HOUSE BILL 72

57th legislature - STATE OF NEW MEXICO - first session, 2025

INTRODUCED BY

Eleanor Chávez and Katy M. Duhigg

 

 

 

 

 

AN ACT

RELATING TO HEALTH CARE; REQUIRING THE HEALTH CARE AUTHORITY TO PROMULGATE AND ENFORCE MINIMUM NURSING STAFF-TO-PATIENT RATIOS IN LICENSED HOSPITALS; CREATING THE STAFFING ADVISORY COMMITTEE; REQUIRING LICENSED HOSPITALS TO DEVELOP AND IMPLEMENT POLICIES AND PROCEDURES; PROVIDING ADMINISTRATIVE PENALTIES; DECLARING AN EMERGENCY.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--DEFINITIONS.--As used in Sections 1 through 5 of this 2025 act:

          A. "critical care unit" means a unit that is established to treat patients whose severity of medical conditions require continuous monitoring and complex intervention by licensed nurses;

          B. "hospital" means any public, private for-profit or not-for-profit acute care, rehabilitation, limited services, critical access, general or specific facility offering inpatient services, nursing and overnight care seven days per week on a twenty-four-hour basis that is capable of treating no fewer than three patients for the purposes of diagnosing, treating and providing medical, psychological or surgical care for physical or mental illness, disease, injury, rehabilitative conditions and pregnancies; and

          C. "hospital unit" includes critical care units, burn units, labor and delivery rooms, post-anesthesia service areas, emergency departments, operating rooms, pediatric units, step-down or intermediate care units, specialty care units, telemetry units, general medical care units, subacute care units and transitional inpatient care units." 

     SECTION 2. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--STAFFING ADVISORY COMMITTEE--CREATION--ORGANIZATION.--

          A. The "staffing advisory committee" is created for the purpose of advising the authority on matters related to nurse staffing as provided in this 2025 act. The committee consists of eleven members that reflect a geographic representation of the state, appointed by the authority as follows:

                (1) two members shall be private hospital administrators or chief nursing officers;

                (2) two members shall be public hospital administrators or chief nursing officers;

                (3) two members shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care;

                (4) two members shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care;

                (5) two members shall represent labor organizations representing employees in public or private hospitals; and

                (6) one nonvoting advisory member shall represent the authority.

          B. The members of the staffing advisory committee shall serve for terms of four years and no more than three terms. A member appointed by the committee to fill a vacancy shall serve the remainder of the term.

          C. Term-length conditions for voting members appointed to the staffing advisory committee are:

                (1) for initial appointments, four members shall serve for four-year terms, three members shall serve for three-year terms, two members shall serve for two-year terms and one member shall serve for a one-year term;

                (2) for regular appointments after the initial appointments, four-year terms;

                (3) for a vacancy appointment, the balance of the term; and

                (4) a committee member shall continue to serve on the committee until a replacement is appointed.

          D. The staffing advisory committee shall elect annually a chair and other officers as the committee determines to be necessary.

          E. The staffing advisory committee shall meet at a frequency necessary for the committee to advise and provide data for the authority to use in promulgating rules pursuant to Section 3 of this 2025 act.

          F. A majority of the staffing advisory committee members currently serving constitutes a quorum.

          G. The authority may remove from office a member of the staffing advisory committee for neglect of duties."

     SECTION 3. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITALS--LICENSED NURSE-TO-PATIENT RATIOS--AUTHORITY--COMMITTEE--POWERS AND DUTIES.--

          A. The authority, with the advice of the staffing advisory committee, may:

                (1) ensure that staffing ratios promulgated by the authority are maintained by a hospital;

                (2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and

                (3) seek injunctive relief for violations of this 2025 act.

          B. By July 1, 2026, the authority, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding:

                (1) minimum, specific and numerical staffing ratios for hospitals licensed by the authority pursuant to the Health Care Code, which shall include:

                     (a) licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and

                     (b) unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care;

                (2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs;

                (3) emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and

                (4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the:

                     (a) severity of the illness to be treated;

                     (b) need for specialized equipment and technology;

                     (c) complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and

                     (d) licensure of the personnel required for care.

          C. The rules promulgated by the authority pursuant to Subsection B of this section shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.

          D. The authority, in consultation with the staffing advisory committee, shall:

                (1) review the rules adopted pursuant to Subsection B of this section after five years following the adoption of the rules; and

                (2) report proposed rules to the legislature prior to promulgation."

     SECTION 4. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--HOSPITAL POLICIES AND PROCEDURES--TRAINING.-- 

          A. A hospital shall:

                (1) employ staff to meet the staffing ratios established by the authority, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and

                (2) adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require:

                     (a) training and orientation for providing direct patient care;

                     (b) orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and

                     (c) temporary personnel orientation and competency evaluation.

          B. A hospital may employ additional staff in accordance with a documented patient classification system.

          C. A hospital shall not:

                (1) assign unlicensed personnel to perform nursing functions in lieu of a registered nurse; or

                (2) allow unlicensed personnel under the direct clinical supervision of a registered nurse to perform functions that require a substantial amount of scientific knowledge and technical skills, including:

                     (a) administration of medication;

                     (b) venipuncture or intravenous therapy;

                     (c) parenteral or tube feedings;

                     (d) invasive procedures, including inserting nasogastric tubes, inserting catheters and tracheal suctioning;

                     (e) assessment of the condition of a patient;

                     (f) educating patients and their families concerning the patient's health care problems, including post-discharge care; and

                     (g) moderate complexity laboratory tests.

          D. All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care. No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area. The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel shall receive orientation and be subject to competency validation.

          E. Nothing in this section precludes a licensed or registered nurse from working within that person's scope of practice."

     SECTION 5. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--VIOLATION--ENFORCEMENT--REMEDIES.--

          A. A hospital shall not deviate from any staffing ratios established by the authority pursuant to this 2025 act more than six times during a rolling thirty-day period. The unit manager shall notify the staffing advisory committee and the authority no later than ten days after each deviation. Each subsequent deviation during the thirty-day period constitutes a separate violation.

          B. The authority shall, no later than July 1, 2026, adopt rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules shall specify reporting requirements for deviations consistent with this section and allow for the acceptance, investigation and resolution of complaints from hospital staff, exclusive representatives of hospital staff or members of the public.

          C. If the authority determines, whether through a complaint process, hospital reporting or the authority's own independent investigation, that a hospital has engaged in a violation of staffing requirements, the authority shall:

                (1) issue a warning for the first violation in a four-year period;

                (2) impose a civil penalty of one thousand seven hundred fifty dollars ($1,750) for the second violation of the same provision in a four-year period;

                (3) impose a civil penalty of two thousand five hundred dollars ($2,500) for the third violation of the same provision in a four-year period; and

                (4) impose a civil penalty of five thousand dollars ($5,000) for the fourth and subsequent violations of the same provision in a four-year period.

          D. If the authority finds that a hospital has committed multiple violations of the staffing ratio requirements of a similar nature, it shall require the hospital to submit a corrective action plan for approval. If a hospital does not follow the corrective action plan approved by the authority, the hospital shall be fined fifty thousand dollars ($50,000) every thirty days until the hospital complies.

          E. The requirements of this section or any rules adopted pursuant to this 2025 act may be enforced by a civil action brought by any interested person or organization for injunctive relief to enforce the provisions of this section or any rules adopted hereunder. In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.

          F. A hospital is not required to follow the staffing ratios established by the authority in the event of:

                (1) a national or state emergency requiring the implementation of a facility disaster plan;

                (2) sudden and unforeseen adverse weather conditions; or

                (3) an infectious disease epidemic suffered by hospital staff.

          G. The authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff."

     SECTION 6. EMERGENCY.--It is necessary for the public peace, health and safety that this act take effect immediately.

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