All Roll Calls
Yes: 40 • No: 23
NevadaSB18283rd Regular Session (2025)Senate
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.
Sponsored By: Rochelle T. Nguyen (Democratic)
Vetoed
BDR 40-33
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Bill Overview
Analyzed Economic Effects
10 provisions identified: 7 benefits, 2 costs, 1 mixed.
Nurses gain assignment and complaint protections
Beginning October 1, 2025, covered facilities must give nurses and certified nursing assistants written assignment-refusal and objection procedures. This requirement covers facilities licensed for more than 70 beds in Nevada counties with at least 100,000 people. Workers can object to assignments that break staffing laws while still accepting the assignment. Facilities must respond as soon as practicable, within 45 days at the latest. Refusal is allowed for the safety reasons stated in law, not simply because a worker dislikes an assignment. After a supervisor denies relief, refusal requires no adequate or timely remedy, an untimely regulatory complaint process, and an honest belief that legal refusal grounds exist. Facilities must keep relief requests, refusals, and objections for at least two years. If they have a nursing staffing committee, they must report counts and explain how concerns were handled. Medical facilities, their agents, and employees cannot retaliate or unfairly discriminate over protected staffing actions, including reports to the state health division or Labor Commissioner. Contracts and policies cannot block those actions, and reports requiring good faith must be honest.
Hospitals face staffing records and investigations
Beginning October 1, 2025, these oversight rules cover Nevada facilities licensed for more than 70 beds in counties with at least 100,000 people. Covered hospitals must keep accurate daily records for each unit as a licensing condition. Records include admissions, releases, patient counts, staff names and duty hours, and missed direct-care nurse meal or rest breaks. They also track deaths, illness, infections, accidents, injuries, and medical errors. Hospitals must keep records at least seven years and provide them to the state health division or Labor Commissioner on request. The Division must adopt rules for random, unannounced visits and provide confidential reporting for nursing, technical, and service staff. It must investigate and resolve reports within applicable federal health agency deadlines unless circumstances require more time. Confirmed violations require appropriate disciplinary action. The Labor Commissioner can inspect, investigate complaints, and refer violations to the Division.
Hospitals must add patient support staff
Beginning October 1, 2025, these rules cover Nevada hospitals licensed for more than 70 beds in counties with at least 100,000 people. Hospitals using certified nursing assistants must limit assignments to seven patients from 6 a.m. through 8 p.m. The limit is 11 patients from 8:01 p.m. through 5:59 a.m. Assistants without main responsibility for patient care cannot count. Beyond other staffing ratios, operating rooms need at least one scrub assistant per patient. Every unit needs at least one patient care technician, nurse apprentice, sitter, or equivalent observation worker for every two patients.
Hospitals must limit nurses’ patient loads
Beginning October 1, 2025, Nevada hospitals licensed for more than 70 beds in counties with at least 100,000 people must meet nurse staffing limits. Each direct-care nurse can serve only one patient in operating rooms, critical care, intensive care, postanesthesia, and conscious-sedation units. Emergency limits are one trauma or critical-care patient, or three other patients, per nurse. Emergency units must also assign a separate triage nurse who does not count toward these limits. The limit is three patients in cardiac telemetry, intermediate or step-down care, pediatric, and observation units. It is four in ambulatory, oncology, acute rehabilitation, medical-surgical, pre-surgical, psychiatric, and otherwise unlisted units. Well-baby nurseries have a six-patient limit. Active labor requires one nurse per patient; postpartum care generally has a two-patient limit, with a separate four-patient exception. Delivery requires one nurse per newborn, and some newborn intermediate care has a two-patient limit. The law also sets separate fetal-monitoring and delivery-care rules. Hospitals must add nurses when needed, including for breaks. Only properly licensed nurses with documented orientation, verified skills, and patient-care responsibility count. Division-operated psychiatric hospitals are excluded, authorized emergency departures are allowed, and stricter staffing plans or union agreements remain in force.
Patients get public facility staffing ratings
Beginning October 1, 2025, Nevada facility ratings must include staffing compliance after inspections and qualifying investigations. The rules cover facilities licensed for more than 70 beds in counties with at least 100,000 people. The state uses a one-to-five-star system to compare similar facilities. Facilities have 30 days to appeal findings. Within five days after a rating becomes final, the state must publish it, unresolved violations, and proposed fixes online. Facilities must display final ratings near each public entrance and on their publicly accessible website, if they have one.
Hospital workers gain staffing plan input
Beginning October 1, 2025, covered Nevada hospitals must maintain nursing, technical, and service staffing committees. Coverage requires more than 70 licensed beds and a county population of at least 100,000. At least half of nursing committee members must be direct-care nurses or certified nursing assistants; administration appoints at least half. Units elect staff representatives and alternates. Technical and service committees each have at least half staff members and at least half managers. Their staff elections must allow at least three days to vote. Qualifying union committees can serve instead. Committees meet at least quarterly and work together on one documented staffing plan and written policy. Annual reports on their work and effectiveness are due December 31, with legislative reporting every two years. Covered facilities must make their policy, plan, and certification of adequate staffing available to the state as a licensing condition. Plans must detail each unit’s patient needs, staffing numbers and skills, equipment, and expected changes. They must address support-staff experience, technical and service staffing, emergencies, patient surges, absences, and assignment refusals. Hospital committee members sign the documents and have space to record objections. Facilities must follow their plans, and hospital plans must meet the legal staffing ratios, except during authorized emergency departures.
Medical workers gain broader safety representation
Beginning October 1, 2025, Nevada medical facility safety committees must include members from every staffing committee established by law or union agreement. Operators must also appoint employees from facility areas those committees do not represent. Without staffing committees, operators must appoint employees from all major facility areas. Facilities must maintain a written, unit-specific workplace violence prevention and response plan developed with the safety committee. Training is required when the plan starts, at hiring, annually, and when hazards change. Plans must cover incident investigation, hazard fixes, security help, active shooters, and mass casualties, with an annual effectiveness review.
Facilities face fines for staffing violations
Beginning October 1, 2025, Nevada’s health division can deny, suspend, or revoke licenses for covered staffing violations. These license actions are allowed, not automatic. The Division can bar new admissions, cap occupancy at the level when a violation occurred, require fixes, or appoint temporary management. If an occupancy cap requires patient transfers, the facility pays for those transfers. Fines can reach $5,000 per violation per day, plus interest of up to 10% a year. Unpaid fines can lead to license suspension, collection costs, and attorney fees. Collected penalties must be tracked separately and used for enforcement and patient protection.
Some facilities remain outside staffing protections
Beginning October 1, 2025, the law’s staffing protections exclude several facility types. These include foster homes and church-run facilities providing care solely through spiritual healing. Qualifying medical facilities and dependent-care facilities operated and maintained by the federal government or its agencies are also excluded. Church-run facilities must still follow applicable sanitation and safety rules.
Hospitals get limited emergency staffing flexibility
Beginning October 1, 2025, covered Nevada hospitals can depart from staffing plans and ratios during qualifying emergencies. Coverage requires more than 70 licensed beds and a county population of at least 100,000. Qualifying events include state or federal emergencies, public health emergencies, and disasters requiring crisis standards of care. This flexibility allows staffing below ordinary requirements. Hospitals must report departures and emergency nurse-staffing needs to nursing committee co-chairs or designated liaisons within 30 days. If the departure remains needed when reported, the committee must develop a backup staffing plan with crisis care standards. Continuing beyond 90 days requires prior nursing staffing committee approval.
Sponsors & Cosponsors
Sponsor
Rochelle T. Nguyen
Democratic • Senate
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
House vote • 6/2/2025
Final Passage - Assembly (1st Reprint)
Yes: 27 • No: 15
Senate vote • 5/22/2025
Final Passage - Senate (1st Reprint)
Yes: 13 • No: 8
Actions Timeline
Vetoed by the Governor.
6/12/2025legislatureEnrolled and delivered to Governor.
6/5/2025legislatureTo enrollment.
6/4/2025SenateIn Senate.
6/3/2025SenateRead third time. Passed. Title approved. (Yeas: 27, Nays: 15.) To Senate.
6/2/2025HouseRead second time.
6/1/2025HousePlaced on Second Reading File.
6/1/2025HouseFrom committee: Do pass.
6/1/2025HouseRereferred to Committee on Ways and Means. To committee.
5/26/2025HouseWithdrawn from Committee on Health and Human Services.
5/26/2025HouseRead first time. Referred to Committee on Health and Human Services. To committee.
5/23/2025HouseIn Assembly.
5/23/2025HouseRead third time. Passed, as amended. Title approved, as amended. (Yeas: 13, Nays: 8.) To Assembly.
5/22/2025SenatePlaced on General File.
5/22/2025SenateFrom committee: Do pass.
5/22/2025SenateTo committee.
4/23/2025SenateFrom printer. To engrossment. Engrossed. First reprint.
4/23/2025SenateTaken from General File. Re-referred to Committee on Finance. Exemption effective. To printer.
4/21/2025SenateNotice of eligibility for exemption.
4/21/2025SenateRead second time. Amended. (Amend. No. 349.)
4/21/2025SenatePlaced on Second Reading File.
4/21/2025SenateFrom committee: Amend, and do pass as amended.
4/21/2025SenateRead first time. To committee.
2/5/2025SenateFrom printer.
2/5/2025SenateTo printer.
2/4/2025Senate
Bill Text
As Enrolled
As Introduced
Reprint 1
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