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SENATE BILL NO. 283
IN THE LEGISLATURE OF THE STATE OF ALASKA
THIRTY-FOURTH LEGISLATURE - SECOND SESSION
BY THE SENATE LABOR AND COMMERCE COMMITTEE
Introduced: 4/15/26
Referred: Labor and Commerce, Health and Social Services
A BILL
FOR AN ACT ENTITLED
"An Act relating to staffing standards for registered nurses; and providing for an 1
effective date." 2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 3
* Section 1. AS 18.20 is amended by adding new sections to read: 4
Article 2A. Hospital Registered Nurse Staffing. 5
Sec. 18.20.265. Registered nurse minimum staffing standards for 6
hospitals. (a) A hospital shall comply with the registered nurse minimum staffing 7
standards established in this section. 8
(b) The maximum number of patients each registered nurse may be assigned 9
during a shift is as follows: 10
(1) in an emergency department, four patients or, if an assigned patient 11
will be admitted as an in-patient in another unit, the lowest maximum number of 12
patients permitted in that unit; a registered nurse may not be assigned more than one 13
trauma or critical care patient; 14
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(2) in an intensive care unit, 1
(A) two patients; or 2
(B) one patient, if the patient is assessed as a high acuity 3
patient; 4
(3) in a labor and delivery unit, 5
(A) two patients; or 6
(B) one patient, if the patient is in active labor or is in any stage 7
of labor and experiencing complications; 8
(4) in a postpartum or antepartum unit or well-baby nursery, six 9
patients; for the purpose of this paragraph, each mother and each baby is a separate 10
patient; 11
(5) in an operating room, one patient; 12
(6) in an oncology unit, four patients; 13
(7) in a post-anesthesia care unit, two patients; 14
(8) in a progressive care or step-down unit, four patients; 15
(9) in an intermediate specialty care unit, three patients; 16
(10) in a medical-surgical unit, four patients; 17
(11) in a telemetry unit, four patients; 18
(12) in a psychiatric unit, 19
(A) four patients; or 20
(B) fewer than four patients, as determined by the hospital's 21
registered nurse staffing standards, if an assigned patient 22
(i) requires one-on-one observation; 23
(ii) is in an acute-manic phase; 24
(iii) is volatile; 25
(iv) is physically compromised; or 26
(v) is assessed as a high acuity patient; 27
(13) in a pediatrics unit, four patients; and 28
(14) in an in-patient hemodialysis unit, one patient. 29
(c) The registered nurse staffing standards established in this section are based 30
on the type of care provided in a patient care unit, regardless of the specific name or 31
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reference used by the hospital for the unit. 1
(d) A hospital may not average the number of patients or the total number of 2
registered nurses assigned to patients in a patient care unit during a single shift or over 3
any period to meet the registered nurse staffing standards established in this section. 4
(e) A hospital may not include a registered nurse in charge of coordinating 5
patient care responsibilities among nurses, a coordinator of patient care flow, or a 6
persona generated by artificial intelligence or other nonhuman persona in meeting the 7
registered nurse staffing standards. Registered nurses who are working remotely or 8
virtually and are not physically present in the hospital department may not be included 9
to meet the registered nurse staffing standards. 10
(f) Before a registered nurse may be assigned to a patient care unit or clinical 11
area, the registered nurse must have received an orientation in the clinical area 12
sufficient to demonstrate current competence in providing care in the area. 13
(g) Nothing in this section precludes a hospital from assigning fewer patients 14
to a registered nurse than the maximum determined in the staffing standards 15
established in this section. 16
Sec. 18.20.270. Registered nurse staffing plans for hospitals. (a) A hospital 17
shall have a registered nurse staffing plan. The registered nurse staffing plan must 18
include minimum staffing levels for each unit in the hospital, including 19
(1) the number of registered nurses employed in each care unit in the 20
hospital required to meet the registered nurse minimum staffing standards established 21
in AS 18.20.265; 22
(2) the minimum registered nurse skill mix for each patient care unit in 23
the hospital, including in-patient, critical care, and emergency units; and 24
(3) the number of supportive direct patient care personnel required to 25
be assigned to each patient care unit and the classification of each supportive direct 26
patient care personnel member assigned to a patient care unit. 27
(b) A hospital shall include the following in the hospital's registered nurse 28
staffing plan: 29
(1) a patient acuity classification system for determining the nursing 30
care needs of an individual patient; 31
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(2) a written certification that the registered nurse staffing plan is 1
sufficient to provide adequate, appropriate, and safe delivery of health care services to 2
patients during the year; 3
(3) the hospital's employment practices concerning the use of 4
temporary and travel nurses; and 5
(4) the hospital's process for internal review of the registered nurse 6
staffing plan. 7
(c) A hospital's registered nurse staffing plan must be approved by a majority 8
vote of the members of the hospital's staffing committee. 9
(d) A hospital shall post the hospital's registered nurse staffing plan in a 10
location in each unit of the hospital that is visible, conspicuous, and accessible to staff, 11
patients, and the public. 12
(e) The department shall post each hospital's registered nurse staffing plan on 13
the department's Internet website. 14
(f) A hospital may not reduce the level of supportive direct patient care 15
personnel established in a hospital's registered nurse staffing plan or a collective 16
bargaining agreement. 17
Sec. 18.20.275. Variances. (a) A hospital may deviate from the registered 18
nurse minimum staffing standards established in AS 18.20.265 or the hospital's 19
registered nurse staffing plan required by AS 18.20.270 in the following 20
circumstances: 21
(1) an unforeseen emergency situation that could jeopardize patient 22
safety; in this paragraph, "unforeseen emergency situation" has the meaning given in 23
AS 18.20.400(c)(3)(B); 24
(2) a scheduling problem caused by unforeseen weather conditions that 25
prevent a second nurse from arriving at the hospital to relieve the nurse on duty; in this 26
paragraph, "unforeseen weather conditions" has the meaning given in 27
AS 18.20.400(c)(3)(C); 28
(3) the hospital is located in a rural community and declares a 29
temporary nurse staffing emergency under AS 18.20.410. 30
(b) Within 30 days after a hospital deviates from a written registered nurse 31
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staffing plan under circumstances outlined in (a)(1) or (2) of this section, the hospital 1
shall report the deviation to the staffing committee along with an assessment of the 2
staffing needs arising from the circumstances. A deviation from the written registered 3
nurse staffing plan may continue for longer than 90 days only upon a majority vote by 4
the staffing committee approving the deviation. 5
Sec. 18.20.280. Staffing committees for hospitals. (a) A hospital shall 6
maintain a staffing committee to prepare the hospital's registered nurse staffing plan. 7
(b) At least 51 percent of the staffing committee members must be registered 8
nurses who are employed by the hospital in a nonsupervisory capacity and whose 9
primary responsibility is to provide direct patient care. For a hospital in which 10
registered nurses are part of a collective bargaining unit, the representative of the 11
collective bargaining unit shall appoint the registered nurse members of the staffing 12
committee. If the hospital's registered nurses are not part of a collective bargaining 13
unit, the registered nurse members of the staffing committee shall be selected by peers 14
of the registered nurses. 15
(c) At least one member of the staffing committee must be a supportive direct 16
patient care personnel member employed by the hospital in a nonsupervisory and 17
nonmanagerial capacity. For a hospital in which supportive direct patient care 18
personnel are part of a collective bargaining unit, the representative of the collective 19
bargaining unit shall appoint the supportive direct patient care personnel of the 20
staffing committee. If the hospital's supportive direct patient care personnel are not 21
part of a collective bargaining unit, the supportive direct patient care personnel 22
members shall be selected by peers of the supportive direct patient care personnel. 23
(d) The remainder of the members of the staffing committee shall be 24
appointed by the hospital administration. The staffing committee must include the 25
hospital's chief financial officer, chief nursing officer, and patient care unit directors or 26
managers, or designees of the officers, directors, or managers. 27
(e) A hospital shall release each member of the staffing committee from the 28
member's assignment and ensure adequate staffing to cover the member's assignment 29
so that the member can participate in staffing committee meetings. The hospital shall 30
pay each member the member's regular rate of pay, including any differentials, for 31
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time spent at committee meetings. Time spent at committee meetings constitute hours 1
worked for the purpose of payment of overtime wages. 2
(f) If less than all the committee members are present, the committee may take 3
action if least 51 percent of the members present are registered nurses and supportive 4
direct patient care personnel appointed under (b) and (c) of this section. 5
(g) A hospital may not retaliate, discriminate, or take any other adverse action 6
against an employee or any aspect of an employee's employment, including discharge, 7
demotion, reduction in compensation, or changes to terms, conditions, or privileges of 8
employment, because of the employee's participation in the staffing committee or 9
because the employee files a report or complaint or otherwise raises concerns 10
regarding unsafe staffing. 11
(h) A registered nurse, collective bargaining representative, if applicable, 12
patient, or other person may file a report or complaint with the staffing committee 13
about an assignment in a patient care unit that deviates from the hospital's staffing 14
plan. A hospital shall include any report or complaint filed with the staffing committee 15
in the hospital's quarterly report to the department required by AS 18.20.285. 16
(i) The department shall develop a process for issuing a corrective plan of 17
action to a hospital that fails to meet the hospital's registered nurse staffing plan 18
required by AS 18.20.270 or that fails to meet the registered nurse minimum staffing 19
standards established in AS 18.20.265. If the department determines, through regular 20
reporting or review of complaints, that a hospital has been out of compliance with the 21
hospital's registered nurse staffing plan or staffing standards, the department shall 22
issue a corrective plan of action within 30 days after the department presents its 23
findings to the hospital. Failure to comply with a corrective plan of action may result 24
in a civil penalty in accordance with AS 18.20.290. 25
Sec. 18.20.285. Tracking, reporting, and compliance. (a) By October 1 of 26
each year, a hospital shall provide to the department, through a process determined by 27
the department, the hospital's registered nurse staffing plan for the following calendar 28
year. A hospital shall notify the department each time the registered nurse staffing 29
plan is updated. 30
(b) Not later than the last business day of the month following each quarter, a 31
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hospital shall submit a quarterly report to the department. The quarterly report must 1
include 2
(1) each date the hospital failed to meet the requirements of the 3
registered nurse staffing plan established in AS 18.20.270, the unit in which the failure 4
occurred, the classification of each patient care provider not adequately staffed, and 5
the staffing levels for that classification; and 6
(2) any report or complaint filed with the staffing committee. 7
(c) If a hospital has not submitted a registered nurse staffing plan to the 8
department, the quarterly report must include 9
(1) each date the hospital failed to meet the registered nurse minimum 10
staffing standards established in AS 18.20.265, the unit in which the failure occurred, 11
the classification of each patient care provider not adequately staffed, and the staffing 12
levels for that classification; and 13
(2) any report or complaint filed with the staffing committee. 14
Sec. 18.20.290. Civil penalties. (a) In accordance with regulations adopted by 15
the department under AS 44.62.010 - 44.62.305, the department may assess and 16
collect a civil penalty of 17
(1) $10,000 for each day a hospital with 100 beds or more, or $2,500 18
for each day a hospital with fewer than 100 beds, is found to be in violation of 19
AS 18.20.285(a); 20
(2) $5,000 for each business day a hospital with 100 beds or more, or 21
$1,000 for each business day a hospital with fewer than 100 beds, is found to be in 22
violation of AS 18.20.285(b) or (c); 23
(3) $5,000 for each violation for which a hospital with 100 beds or 24
more, or $1,000 for each violation for which a hospital with fewer than 100 beds, is 25
found to have failed to follow a corrective plan issued under AS 18.20.280(i). 26
(b) The department may use any remedy available under law to collect an 27
unpaid civil penalty for a violation of AS 18.20.265 - 18.20.295. 28
Sec. 18.20.295. Definitions. In AS 18.20.265 - 18.20.295, 29
(1) "acuity" means the level of a patient's need for nursing care, as 30
determined by a nursing assessment; 31
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(2) "department" means the Department of Health; 1
(3) "direct care" means care that is delivered directly to patients, not 2
telephonically or virtually; 3
(4) "hospital" has the meaning given in AS 18.20.130; 4
(5) "intensive care unit" includes a critical care unit, special care unit, 5
coronary care unit, pediatric intensive care unit, neonatal intensive care unit, 6
neurological critical care unit, burn unit, or any unit within a hospital that provides 7
specialized care to a patient with a life-threatening illness or injury that requires 8
continuous monitoring and treatment 24 hours a day; 9
(6) "registered nurse" has the meaning given to "licensed registered 10
nurse" in AS 08.68.850; 11
(7) "skill mix" means the experience levels and number of nursing and 12
ancillary health personnel; 13
(8) "staffing committee" means the staffing committees for hospitals 14
established in AS 18.20.280; 15
(9) "supportive direct patient care personnel" includes nurse aides, 16
orderlies, assistants, technicians, mental health professionals or associates, or other 17
persons who provide direct care to patients. 18
* Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 19
read: 20
TRANSITION. A hospital subject to AS 18.20.285, enacted by sec. 1 of this Act, shall 21
implement its initial registered nurse staffing plan on or before January 1, 2027. 22
* Sec. 3. This Act takes effect immediately under AS 01.10.070(c). 23