HOUSE BILL 236
56th legislature - STATE OF NEW MEXICO - first session, 2023
Eleanor Chávez and Cynthia Borrego and Angelica Rubio and Patricia Roybal Caballero and Ambrose Castellano
RELATING TO HEALTH CARE; REQUIRING THE DEPARTMENT OF HEALTH TO PROMULGATE AND ENFORCE MINIMUM NURSING STAFF-TO-PATIENT RATIOS IN LICENSED HOSPITALS; CREATING THE STAFFING ADVISORY COMMITTEE; REQUIRING LICENSED HOSPITALS TO DEVELOP AND IMPLEMENT POLICIES AND PROCEDURES; PROVIDING ADMINISTRATIVE PENALTIES; DECLARING AN EMERGENCY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the Public Health Act is enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--DEFINITIONS.--As used in Sections 1 through 5 of this 2023 act:
A. "critical care unit" means a unit that is established to treat patients whose severity of medical conditions require continuous monitoring and complex intervention by licensed nurses;
B. "hospital" means any public, private for-profit or not-for-profit acute care, rehabilitation, limited services, critical access, general or specific facility offering in-patient services, nursing and overnight care seven days a week on a twenty-four-hour basis that is capable of treating no fewer than three patients for the purposes of diagnosing, treating and providing medical, psychological or surgical care for physical or mental illness, disease, injury, rehabilitative conditions and pregnancies; and
C. "hospital unit" includes critical care units, burn units, labor and delivery rooms, post-anesthesia service areas, emergency departments, operating rooms, pediatric units, step-down or intermediate care units, specialty care units, telemetry units, general medical care units, subacute care units and transitional inpatient care units."
SECTION 2. A new section of the Public Health Act is enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--STAFFING ADVISORY COMMITTEE--CREATION--PER DIEM AND MILEAGE--ORGANIZATION.--
A. The "staffing advisory committee" is created for the purpose of advising the department on matters related to nurse staffing as provided in this 2023 act. The committee shall have ten members, appointed by the department as follows:
(1) two members shall be private hospital administrators or chief nursing officers;
(2) two members shall be public hospital administrators or chief nursing officers;
(3) two members shall be non-managerial and non-supervisory employees of private hospitals involved in direct patient care;
(4) two members shall be non-managerial and non-supervisory employees of public hospitals involved in direct patient care; and
(5) two members shall represent labor organizations representing employees in public or private hospitals.
B. The members of the staffing advisory committee shall serve for terms of four years and no more than three terms. A member appointed by the committee to fill a vacancy shall serve the remainder of the term.
C. Term-length conditions for appointments to the staffing advisory committee are:
(1) for initial appointments, four members shall serve for four-year terms, three members shall serve for three-year terms, two members shall serve for two-year terms and one member shall serve for a one-year term;
(2) for regular appointments after the initial appointments, four-year terms;
(3) for a vacancy appointment, the balance of the term; and
(4) a committee member shall continue to serve on the committee until a replacement is appointed.
D. The staffing advisory committee shall elect annually a chairperson and other officers as the committee determines to be necessary.
E. The staffing advisory committee shall meet at a frequency necessary for the committee to advise and provide data for the department to use in promulgating rules pursuant to Section 3 of this 2023 act.
F. A majority of the staffing advisory committee members currently serving shall constitute a quorum.
G. Public members of the staffing advisory committee shall be reimbursed as nonsalaried public officers pursuant to the Per Diem and Mileage Act. Members shall receive no other compensation, perquisite or allowance for their service on the committee.
H. The department may remove from office a member of the staffing advisory committee for neglect of duties."
SECTION 3. A new section of the Public Health Act is enacted to read:
"[NEW MATERIAL] HOSPITALS--LICENSED NURSE-TO-PATIENT RATIOS--DEPARTMENT--COMMITTEE--POWERS AND DUTIES.--
A. The department, with the advice of the staffing advisory committee, shall have the power to:
(1) ensure that staffing ratios promulgated by the department are maintained by a hospital;
(2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and
(3) seek injunctive relief for violations of this 2023 act.
B. By July 1, 2024, the department, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding:
(1) minimum, specific and numerical staffing ratios for hospitals licensed by the department pursuant to the Public Health Act, which shall include:
(a) licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and
(b) unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care;
(2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs;
(3) emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and
(4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the:
(a) severity of the illness to be treated;
(b) need for specialized equipment and technology;
(c) complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and
(d) licensure of the personnel required for care.
C. The rules promulgated by the department pursuant to Subsection B of this section shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2023 act.
D. The department, in consultation with the staffing advisory committee, shall:
(1) review the rules adopted pursuant to Subsection B of this section after five years following the adoption of the rules; and
(2) report proposed rules to the legislature prior to promulgation."
SECTION 4. A new section of the Public Health Act is enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--HOSPITAL POLICIES AND PROCEDURES--TRAINING.--
A. A hospital shall:
(1) employ staff to meet the staffing ratios established by the department, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and
(2) adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require:
(a) training and orientation for providing direct patient care;
(b) orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and
(c) temporary personnel orientation and competency evaluation.
B. A hospital may employ additional staff in accordance with a documented patient classification system.
C. A hospital shall not:
(1) assign unlicensed personnel to perform nursing functions in lieu of a registered nurse; or
(2) allow unlicensed personnel under the direct clinical supervision of a registered nurse to perform functions that require a substantial amount of scientific knowledge and technical skills, including:
(a) administration of medication;
(b) venipuncture or intravenous therapy;
(c) parenteral or tube feedings;
(d) invasive procedures, including inserting nasogastric tubes, inserting catheters and tracheal suctioning;
(e) assessment of the condition of a patient;
(f) educating patients and their families concerning the patient's health care problems, including post-discharge care; and
(g) moderate complexity laboratory tests.
D. Nothing in this section precludes a licensed or registered nurse from working within that person's scope of practice."
SECTION 5. A new section of the Public Health Act is enacted to read:
"[NEW MATERIAL] HOSPITAL STAFFING RATIOS--VIOLATION--REMEDIES.--The requirements of this 2023 act or any rules promulgated may be enforced by a civil action brought by any interested person or organization, including the department, for injunctive relief to enforce the provisions of this 2023 act or any rules promulgated pursuant to Section 3 of this 2023 act. In the event such an action is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees."
SECTION 6. EMERGENCY.--It is necessary for the public peace, health and safety that this act take effect immediately.
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