular 38
newborn child; 39
(5) During the 2-hour period immediately following birth: 40
(I) One direct care nurse for the postpartum patient and 41
newborn child; and 42
(II) If the birth resulted in multiple children, one direct 43
care nurse for each additional newborn child birthed by the 44
postpartum patient; 45
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(6) During any period more than 2 hours after the birth of 1
a child: 2
(I) Except as otherwise provided in subparagraph (7), 3
one direct care nurse for every two postpartum patients and their 4
newborn children; and 5
(II) If a newborn child is in an unstable condition, as 6
determined by a direct care nurse, one direct care nurse for each 7
such newborn child; 8
(7) One direct care nurse for every four postpartum patients 9
or postoperative gynecological care patients, if each such direct 10
care nurse is assigned to care for any postpartum patients or 11
postoperative gynecological care patients, as applicable; and 12
(8) One direct care nurse for every two newborn children 13
receiving intermediate care. 14
(d) A ratio of one direct care nurse for every three patients in 15
each: 16
(1) Cardiac telemetry unit; 17
(2) Intermediate care unit; 18
(3) Pediatric unit; or 19
(4) Observational unit. 20
(e) A ratio of one direct care nurse for every four patients in 21
each: 22
(1) Ambulatory care unit; 23
(2) Oncology unit; 24
(3) Acute rehabilitation unit; 25
(4) Medical-surgical unit; 26
(5) Pre-surgical unit; 27
(6) Psychiatric unit; or 28
(7) Unit, including, without limitation, a specialty or 29
subspecialty unit, not otherwise listed in this subsection. 30
(f) A ratio of one direct care nurse for every six patients in 31
each nursery for well babies. 32
2. A hospital located in a county whose population is 100,000 33
or more and which is licensed to have more than 70 beds and 34
which has an emergency unit shall assign at least one direct care 35
nurse to the emergency unit to triage patients who present to the 36
emergency unit. A hospital shall not include a nurse assigned to 37
triage patients in the calculation of any ratio for the purposes of 38
subsection 1. 39
3. A hospital located in a county whose population is 100,000 40
or more and which is licensed to have more than 70 beds shall not 41
include a registered nurse who does not have the principal 42
responsibility for caring for a patient, including, without 43
limitation, a nurse administrator or supervisor, in the calculation 44
of any ratio for the purposes of subsection 1. 45
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4. A hospital located in a county whose population is 100,000 1
or more and which is licensed to have more than 70 beds shall 2
adjust its staff as necessary to reflect the need for additional direct 3
care nurses to ensure that each unit within the hospital is 4
adequately staffed in accordance with the requirements of 5
subsection 1, including, without limitation, when a direct care 6
nurse takes a meal or rest break. 7
5. A hospital located in a county whose population is 100,000 8
or more and which is licensed to have more than 70 beds that 9
includes certified nursing assistants in the nursing staff of the 10
hospital shall include in its documented staffing plan the 11
following ratios for the maximum number of patients that may be 12
assigned to a certified nursing assistant: 13
(a) During the hours of 6 a.m. until 8 p.m., a ratio of one 14
certified nursing assistant for every seven patients in any unit. 15
(b) During the hours of 8:01 p.m., until 5:59 a.m., a ratio of 16
one certified nursing assistant for every 11 patients in any unit. 17
6. A hospital located in a county whose population is 100,000 18
or more and which is licensed to have more than 70 beds shall not 19
include a certified nursing assistant who does not have the 20
principal responsibility for caring for a patient in the calculation 21
of any ratio for the purposes of subsection 5. 22
7. In addition to any ratio established pursuant to subsections 23
1 or 5, a hospital located in a county whose population is 100,000 24
or more and which is licensed to have more than 70 beds shall 25
assign: 26
(a) At least one scrub assistant to an operating room for each 27
patient in the operating room. 28
(b) At least one patient care technician, nurse apprentice, 29
patient sitter or other person responsible for the direct observation 30
and safety of patients for every two patients in any unit of the 31
hospital. 32
8. A hospital located in a county whose population is 100,000 33
or more and which is licensed to have more than 70 beds may only 34
assign a registered nurse to a unit or a clinical area and include 35
the registered nurse in the count of assigned nursing staff for the 36
purposes of compliance with subsection 1 if: 37
(a) The registered nurse is appropriately licensed for 38
assignment to that unit or clinical area; 39
(b) The hospital has provided orientation to the registered 40
nurse before assigning that registered nurse to that unit or clinical 41
area; and 42
(c) The hospital has verified that the registered nurse is 43
capable of providing competent nursing care to the patients in that 44
unit or clinical area. 45
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9. The provisions of this section: 1
(a) Do not apply to a psychiatric hospital operated by the 2
Division. 3
(b) Do not apply under the circumstances when a hospital is 4
authorized by the provisions of section 9.5 of this act to deviate 5
from the maximum ratios established by this section. 6
(c) Shall not be construed to prohibit a collective bargaining 7
agreement or documented staffing plan required pursuant to NRS 8
449.2421 from requiring ratios which are more restrictive than 9
those required by this section. 10
10. As used in this section: 11
(a) “Intensive care unit” means a unit that provides care to 12
critically ill patients who require advanced treatments such as 13
mechanical ventilation, vasoactive infusions, continuous renal 14
replacement treatment or frequent assessment or monitoring, 15
including, without limitation, any coronary, acute respiratory, 16
burn, pediatric or neonatal intensive care unit. 17
(b) “Intermediate care unit” means a unit that provides 18
progressive care, intensive specialty care or step-down care. 19
(c) “Progressive care” means care provided to patients who 20
need more monitoring and assessment than patients on a general 21
unit but whose conditions are not so unstable that care in an 22
intensive care unit is required. 23
(d) “Step-down care” means care for patients transitioning out 24
of the intensive care unit who require more care and attention 25
than patients on a general unit. 26
Sec. 9. 1. As a condition for licensure, each hospital 27
located in a county whose population is 100,000 or more and 28
which is licensed to have more than 70 beds shall maintain 29
accurate daily records showing for each unit: 30
(a) The number of patients admitted, released and present in 31
the unit; 32
(b) The identity and duty hours of each direct care nurse in the 33
unit; 34
(c) The identity and duty hours of each certified nursing 35
assistant and licensed practical nurse in the unit; and 36
(d) Any meal or rest break missed by each direct care nurse in 37
the unit. 38
2. As a condition for licensure, each hospital located in a 39
county whose population is 100,000 or more and which is licensed 40
to have more than 70 beds shall maintain daily statistics, by unit, 41
of mortality, morbidity, infection, accident, injury and medical 42
errors. 43
3. A hospital located in a county whose population is 100,000 44
or more and which is licensed to have more than 70 beds shall: 45
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(a) Maintain all records required to be maintained by this 1
section, for at least 7 years after the date on which the record was 2
created; and 3
(b) Make all records required to be maintained by this section 4
available for inspection upon the request of the Division or the 5
Labor Commissioner. 6
Sec. 9.5. 1. A hospital located in a county whose population 7
is 100,000 or more and which is licensed to have more than 70 8
beds may deviate from a documented staffing plan developed 9
pursuant to NRS 449.2421 or the maximum ratios prescribed in 10
section 8 of this act during the existence of a state of emergency. 11
2. If a hospital deviates from a documented staffing plan 12
developed pursuant to NRS 449.2421 or the maximum ratios 13
prescribed in section 8 of this act pursuant to subsection 1, the 14
hospital shall, not later than 30 days after the deviation, report to 15
the co-chairs of the nursing staffing committee established by the 16
hospital pursuant to NRS 449.242 or, if the committee has not 17
elected co-chairs, report to two persons appointed by the 18
committee to serve as liaisons during the state of emergency. The 19
report must contain an assessment of the needs of the hospital 20
with respect to the staffing of nurses arising from the emergency. 21
3. If the state of emergency requires the hospital to continue 22
to deviate from the documented staffing plan developed pursuant 23
to NRS 449.2421 or the maximum ratios prescribed in section 8 of 24
this act when the nursing staffing committee receives the report 25
described in subsection 2, the nursing staffing committee shall 26
develop a contingency documented staffing plan for the staffing or 27
nurses that addresses the needs identified in the report. The 28
contingency documented staffing plan developed pursuant to this 29
subsection must include standards of care for crises which may 30
arise from the state of emergency. 31
4. A hospital may not continue to deviate from the 32
documented staffing plan developed pursuant to NRS 449.2421 or 33
the maximum ratios prescribed in section 8 of this act for more 34
than 90 days, unless the hospital first receives the approval of the 35
nursing staffing committee. 36
5. As used in this section, “state of emergency” means: 37
(a) A state of emergency or declaration of disaster pursuant to 38
NRS 414.070; 39
(b) A public health emergency or other event pursuant to 40
NRS 439.970; 41
(c) A state of emergency declared by an agency of the Federal 42
Government; or 43
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(d) An event similar to the events described in paragraph (a), 1
(b) and (c) which requires a hospital to utilize standards of care 2
for crisis situations. 3
Sec. 10. 1. The Labor Commissioner shall collaborate with 4
the Division to ensure compliance with the provisions of NRS 5
449.242 to 449.2428, inclusive, and sections 2 to 10, inclusive, of 6
this act. The Labor Commissioner may: 7
(a) Inspect a health care facility to assess compliance with 8
NRS 449.242 to 449.2428, inclusive, and sections 2 to 10, 9
inclusive, of this act; 10
(b) Accept reports of alleged violations of NRS 449.242 to 11
449.2428, inclusive, and sections 2 to 10, inclusive, of this act; 12
(c) Investigate an alleged violation of NRS 449.242 to 13
449.2428, inclusive, and sections 2 to 10, inclusive, of this act or 14
assist the Division with such an investigation; and 15
(d) Report a violation of NRS 449.242 to 449.2428, inclusive, 16
and sections 2 to 10, inclusive, of this act to the Division. 17
2. Upon receiving from the Labor Commissioner pursuant to 18
paragraph (d) of subsection 1 a report that a health care facility 19
has violated NRS 449.242 to 449.2428, inclusive, and sections 2 to 20
10, inclusive, of this act, the Division shall initiate disciplinary 21
proceedings against the health care facility. 22
Sec. 11. NRS 449.0301 is hereby amended to read as follows: 23
449.0301 The provisions of NRS 449.029 to 449.2428, 24
inclusive, and sections 2 to 10, inclusive, of this act, do not apply 25
to: 26
1. Any facility conducted by and for the adherents of any 27
church or religious denomination for the purpose of providing 28
facilities for the care and treatment of the sick who depend solely 29
upon spiritual means through prayer for healing in the practice of 30
the religion of the church or denomination, except that such a 31
facility shall comply with all regulations relative to sanitation and 32
safety applicable to other facilities of a similar category. 33
2. Foster homes as defined in NRS 424.014. 34
3. Any medical facility, facility for the dependent or facility 35
which is otherwise required by the regulations adopted by the Board 36
pursuant to NRS 449.0303 to be licensed that is operated and 37
maintained by the United States Government or an agency thereof. 38
Sec. 12. NRS 449.160 is hereby amended to read as follows: 39
449.160 1. The Division may deny an application for a 40
license or may suspend or revoke any license issued under the 41
provisions of NRS 449.029 to 449.2428, inclusive, and sections 2 to 42
10, inclusive, of this act upon any of the following grounds: 43
(a) Violation by the applicant or the licensee of any of the 44
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 45
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sections 2 to 10, inclusive, of this act, or 449A.100 to 449A.124, 1
inclusive, and 449A.270 to 449A.286, inclusive, or of any other law 2
of this State or of the standards, rules and regulations adopted 3
thereunder. 4
(b) Aiding, abetting or permitting the commission of any illegal 5
act. 6
(c) Conduct inimical to the public health, morals, welfare and 7
safety of the people of the State of Nevada in the maintenance and 8
operation of the premises for which a license is issued. 9
(d) Conduct or practice detrimental to the health or safety of the 10
occupants or employees of the facility. 11
(e) Failure of the applicant to obtain written approval from the 12
Director of the Department of Health and Human Services as 13
required by NRS 439A.100 or 439A.102 or as provided in any 14
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 15
and sections 2 to 10, inclusive, of this act, and 449.435 to 449.531, 16
inclusive, and chapter 449A of NRS if such approval is required, 17
including, without limitation, the closure or conversion of any 18
hospital in a county whose population is 100,000 or more that is 19
owned by the licensee without approval pursuant to NRS 439A.102. 20
(f) Failure to comply with the provisions of NRS 441A.315 and 21
any regulations adopted pursuant thereto or NRS 449.2486. 22
(g) Violation of the provisions of NRS 458.112. 23
(h) Failure to comply with the provisions of NRS 449A.170 to 24
449A.192, inclusive, and any regulation adopted pursuant thereto. 25
(i) Violation of the provisions of NRS 629.260. 26
2. In addition to the provisions of subsection 1, the Division 27
may revoke a license to operate a facility for the dependent if, with 28
respect to that facility, the licensee that operates the facility, or an 29
agent or employee of the licensee: 30
(a) Is convicted of violating any of the provisions of 31
NRS 202.470; 32
(b) Is ordered to but fails to abate a nuisance pursuant to NRS 33
244.360, 244.3603 or 268.4124; or 34
(c) Is ordered by the appropriate governmental agency to correct 35
a violation of a building, safety or health code or regulation but fails 36
to correct the violation. 37
3. The Division shall maintain a log of any complaints that it 38
receives relating to activities for which the Division may revoke the 39
license to operate a facility for the dependent pursuant to subsection 40
2. The Division shall provide to a facility for the care of adults 41
during the day: 42
(a) A summary of a complaint against the facility if the 43
investigation of the complaint by the Division either substantiates 44
the complaint or is inconclusive; 45
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(b) A report of any investigation conducted with respect to the 1
complaint; and 2
(c) A report of any disciplinary action taken against the facility. 3
The facility shall make the information available to the public 4
pursuant to NRS 449.2486. 5
4. On or before February 1 of each odd-numbered year, the 6
Division shall submit to the Director of the Legislative Counsel 7
Bureau a written report setting forth, for the previous biennium: 8
(a) Any complaints included in the log maintained by the 9
Division pursuant to subsection 3; and 10
(b) Any disciplinary actions taken by the Division pursuant to 11
subsection 2. 12
Sec. 13. NRS 449.163 is hereby amended to read as follows: 13
449.163 1. In addition to the payment of the amount required 14
by NRS 449.0308, if a medical facility, facility for the dependent or 15
facility which is required by the regulations adopted by the Board 16
pursuant to NRS 449.0303 to be licensed violates any provision 17
related to its licensure, including any provision of NRS 439B.410 or 18
449.029 to 449.2428, inclusive, and sections 2 to 10, inclusive, of 19
this act, or any condition, standard or regulation adopted by the 20
Board, the Division, in accordance with the regulations adopted 21
pursuant to NRS 449.165, may: 22
(a) Prohibit the facility from admitting any patient until it 23
determines that the facility has corrected the violation; 24
(b) Limit the occupancy of the facility to the number of beds 25
occupied when the violation occurred, until it determines that the 26
facility has corrected the violation; 27
(c) If the license of the facility limits the occupancy of the 28
facility and the facility has exceeded the approved occupancy, 29
require the facility, at its own expense, to move patients to another 30
facility that is licensed; 31
(d) Except where a greater penalty is authorized by subsection 2, 32
impose an administrative penalty of not more than $5,000 per day 33
for each violation, together with interest thereon at a rate not to 34
exceed 10 percent per annum; and 35
(e) Appoint temporary management to oversee the operation of 36
the facility and to ensure the health and safety of the patients of the 37
facility, until: 38
(1) It determines that the facility has corrected the violation 39
and has management which is capable of ensuring continued 40
compliance with the applicable statutes, conditions, standards and 41
regulations; or 42
(2) Improvements are made to correct the violation. 43
2. If an off-campus location of a hospital fails to obtain a 44
national provider identifier that is distinct from the national provider 45
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identifier used by the main campus and any other off-campus 1
location of the hospital in violation of NRS 449.1818, the Division 2
may impose against the hospital an administrative penalty of not 3
more than $10,000 for each day of such failure, together with 4
interest thereon at a rate not to exceed 10 percent per annum, in 5
addition to any other action authorized by this chapter. 6
3. If the facility fails to pay any administrative penalty imposed 7
pursuant to paragraph (d) of subsection 1 or subsection 2, the 8
Division may: 9
(a) Suspend the license of the facility until the administrative 10
penalty is paid; and 11
(b) Collect court costs, reasonable attorney’s fees and other 12
costs incurred to collect the administrative penalty. 13
4. The Division may require any facility that violates any 14
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 15
sections 2 to 10, inclusive, of this act or any condition, standard or 16
regulation adopted by the Board to make any improvements 17
necessary to correct the violation. 18
5. Any money collected as administrative penalties pursuant to 19
paragraph (d) of subsection 1 or subsection 2 must be accounted for 20
separately and used to administer and carry out the provisions of 21
NRS 449.001 to 449.430, inclusive, and sections 2 to 10, inclusive, 22
of this act, 449.435 to 449.531, inclusive, and chapter 449A of NRS 23
to protect the health, safety, well-being and property of the patients 24
and residents of facilities in accordance with applicable state and 25
federal standards or for any other purpose authorized by the 26
Legislature. 27
Sec. 14. (Deleted by amendment.) 28
Sec. 15. NRS 449.205 is hereby amended to read as follows: 29
449.205 1. A medical facility or any agent or employee 30
thereof shall not retaliate or discriminate unfairly against: 31
(a) An employee of the medical facility or a person acting on 32
behalf of the employee who in good faith: 33
(1) Reports to the Board of Medical Examiners or the State 34
Board of Osteopathic Medicine, as applicable, information relating 35
to the conduct of a physician which may constitute grounds for 36
initiating disciplinary action against the physician or which 37
otherwise raises a reasonable question regarding the competence of 38
the physician to practice medicine with reasonable skill and safety 39
to patients; 40
(2) Reports a sentinel event to the Division pursuant to NRS 41
439.835; [or] 42
(3) Cooperates or otherwise participates in an investigation 43
or proceeding conducted by the Board of Medical Examiners, the 44
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State Board of Osteopathic Medicine or another governmental entity 1
relating to conduct described in subparagraph (1) or (2); or 2
(4) Reports to the Division or the Labor Commissioner any 3
information concerning a potential or actual violation of the 4
provisions of NRS 449.242 to 449.2428, inclusive, and sections 2 5
to 10, inclusive, of this act; 6
(b) A registered nurse, licensed practical nurse, nursing assistant 7
or medication aide - certified who is employed by or contracts to 8
provide nursing services for the medical facility and who: 9
(1) In accordance with the policy, if any, established by the 10
medical facility: 11
(I) Reports to his or her immediate supervisor, in writing, 12
that he or she does not possess the knowledge, skill or experience to 13
comply with an assignment to provide nursing services to a patient; 14
and 15
(II) Refuses to provide to a patient nursing services for 16
which, as verified by documentation in the personnel file of the 17
registered nurse, licensed practical nurse, nursing assistant or 18
medication aide - certified concerning his or her competence to 19
provide various nursing services, he or she does not possess the 20
knowledge, skill or experience to comply with the assignment to 21
provide nursing services to the patient, unless the refusal constitutes 22
unprofessional conduct as set forth in chapter 632 of NRS or any 23
regulations adopted pursuant thereto; 24
(2) In accordance with a policy adopted pursuant to NRS 25
449.2423, requests to be relieved of, refuses or objects to a work 26
assignment; 27
(3) In good faith, reports to the medical facility, the Board of 28
Medical Examiners, the State Board of Osteopathic Medicine, the 29
State Board of Nursing, the Legislature or any committee thereof or 30
any other governmental entity: 31
(I) Any information concerning the willful conduct of 32
another registered nurse, licensed practical nurse, nursing assistant 33
or medication aide - certified which violates any provision of 34
chapter 632 of NRS or which is required to be reported to the State 35
Board of Nursing; 36
(II) Any concerns regarding patients who may be exposed 37
to a substantial risk of harm as a result of the failure of the medical 38
facility or any agent or employee thereof to comply with minimum 39
professional or accreditation standards or applicable statutory or 40
regulatory requirements; or 41
(III) Any other concerns regarding the medical facility, 42
the agents and employees thereof or any situation that reasonably 43
could result in harm to patients; or 44
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(4) Refuses to engage in conduct that would violate the duty 1
of the registered nurse, licensed practical nurse, nursing assistant or 2
medication aide - certified to protect patients from actual or 3
potential harm, conduct which would violate any provision of 4
chapter 632 of NRS or conduct which would subject the registered 5
nurse, licensed practical nurse, nursing assistant or medication aide - 6
certified to disciplinary action by the State Board of Nursing; or 7
(c) An employee or other provider of care who takes an action 8
described in subsection 3 of NRS 618.7315. 9
2. A medical facility or any agent or employee thereof shall not 10
retaliate or discriminate unfairly against an employee of the medical 11
facility or a registered nurse, licensed practical nurse, nursing 12
assistant or medication aide - certified who is employed by or 13
contracts to provide nursing services for the medical facility because 14
the employee, registered nurse, licensed practical nurse, nursing 15
assistant or medication aide - certified has taken an action described 16
in subsection 1. 17
3. A medical facility or any agent or employee thereof shall not 18
prohibit, restrict or attempt to prohibit or restrict by contract, policy, 19
procedure or any other manner the right of an employee of the 20
medical facility or a registered nurse, licensed practical nurse, 21
nursing assistant or medication aide - certified who is employed by 22
or contracts to provide nursing services for the medical facility to 23
take an action described in subsection 1. 24
4. As used in this section: 25
(a) “Good faith” means honesty in fact in the reporting of the 26
information or in the cooperation in the investigation concerned. 27
(b) “Physician” means a person licensed to practice medicine 28
pursuant to chapter 630 or 633 of NRS. 29
(c) “Retaliate or discriminate”: 30
(1) Includes, without limitation, any of the following actions 31
if taken solely because the employee, registered nurse, licensed 32
practical nurse, nursing assistant or medication aide - certified took 33
an action described in subsection 1: 34
(I) Frequent or undesirable changes in the location where 35
the person works; 36
(II) Frequent or undesirable transfers or reassignments; 37
(III) The issuance of letters of reprimand, letters of 38
admonition or evaluations of poor performance; 39
(IV) A demotion; 40
(V) A reduction in pay; 41
(VI) The denial of a promotion; 42
(VII) A suspension; 43
(VIII) A dismissal; 44
(IX) A transfer; or 45
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(X) Frequent changes in working hours or workdays. 1
(2) Does not include an action described in sub-2
subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action 3
is taken in the normal course of employment or as a form of 4
discipline. 5
Sec. 16. NRS 449.240 is hereby amended to read as follows: 6
449.240 The district attorney of the county in which the facility 7
is located shall, upon application by the Division, institute and 8
conduct the prosecution of any action for violation of any provisions 9
of NRS 449.029 to 449.245, inclusive [.] and sections 2 to 10, 10
inclusive, of this act. 11
Sec. 17. NRS 449.241 is hereby amended to read as follows: 12
449.241 As used in NRS 449.241 to 449.2428, inclusive, and 13
sections 2 to 10, inclusive, of this act, unless the context otherwise 14
requires, the words and terms defined in NRS 449.2413 to 15
449.2418, inclusive, and sections 2, 3 and 4 of this act have the 16
meanings ascribed to them in those sections. 17
Sec. 18. NRS 449.242 is hereby amended to read as follows: 18
449.242 1. Except as otherwise provided in subsection 4, 19
each hospital located in a county whose population is 100,000 or 20
more and which is licensed to have more than 70 beds shall 21
establish a nursing staffing committee . [to develop a written policy 22
as required pursuant to NRS 449.2423 and a documented staffing 23
plan as required pursuant to NRS 449.2421.] Each nursing staffing 24
committee established pursuant to this subsection must consist of: 25
(a) Not less than one-half of the total regular members of the 26
nursing staffing committee from the licensed nursing staff and 27
certified nursing assistants who are providing direct patient care at 28
the hospital. The members described in this paragraph must consist 29
of: 30
(1) One member representing each unit of the hospital who is 31
a licensed nurse who provides direct patient care on that unit, 32
elected by the licensed nursing staff who provide direct patient care 33
on the unit that the member will represent. 34
(2) One member representing each unit of the hospital who is 35
a certified nursing assistant who provides direct patient care on that 36
unit, elected by the certified nursing assistants who provide direct 37
patient care on the unit that the member will represent. 38
(b) Not less than one-half of the total regular members of the 39
nursing staffing committee appointed by the administration of the 40
hospital. 41
(c) One alternate member representing each unit of the hospital 42
who is a licensed nurse or certified nursing assistant who provides 43
direct patient care on that unit, elected by the licensed nursing staff 44
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and certified nursing assistants who provide direct patient care on 1
the unit that the member represents. 2
2. Each time a new nursing staffing committee is formed 3
pursuant to subsection 1, the administration of the hospital shall 4
hold an election to select the members described in paragraphs (a) 5
and (c) of subsection 1. Each licensed nurse and certified staffing 6
assistant who provides direct patient care at the hospital must be 7
allowed at least 3 days to vote for: 8
(a) The regular member described in paragraph (a) of subsection 9
1 who will represent his or her unit and profession; and 10
(b) The alternate member described in paragraph (c) of 11
subsection 1 who will represent his or her unit. 12
3. If a vacancy occurs in a position on a nursing staffing 13
committee described in paragraph (a) or (c) of subsection 1, a new 14
regular or alternate member, as applicable, must be elected in the 15
same manner as his or her predecessor. 16
4. If a nursing staffing committee is established for a health 17
care facility described in subsection 1 through collective bargaining 18
with an employee organization representing the licensed nursing 19
staff and certified nursing assistants of the health care facility: 20
(a) The health care facility is not required to form a nursing 21
staffing committee pursuant to that subsection; and 22
(b) The nursing staffing committee established pursuant to the 23
collective bargaining agreement shall be deemed to be the nursing 24
staffing committee established for the health care facility pursuant to 25
subsection 1. 26
5. In developing the written policy and the staffing plan [,] as 27
described in subsection 6, the nursing staffing committee shall 28
consider, without limitation, the information received pursuant to 29
paragraph (b) of subsection 5 of NRS 449.2423 regarding requests 30
to be relieved of a work assignment, refusals of a work assignment 31
and objections to a work assignment. 32
6. The nursing staffing committee shall: 33
(a) Collaborate with the technical staffing committee 34
established pursuant to section 5 of this act and the service 35
staffing committee established pursuant to section 6 of this act to 36
develop a documented staffing plan as required by NRS 449.2421; 37
and 38
(b) Develop a written policy as required by NRS 449.2423. 39
7. The nursing staffing committee of a hospital shall meet at 40
least quarterly. 41
[7. Each hospital that is required to establish a staffing 42
committee pursuant to this section shall prepare a written report 43
concerning the establishment of the staffing committee, the 44
activities and progress of the staffing committee and a determination 45
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of the efficacy of the staffing committee. The hospital shall submit 1
the report on or before December 31 of each: 2
(a) Even-numbered year to the Director of the Legislative 3
Counsel Bureau for transmission to the next regular session of the 4
Legislature. 5
(b) Odd-numbered year to the Joint Interim Standing Committee 6
on Health and Human Services.] 7
Sec. 19. NRS 449.2421 is hereby amended to read as follows: 8
449.2421 1. As a condition of licensing, a health care facility 9
located in a county whose population is 100,000 or more and which 10
is licensed to have more than 70 beds shall make available to the 11
Division a written policy adopted pursuant to NRS 449.2423, a 12
documented staffing plan and a written certification that the written 13
policy and the documented staffing plan are adequate to meet the 14
needs of the patients of the health care facility. If the health care 15
facility is a hospital [, the] : 16
(a) The written policy [and the documented staffing plan] must: 17
[(a)] (1) Be signed by each member of the nursing staffing 18
committee of the hospital established pursuant to NRS 449.242 to 19
indicate that the member has received a copy of the written policy 20
[and the staffing plan] and, if applicable, actively participated in the 21
development of the written policy ; [and the staffing plan;] and 22
[(b)] (2) Include a place where a member of the nursing staffing 23
committee may note any objections to the written policy . [or the 24
staffing plan.] 25
(b) The documented staffing plan must: 26
(1) Be signed by each member of the staffing committees of 27
the hospital established pursuant to NRS 449.242 and sections 5 28
and 6 of this act to indicate that the member has received a copy of 29
the staffing plan and, if applicable, actively participated in the 30
development of the staffing plan; and 31
(2) Include a place where a member of a staffing committee 32
may note any objections to the staffing plan. 33
2. The documented staffing plan must include, without 34
limitation: 35
(a) A detailed written plan setting forth: 36
(1) The number, skill mix and classification of licensed 37
nurses required in each unit in the health care facility, which must 38
[take] : 39
(I) Take into account the experience of the clinical and 40
nonclinical support staff with whom the licensed nurses collaborate, 41
supervise or otherwise delegate assignments; and 42
(II) If the health care facility is a hospital, conform to 43
the maximum ratios prescribed in section 8 of this act; and 44
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- *SB182_R1*
(2) The number of certified nursing assistants required in 1
each unit in the health care facility [;] , which must conform to the 2
maximum ratios prescribed in section 8 of this act if the health 3
care facility is a hospital; 4
(b) A description of the types of patients who are treated in each 5
unit, including, without limitation, the type of care required by the 6
patients; 7
(c) A description of the activities in each unit, including, without 8
limitation, discharges, transfers and admissions; 9
(d) A description of the size and geography of each unit; 10
(e) A description of any specialized equipment and technology 11
available for each unit; 12
(f) Any foreseeable changes in the size or function of each unit; 13
[and] 14
(g) Protocols for adequately staffing the health care facility: 15
(1) In the event of an emergency, including, without 16
limitation, mass casualties and a significant change in the acuity or 17
number of patients; 18
(2) If applicable, in circumstances when a significant number 19
of patients are diverted from another facility; and 20
(3) If a licensed nurse or certified nursing assistant is absent 21
or refuses a work assignment pursuant to NRS 449.2423 [.] ; 22
(h) If the health care facility is a hospital, policies to provide 23
additional compensation for licensed nurses who: 24
(1) Are assigned to float between units; 25
(2) Perform duties that involve unusual hazards; or 26
(3) Serve as preceptors; and 27
(i) A plan for maintaining adequate staffing levels for the 28
technical and service staff of the health care facility as necessary 29
for the facility to: 30
(1) Minimize or reduce the potential for any disruption of 31
the physical or technical capabilities of the health care facility, for 32
which the availability of such capabilities are necessary to safely 33
and efficiently provide care to patients; and 34
(2) Ensure the efficient admission of patients and the timely 35
administration of care to patients. 36
3. A documented staffing plan must provide sufficient 37
flexibility to allow for adjustments based upon changes in a unit of 38
the health care facility. 39
4. [The] Except as otherwise provided in section 9.5 of this 40
act, the health care facility shall ensure that it is staffed in 41
accordance with the documented staffing plan. 42
Sec. 20. NRS 449.2423 is hereby amended to read as follows: 43
449.2423 1. As a condition of licensure, a health care facility 44
which is located in a county whose population is 100,000 or more 45
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and which is licensed to have more than 70 beds must adopt and 1
disseminate to each licensed nurse and certified nursing assistant 2
employed by the health care facility a written policy that sets forth 3
the circumstances under which a licensed nurse or certified nursing 4
assistant may refuse or object to a work assignment. 5
2. The written policy concerning work assignments must, at a 6
minimum, allow a licensed nurse or certified nursing assistant to: 7
(a) Refuse a work assignment for any reason for refusal set forth 8
in paragraph (b) of subsection 1 of NRS 449.205; and 9
(b) File an objection to a work assignment if the work 10
assignment violates any provision of NRS 449.241 to 449.2428, 11
inclusive [.] , and sections 2 to 10, inclusive, of this act. 12
3. For the purposes of refusing a work assignment pursuant to 13
paragraph (a) of subsection 2, the written policy concerning work 14
assignments must contain: 15
(a) Reasonable requirements for prior notice to the supervisor of 16
the licensed nurse or certified nursing assistant of the request by the 17
licensed nurse or certified nursing assistant to be relieved of the 18
work assignment, including, without limitation, the reasons 19
supporting the request; 20
(b) Reasonable requirements which provide, if feasible, an 21
opportunity for the supervisor to review a request by the licensed 22
nurse or certified nursing assistant to be relieved of the work 23
assignment, including any specific conditions supporting the 24
request, and based upon that review: 25
(1) Relieve the licensed nurse or certified nursing assistant of 26
the work assignment as requested; or 27
(2) Deny the request; and 28
(c) A process pursuant to which a licensed nurse or certified 29
nursing assistant may exercise his or her right to refuse a work 30
assignment if the supervisor does not approve the request to be 31
relieved of the work assignment if: 32
(1) The supervisor failed to approve the request without 33
proposing a remedy or, if a remedy is proposed, the proposed 34
remedy would be inadequate or untimely; 35
(2) The process for filing a complaint with the Division or 36
any other appropriate regulatory entity, including any investigation 37
that would be required, would be untimely to address the concerns 38
of the licensed nurse or certified nursing assistant in refusing a work 39
assignment; and 40
(3) The licensed nurse or certified nursing assistant in good 41
faith believes that the work assignment meets the conditions 42
established in the written policy justifying refusal. 43
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4. For the purposes of objecting to a work assignment pursuant 1
to paragraph (b) of subsection 2, the written policy concerning work 2
assignments must contain: 3
(a) A process for a licensed nurse or certified nursing assistant 4
to file an objection with the health care facility, but still accept the 5
work assignment despite the objection; and 6
(b) A requirement that the health care facility respond to the 7
objection as soon as practicable, but not later than 45 days after 8
receiving the objection. 9
5. The health care facility shall: 10
(a) Maintain records for at least 2 years of each request to be 11
relieved of a work assignment, each refusal of a work assignment 12
and each objection to a work assignment that is filed with the health 13
care facility pursuant to the written policy adopted pursuant to this 14
section; 15
(b) If the health care facility has established a nursing staffing 16
committee pursuant to NRS 449.242, provide to the nursing staffing 17
committee: 18
(1) The number of requests to be relieved of a work 19
assignment and refusals of a work assignment made by a licensed 20
nurse or a certified nursing assistant at the health care facility 21
pursuant to this section; 22
(2) The number of objections to a work assignment filed by a 23
licensed nurse or a certified nursing assistant at the health care 24
facility pursuant to this section; and 25
(3) An explanation of how the health care facility addressed 26
the requests, refusals and objections; and 27
(c) Ensure that the health care facility complies with the written 28
policy adopted pursuant to this section. 29
Sec. 21. NRS 449.2425 is hereby amended to read as follows: 30
449.2425 1. The Division shall adopt regulations 31
establishing: 32
(a) A system for rating each 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 on the compliance by the facility with the 35
provisions of this section and NRS 449.241 to 449.2428, inclusive, 36
and sections 2 to 10, inclusive, of this act, including, without 37
limitation, the number of resolved and unresolved violations and the 38
severity of those violations. The rating system must provide for the 39
assignment of a star rating of not more than five stars and not less 40
than one star to each such facility after: 41
(1) Each inspection conducted by the Division pursuant to 42
NRS 449.132 [;] and 449.2428. 43
(2) Each investigation conducted by the Division pursuant to 44
NRS 449.0307 and 449.2428 concerning a complaint that alleges a 45
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violation of the provisions of this section and NRS 449.241 to 1
449.2428, inclusive [.] , and sections 2 to 10, inclusive, of this act. 2
(b) Procedures by which a health care facility located in a 3
county whose population is 100,000 or more and which is licensed 4
to have more than 70 beds may, not later than 30 days after an 5
investigation or inspection, appeal a finding concerning a violation 6
of the provisions of this section and NRS 449.241 to 449.2428, 7
inclusive, and sections 2 to 10, inclusive, of this act or request a 8
follow-up inspection. 9
2. A star rating assigned pursuant to subsection 1 becomes 10
final: 11
(a) Thirty days after the investigation or inspection on which the 12
star rating is based; or 13
(b) After the completion of any follow-up inspection or the final 14
determination of any appeal pursuant to subsection 1, 15
whichever is later. 16
3. Not later than 5 days after a star rating becomes final 17
pursuant to subsection 2, the Division shall post on an Internet 18
website maintained by the Division a report which must include: 19
(a) The final star rating assigned to the facility pursuant to 20
subsection 1; and 21
(b) A report of each unresolved violation of an applicable statute 22
or regulation and all proposed actions to correct the violation. 23
4. A health care facility located in a county whose population 24
is 100,000 or more and which is licensed to have more than 70 beds 25
shall post the final star rating assigned to the facility pursuant to 26
subsection 1 after the most recent investigation or inspection in a 27
conspicuous place near each entrance to the facility that is regularly 28
used by the public and, if the facility maintains an Internet website 29
that is accessible to the public, on that Internet website. 30
Sec. 22. NRS 449.2428 is hereby amended to read as follows: 31
449.2428 For each health care facility which is located in a 32
county whose population is 100,000 or more and which is licensed 33
to have more than 70 beds, the Division shall: 34
1. Ensure the general compliance of the health care facility 35
with the provisions of NRS 449.241 to 449.2428, inclusive, and 36
sections 2 to 10, inclusive, of this act, including, without limitation, 37
those provisions relating to documented staffing plans and written 38
policies adopted pursuant to NRS 449.2421 and 449.2423 [;] , 39
respectively; and 40
2. Adopt such regulations as are necessary or appropriate to 41
carry out the provisions of this section. The regulations must 42
provide: 43
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(a) For unannounced, random visits at a health care facility to 1
determine whether the facility is in compliance with NRS 449.241 2
to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act. 3
(b) An accessible and confidential system pursuant to which 4
the nursing, technical and service staff of a hospital may report 5
the failure of the hospital to comply with the provisions of NRS 6
449.241 to 449.2428, inclusive, and sections 2 to 10, inclusive, of 7
this act. 8
(c) Procedures for timely investigating and resolving a report 9
received pursuant to the system described in paragraph (b). The 10
procedures must include, without limitation, a requirement that 11
the Division: 12
(1) Investigate and resolve a report within the applicable 13
maximum amount of time prescribed for the investigation of 14
complaints or incidents by the Centers for Medicare and Medicaid 15
Services of the United States Department of Health and Human 16
Services, based on intake priority, in accordance with the State 17
Operations Manual published by the Centers for Medicare and 18
Medicaid Services, unless the applicable circumstances of an 19
investigation require additional time; and 20
(2) Take appropriate disciplinary action pursuant to NRS 21
449.160 or 449.163, as appropriate, against a health care facility 22
that is found to have violated the provisions of NRS 449.241 to 23
449.2428, inclusive, and sections 2 to 10, inclusive, of this act 24
pursuant to an investigation completed pursuant to the procedures 25
described in this paragraph. 26
(d) A systematic means for investigating and correcting 27
violations of any provision of NRS 449.241 to 449.2428, inclusive, 28
and sections 2 to 10, inclusive, of this act. 29
Sec. 23. NRS 618.7312 is hereby amended to read as follows: 30
618.7312 1. A medical facility shall: 31
(a) Establish a committee on workplace safety, which must 32
consist of: 33
(1) If [a] staffing [committee has] committees have been 34
established for the medical facility pursuant to NRS 449.242 and 35
sections 5 and 6 of this act or an applicable collective bargaining 36
agreement: 37
(I) The members of [the] each staffing committee; and 38
(II) Employees of the medical facility who work in areas 39
of the medical facility other than those represented on the staffing 40
[committee,] committees, appointed by the operator of the medical 41
facility. 42
(2) If [a staffing committee has] staffing committees have 43
not been established for the medical facility pursuant to NRS 44
449.242 or sections 5 or 6 of this act or an applicable collective 45
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bargaining agreement, employees of the medical facility appointed 1
by the operator of the medical facility. Such employees must 2
include, without limitation, employees who work in all major areas 3
of the medical facility. 4
(b) Develop and maintain a plan for the prevention of and 5
response to workplace violence. The plan must: 6
(1) Be in writing; 7
(2) Be in effect at all times; 8
(3) Be available to be viewed by each employee of the 9
medical facility or other provider of care at the medical facility at all 10
times; 11
(4) Be specific for each unit, area and location maintained by 12
the medical facility; and 13
(5) Be developed in collaboration with the committee on 14
workplace safety established pursuant to paragraph (a). 15
2. The plan developed pursuant to paragraph (b) of subsection 16
1 must include, without limitation: 17
(a) A requirement that all employees of the medical facility and 18
other providers of care at the medical facility receive the training 19
described in NRS 618.7313 concerning the prevention of workplace 20
violence: 21
(1) Upon the adoption of a new plan for the prevention of 22
workplace violence; 23
(2) Upon commencing employment and annually thereafter; 24
(3) Upon commencing new job duties in a new location of 25
the medical facility or a new assignment in a new location of the 26
medical facility; and 27
(4) When a previously unrecognized hazard is identified or 28
there is a material change in the facility requiring a change to the 29
plan. 30
(b) Procedures that meet the requirements of NRS 618.7314 for 31
responding to and investigating incidents of workplace violence. 32
(c) Procedures that meet the requirements of the regulations 33
adopted pursuant to NRS 618.7317 for assessing and responding to 34
situations that create the potential for workplace violence. 35
(d) Procedures for correcting hazards that increase the risk of 36
workplace violence, including, without limitation, using engineering 37
controls that are feasible and applicable to the medical facility and 38
work practice controls to eliminate or minimize exposure of 39
employees and other providers of care to such hazards. 40
(e) Procedures for obtaining assistance from security guards or 41
public safety agencies when appropriate. 42
(f) Procedures for responding to incidents involving an active 43
shooter and other threats of mass casualties through the use of plans 44
– 26 –
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for evacuation and sheltering that are feasible and appropriate for 1
the medical facility. 2
(g) Procedures for annually assessing, in collaboration with the 3
committee on workplace safety established pursuant to paragraph 4
(a) of subsection 1, the effectiveness of the plan. 5
Sec. 24. The provisions of NRS 354.599 do not apply to any 6
additional expenses of a local government that are related to the 7
provisions of this act. 8
Sec. 25. The provisions of subsection 1 of NRS 218D.380 do 9
not apply to any provision of this act which adds or revises a 10
requirement to submit a report to the Legislature. 11
Sec. 26. 1. This section becomes effective upon passage and 12
approval. 13
2. Sections 1 to 25, inclusive, of this act become effective: 14
(a) Upon passage and approval for the purpose of adopting any 15
regulations and performing any other preparatory administrative 16
tasks that are necessary to carry out the provisions of this act; and 17
(b) On October 1, 2025, for all other purposes. 18
H