Revises provisions relating to the staffing of health care facilities. (BDR 40-33)

- 83rd Session (2025)
Senate Bill No. 182–Senator Nguyen

CHAPTER..........

AN ACT relating to health care; requiring certain hospitals to
establish staffing committees for technical and service staff;
establishing requirements governing the st affing 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 certa in 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
or more (currently Clark and Washoe Counties) to establish a staffing committee,
which must consist, in part, of certain nurses who are on the staff of the hospital.
(NRS 449.242) Existing law requires a hospital and certain other health care
facilities in such counties to develop a documented staffing plan which must
include certain items, such as the number of nurses required in each unit of the
hospital and protocols for adequately staff ing the hospital upon the occurrence of
certain events. (NRS 449.2421) If the health care facility is a hospital, existing law
requires the staffing committee established for the hospital to develop the staffing
plan. (NRS 442.242) Sections 5 and 6 of this bill require each hospital that is
required to establish a staffing committee for nurses to additionally establish a
technical staffing committee and a service staffing committee, respectively, to
represent the technical and service workers of the hospita l. Sections 18-20 of this
bill make conforming changes to refer to existing staffing committees for nurses as
“nursing staffing committees.” Sections 5, 6 and 18 require the technical staffing
committee, the service staffing committee and the nursing staffing committee to
collaborate to develop the documented staffing plan for the hospital. Section 19
requires a documented staffing plan to contain certain provisio ns relating to the
adequate staffing of technical and service workers. Section 23 of this bill requires a
hospital that has established a technical staffing committee and a service staffing
committee to include the members of those committees on the hospit al’s committee
on workplace safety, which performs certain duties relating to the prevention of
workplace violence at the hospital. (NRS 618.7312)
Existing law requires each hospital that is required to establish a nursing
staffing committee to report ann ually to the Legislature concerning the
establishment of the nursing staffing committee, the activities and progress of the
nursing staffing committee and a determination of the efficacy of the nursing
staffing committee. (NRS 449.242) Sections 7 and 18 of this bill require that report
to additionally include such information for the technical staffing committee and
the service staffing committee.
Section 8 of this bill establishes the maximum ratios for the number of patients
that may be assigned to a dir ect care nurse at one time in certain hospitals in a
county whose population is 100,000 or more (currently Clark and Washoe
Counties). The ratios established by section 8 vary based on the unit of the hospital
to which a direct care nurse is assigned. Section 8 also establishes certain other

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staffing requirements for certain hospitals in a county whose population is 100,000
or more (currently Clark and Washoe Counties), including maximum ratios for the
number of patients that may be assigned to a certified nursing assistant, in any unit,
at one time. Section 19 requires the documented staffing plan of a hospital to
provide for staffing in accordance with the maximum ratios of patients to direct
care nurses established by section 8. Section 19 also requires s uch a documented
staffing plan to provide for additional compensation for nurses who perform certain
duties. Section 9 of this bill requires a hospital to maintain certain records
containing information relevant for measuring the compliance of the hospital with
the nurse-to-patient ratios established by section 8.
Section 9.5 of this bill authorizes hospitals which are required to establish a
nursing staffing committee and adhere to the maximum ratios prescribed in section
8 to deviate from those maximum ratios and the documented staffing plan of the
hospital during a state of emergency. Section 9.5 establishes certain procedures that
must be followed by the hospital and the nursing staffing committee upon such a
deviation.
Sections 12 and 13 of this bill authorize the Division of Public and Behavioral
Health of the Department of Health and Human Services to discipline a health care
facility that fails to comply with the requirements of this bill in the same manner as
violations of other requirements govern ing health care facilities. Section 22 of this
bill requires the Division to establish: (1) procedures for random visits to health
care facilities to ensure compliance with the requirements of this bill, where
applicable, and certain other requirements gov erning the staffing of health care
facilities; (2) an accessible and confidential system that allows certain staff of a
health care facility to report a violation of those requirements; and (3) procedures
for timely investigating and resolving such a repor t. Section 10 of this bill
additionally authorizes the Labor Commissioner to take certain actions to ensure
that a health care facility complies with the requirements of this bill, where
applicable, and certain other requirements relating to the staffing o f health care
facilities. Section 15 of this bill prohibits a health care facility from retaliating
against an employee of the facility for reporting a violation to the Division or the
Labor Commissioner.
Existing law requires the establishment of a syste m for rating certain health
care facilities located in a county whose population is 100,000 or more on their
compliance with requirements governing staffing. (NRS 449.2425) Section 21 of
this bill requires the Division to assign a new rating to a facility after an inspection
or investigation conducted pursuant to section 22.
Sections 2-4 of this bill define certain terms relating to the staffing of health
care facilities, and section 17 of this bill establishes the applicability of those
definitions. Sections 11 and 16 of this bill make conforming changes relating to the
applicability and enforcement of sections 2-10.

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- 83rd Session (2025)
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

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
thereto the provisions set forth as sections 2 to 10, inclusive, of this
act.
Sec. 2. “Direct care nurse” means a registered nurse who is
assigned the principal responsibility to oversee or carry out
medical regimens or nursing care , in person and in a hands -on
capacity, for one or more patients.
Sec. 3. “Service staff” means the staff of a health care
facility who:
1. Interact directly with patients or with other staff;
2. Do not provide medical care or related services to patients;
and
3. Are not a part of the technical staff of the health care
facility.
Sec. 4. “Technical staff” means the staff of a health care
facility whose primary job duties relate to servicing medical
equipment and machinery, providing information technology
support services or performing other duties which involve
technical skills and which are not related to the direct provision of
medical care to patients.
Sec. 5. 1. Except as otherwise provided in subsection 4,
each hospital located in a county whose population is 100,000 or
more and which is licensed to have more than 70 beds shall
establish a techn ical staffing committee. Each technical staffing
committee established pursuant to this subsection must consist of:
(a) Not less than one-half of the total members of the technical
staffing committee from the technical staff of the hospital. The
members described in this paragraph must consist of one member
representing each division of the technical staff of the hospital,
elected by the members of the technical staff within that division.
(b) Not less than one-half of the total members of the technical
staffing committee from the managers of the technical staff of the
hospital, appointed by the administration of the hospital.
(c) One alternate member representing each division of the
technical staff of the hospital, elected by the members of the
technical staff within that division.
2. Each time a new technical staffing committee is formed
pursuant to subsection 1, the administration of the hospital shall

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hold an election to select the members described in paragraphs (a)
and (c) of subsection 1. Each m ember of the technical staff at the
hospital must be allowed at least 3 days to vote for:
(a) The regular member described in paragraph (a) of
subsection 1; and
(b) The alternate member described in paragraph (c) of
subsection 1.
3. If a vacancy occurs in a position on a staffing committee
described in paragraph (a) or (c) of subsection 1, a new regular or
alternate member, as applicable, must be elected in the same
manner as his or her predecessor.
4. If a technical staffing committee is established for a
hospital described in subsection 1 through collective bargaining
with an employee organization representing the technical staff of
the hospital:
(a) The hospital is not required to form a technical staffing
committee pursuant to that subsection; and
(b) The technical staffing committee established pursuant to
the collective bargaining agreement shall be deemed to be the
technical staffing committee established for the hospital pursuant
to subsection 1.
5. A technical staffing committee establishe d pursuant to
subsection 1 shall collaborate with the nursing staffing committee
established pursuant to NRS 449.242 and the service staffing
committee established pursuant to section 6 of this act to develop a
documented staffing plan as required by NRS 449.2421.
6. The technical staffing committee of a hospital shall meet at
least quarterly.
Sec. 6. 1. Except as otherwise provided in subsection 4,
each hospital located in a county whose population is 100,000 or
more and which is licensed to have more than 70 beds shall
establish a service staffing committee. Each service staffing
committee established pursuant to this subsection must consist of:
(a) Not less than one -half of the total members of the service
staffing com mittee from the service staff of the hospital. The
members described in this paragraph must consist of one member
representing each division of the service staff of the hospital,
elected by the members of the service staff within that division.
(b) Not less than one -half of the total members of the service
staffing committee from the managers of the service staff
appointed by the administration of the hospital.

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(c) One alternate member representing each division of the
service staff of the hospital, elect ed by the members of the service
staff within that division.
2. Each time a new service staffing committee is formed
pursuant to subsection 1, the administration of the hospital shall
hold an election to select the members described in paragraphs (a)
and (c) of subsection 1. Each member of the service staff at the
hospital must be allowed at least 3 days to vote for:
(a) The regular member described in paragraph (a) of
subsection 1; and
(b) The alternate member described in paragraph (c) of
subsection 1.
3. If a vacancy occurs in a position on a service staffing
committee described in paragraph (a) or (c) of subsection 1, a new
regular or alternate member, as applicable, must be elected in the
same manner as his or her predecessor.
4. If a service staffing committee is established for a hospital
described in subsection 1 through collective bargaining with an
employee organization representing the service staff of the
hospital:
(a) The hospital is not required to form a service staffing
committee pursuant to that subsection; and
(b) The service staffing committee established pursuant to the
collective bargaining agreement shall be deemed to be the service
staffing committee established for the hospital pursuant to
subsection 1.
5. A service staffi ng committee established pursuant to
subsection 1 shall collaborate with the nursing staffing committee
established pursuant to NRS 449.242 and the technical staffing
committee established pursuant to section 5 of this act to develop a
documented staffing plan as required by NRS 449.2421.
6. The service staffing committee of a hospital shall meet at
least quarterly.
Sec. 7. Each hospital located in a county whose population is
100,000 or more and which is licensed to have more than 70 beds
shall prepare a written report concerning the establishment of the
technical staffing committee pursuant to section 5 of this act, the
service staffing committee pursuant to section 6 of this act and
the nursing staffing committee pursuant to NRS 449.242, the
activities and progress of those staffing committees and a
determination of the efficacy of those staffing committees. The
hospital shall submit the report on or before December 31 of each:

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1. Even-numbered year to the Director of the Legislative
Counsel Bureau for transmission to the next regular session of the
Legislature.
2. Odd-numbered year to the Director of the Legislative
Counsel Bureau for transmission to the Joint Interim Standing
Committee on Health and Human Services.
Sec. 8. 1. The ratios for the maximum number of patients
that may be assigned to a direct care nurse in a hospital located in
a county whose population is 100,000 or more and which is
licensed to have more than 70 beds are:
(a) A ratio of one direct care nurse to one patient in each:
(1) Operating room;
(2) Critical care unit;
(3) Intensive care unit;
(4) Postanesthesia unit; or
(5) Unit where a patient receives conscious sedation , as
defined in NRS 449.436.
(b) In each emergency unit:
(1) A ratio of one direct care nurse for each trauma or
critical care patient; and
(2) A ratio of one direct care nurse for ev ery three patients
not described in subparagraph (1).
(c) In each labor and delivery , antepartum, postpartum,
mother-baby or nursery unit, other than a nursery for well babies,
a ratio of:
(1) One direct care nurse for each patient who is:
(I) In active labor; or
(II) In any stage of labor and is experiencing
complications relating to the pregnancy;
(2) One direct care nurse for every two antepartum patients
requiring continuous antepartum fetal monitoring;
(3) One direct care nurse for eve ry three antepartum
patients not described in subparagraph (1) or (2);
(4) During the birth of a child:
(I) One direct care nurse for each patient who is in
labor; and
(II) One additional direct care nurse for each newborn
child, whose sole responsibility is to care for the particular
newborn child;
(5) During the 2-hour period immediately following birth:
(I) One direct care nurse for the postpartum patient and
newborn child; and

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(II) If the birth resulted in multiple children, one d irect
care nurse for each additional newborn child birthed by the
postpartum patient;
(6) During any period more than 2 hours after the birth of
a child:
(I) Except as otherwise provided in subparagraph (7),
one direct care nurse for every two postpartum patients and their
newborn children; and
(II) If a newborn child is in an unstable condition, as
determined by a direct care nurse, one direct care nurse for each
such newborn child;
(7) One direct care nurse for every four postpartum patients
or postoperative gynecological care patients, if each such direct
care nurse is assigned to care for any postpartum patients or
postoperative gynecological care patients, as applicable; and
(8) One direct care nurse for every two newborn children
receiving intermediate care.
(d) A ratio of one direct care nurse for every three patients in
each:
(1) Cardiac telemetry unit;
(2) Intermediate care unit;
(3) Pediatric unit; or
(4) Observational unit.
(e) A ratio of one direct care nurse for every four patients in
each:
(1) Ambulatory care unit;
(2) Oncology unit;
(3) Acute rehabilitation unit;
(4) Medical-surgical unit;
(5) Pre-surgical unit;
(6) Psychiatric unit; or
(7) Unit, including, without limitation, a specialty or
subspecialty unit, not otherwise listed in this subsection.
(f) A ratio of one direct care nurse for every six patients in
each nursery for well babies.
2. A hospital located in a county whose population is 100,000
or more and which is licensed to have more than 70 be ds and
which has an emergency unit shall assign at least one direct care
nurse to the emergency unit to triage patients who present to the
emergency unit. A hospital shall not include a nurse assigned to
triage patients in the calculation of any ratio for the purposes of
subsection 1.

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3. A hospital located in a county whose population is 100,000
or more and which is licensed to have more than 70 beds shall not
include a registered nurse who does not have the principal
responsibility for caring for a patient, including, without
limitation, a nurse administrator or supervisor, in the calculation
of any ratio for the purposes of subsection 1.
4. A hospital located in a county whose population is 100,000
or more and which is licensed to have more than 70 beds shall
adjust its staff as necessary to reflect the need for additional direct
care nurses to ensure that each unit within the hospital i s
adequately staffed in accordance with the requirements of
subsection 1, including, without limitation, when a direct care
nurse takes a meal or rest break.
5. A hospital located in a county whose population is 100,000
or more and which is licensed to h ave more than 70 beds that
includes certified nursing assistants in the nursing staff of the
hospital shall include in its documented staffing plan the
following ratios for the maximum number of patients that may be
assigned to a certified nursing assistant:
(a) During the hours of 6 a.m. until 8 p.m., a ratio of one
certified nursing assistant for every seven patients in any unit.
(b) During the hours of 8:01 p.m., until 5:59 a.m., a ratio of
one certified nursing assistant for every 11 patients in any unit.
6. A hospital located in a county whose population is 100,000
or more and which is licensed to have more than 70 beds shall not
include a certified nursing assistant who does not have the
principal responsibility for caring for a patient in the calculation
of any ratio for the purposes of subsection 5.
7. In addition to any ratio established pursuant to subsections
1 or 5, a hospital located in a county whose population is 100,000
or more and which is licensed to have more than 70 beds shall
assign:
(a) At least one scrub assistant to an operating room for each
patient in the operating room.
(b) At least one patient care technician, nurse apprentice,
patient sitter or other person responsible for the direct observation
and safety of patients f or every two patients in any unit of the
hospital.
8. A hospital located in a county whose population is 100,000
or more and which is licensed to have more than 70 beds may only
assign a registered nurse to a unit or a clinical area and include
the registered nurse in the count of assigned nursing staff for the
purposes of compliance with subsection 1 if:

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(a) The registered nurse is appropriately licensed for
assignment to that unit or clinical area;
(b) The hospital has provided orientation to the registered
nurse before assigning that registered nurse to that unit or clinical
area; and
(c) The hospital has verified that the registered nurse is
capable of providing competent nursing care to the patients in that
unit or clinical area.
9. The provisions of this section:
(a) Do not apply to a psychiatric hospital operated by the
Division.
(b) Do not apply under the circumstances when a hospital is
authorized by the provisions of section 9.5 of this act to deviate
from the maximum ratios established by this section.
(c) Shall not be construed to prohibit a collective bargaining
agreement or documented staffing plan required pursuant to NRS
449.2421 from requiring ratios which are more restrictive than
those required by this section.
10. As used in this section:
(a) “Intensive care unit” means a unit that provides care to
critically ill patients who require advanced treatments such as
mechanical ventilation, vasoactive infusions, continuous renal
replacement treatment or frequent assessment or mon itoring,
including, without limitation, any coronary, acute respiratory,
burn, pediatric or neonatal intensive care unit.
(b) “Intermediate care unit” means a unit that provides
progressive care, intensive specialty care or step-down care.
(c) “Progressive care” means care provided to patients who
need more monitoring and assessment than patients on a general
unit but whose conditions are not so unstable that care in an
intensive care unit is required.
(d) “Step-down care” means care for patients transitioning out
of the intensive care unit who require more care and attention
than patients on a general unit.
Sec. 9. 1. As a condition for licensure, each hospital
located in a county whose population is 100,000 or more and
which is licensed to have more than 70 beds shall maintain
accurate daily records showing for each unit:
(a) The number of patients admitted, released and present in
the unit;
(b) The identity and duty hours of each direct care nurse in the
unit;

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(c) The identity and duty hours of each certified nursing
assistant and licensed practical nurse in the unit; and
(d) Any meal or rest break missed by each direct care nurse in
the unit.
2. As a condition for licensure, each hospital located in a
county whose population is 100,000 or more and which is licensed
to have more than 70 beds shall maintain daily statistics, by unit,
of mortality, morbidity, infection, accident, injury and medical
errors.
3. A hospital located in a county whose population is 100,0 00
or more and which is licensed to have more than 70 beds shall:
(a) Maintain all records required to be maintained by this
section, for at least 7 years after the date on which the record was
created; and
(b) Make all records required to be maintained by this section
available for inspection upon the request of the Division or the
Labor Commissioner.
Sec. 9.5. 1. A hospital located in a county whose population
is 100,000 or more and which is licensed to have more than 70
beds may deviate from a documented staffing plan developed
pursuant to NRS 449.2421 or the maximum ratios prescribed in
section 8 of this act during the existence of a state of emergency.
2. If a hospital deviates from a documented staffing plan
developed pursuant to NRS 449.2421 or the maximum ratios
prescribed in section 8 of this act pursuant to subsection 1, the
hospital shall, not later than 30 days af ter the deviation, report to
the co-chairs of the nursing staffing committee established by the
hospital pursuant to NRS 449.242 or, if the committee has not
elected co -chairs, report to two persons appointed by the
committee to serve as liaisons during th e state of emergency . The
report must contain an assessment of the needs of the hospital
with respect to the staffing of nurses arising from the emergency.
3. If the state of emergency requires the hospital to continue
to deviate from the documented staffing plan developed pursuant
to NRS 449.2421 or the maximum ratios prescribed in section 8 of
this act when the nursing staffing committee receives the report
described in subsection 2, the nursing staffing committee shall
develop a contingency documented staffing plan for the staffing or
nurses that addresses the needs identified in the report. The
contingency documented staffing plan developed pursuant to this
subsection must include standards of care for crises which may
arise from the state of emergency.

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4. A hospital may not continue to deviate from the
documented staffing plan developed pursuant to NRS 449.2421 or
the maximum ratios prescribed in section 8 of this act for more
than 90 days, unless the hospital first receives the approval of the
nursing staffing committee.
5. As used in this section, “state of emergency” means:
(a) A state of emergency or declaration of disaster pursuant to
NRS 414.070;
(b) A public health emergency or other event pursuant to
NRS 439.970;
(c) A state of emergency declared by an agency of the Federal
Government; or
(d) An event similar to the events described in paragraph (a),
(b) and (c) which requires a hospital to utilize standards of care
for crisis situations.
Sec. 10. 1. The Labor Commissioner shall collaborate with
the Division to ensure compliance with the provisions of NRS
449.242 to 449.2428, inclusive, and sections 2 to 10, inclusive, of
this act. The Labor Commissioner may:
(a) Inspect a health care facility to assess compliance with
NRS 449.242 to 449.2428, inclusive, and sections 2 to 10,
inclusive, of this act;
(b) Accept reports of alleged violation s of NRS 449.242 to
449.2428, inclusive, and sections 2 to 10, inclusive, of this act;
(c) Investigate an alleged violation of NRS 449.242 to
449.2428, inclusive, and sections 2 to 10, inclusive, of this act or
assist the Division with such an investigation; and
(d) Report a violation of NRS 449.242 to 449.2428, inclusive,
and sections 2 to 10, inclusive, of this act to the Division.
2. Upon receiving from the Labor Commissioner pursuant to
paragraph (d) of subsection 1 a report that a health care facility
has violated NRS 449.242 to 449.2428, inclusive, and sections 2 to
10, inclusive, of this act, the Division shall initiate disciplinary
proceedings against the health care facility.
Sec. 11. NRS 449.0301 is hereby amended to read as follows:
449.0301 The provisions of NRS 449.029 to 449.2428,
inclusive, and sections 2 to 10, inclusive, of this act, do not apply
to:
1. Any facility conducted by and for the adherents of any
church or religious denomination for the purpose of providing
facilities for the care and treatment of the sick who depend solely
upon spiritual means through prayer for healing in the practice of
the religion of the church or denomination, except that such a

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facility shall comply with all regulations relative to sanitation and
safety applicable to other facilities of a similar category.
2. Foster homes as defined in NRS 424.014.
3. Any medical facility , facility for the dependent or facility
which is otherwise required by the regulations adopted by the Board
pursuant to NRS 449.0303 to be licensed that is operated and
maintained by the United States Government or an agency thereof.
Sec. 12. NRS 449.160 is hereby amended to read as follows:
449.160 1. The Division may deny an application for a
license or may suspend or revoke any license issued under the
provisions of NRS 449.029 to 449.2428, inclusive, and sections 2 to
10, inclusive, of this act upon any of the following grounds:
(a) Violation by the applicant or the licensee of any of the
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and
sections 2 to 10, inclusive, of this act, or 449A.100 to 449A.124,
inclusive, and 449A.270 to 449A.286, inclusive, or of any other law
of this State or of the standards, rules and regulations adopted
thereunder.
(b) Aiding, abetting or permitting the commission of any illegal
act.
(c) Conduct inimical to the public health, morals, welfare and
safety of the people of the State of Nevada in the maintenanc e and
operation of the premises for which a license is issued.
(d) Conduct or practice detrimental to the health or safety of the
occupants or employees of the facility.
(e) Failure of the applicant to obtain written approval from the
Director of the Dep artment of Health and Human Services as
required by NRS 439A.100 or 439A.102 or as provided in any
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive,
and sections 2 to 10, inclusive, of this act, and 449.435 to 449.531,
inclusive, and chapte r 449A of NRS if such approval is required,
including, without limitation, the closure or conversion of any
hospital in a county whose population is 100,000 or more that is
owned by the licensee without approval pursuant to NRS 439A.102.
(f) Failure to comply with the provisions of NRS 441A.315 and
any regulations adopted pursuant thereto or NRS 449.2486.
(g) Violation of the provisions of NRS 458.112.
(h) Failure to comply with the provisions of NRS 449A.170 to
449A.192, inclusive, and any regulation adopted pursuant thereto.
(i) Violation of the provisions of NRS 629.260.
2. In addition to the provisions of subsection 1, the Division
may revoke a license to operate a facility for the dependent if, with

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respect to that facility, the licensee that op erates the facility, or an
agent or employee of the licensee:
(a) Is convicted of violating any of the provisions of
NRS 202.470;
(b) Is ordered to but fails to abate a nuisance pursuant to NRS
244.360, 244.3603 or 268.4124; or
(c) Is ordered by the appropriate governmental agency to correct
a violation of a building, safety or health code or regulation but fails
to correct the violation.
3. The Division shall maintain a log of any complaints that it
receives relating to activities for which the Divis ion may revoke the
license to operate a facility for the dependent pursuant to subsection
2. The Division shall provide to a facility for the care of adults
during the day:
(a) A summary of a complaint against the facility if the
investigation of the comp laint by the Division either substantiates
the complaint or is inconclusive;
(b) A report of any investigation conducted with respect to the
complaint; and
(c) A report of any disciplinary action taken against the facility.
 The facility shall make the information available to the public
pursuant to NRS 449.2486.
4. On or before February 1 of each odd -numbered year, the
Division shall submit to the Director of the Legislative Counsel
Bureau a written report setting forth, for the previous biennium:
(a) Any complaints included in the log maintained by the
Division pursuant to subsection 3; and
(b) Any disciplinary actions taken by the Division pursuant to
subsection 2.
Sec. 13. NRS 449.163 is hereby amended to read as follows:
449.163 1. In addition to the payment of the amount required
by NRS 449.0308, if a medical facility, facility for the dependent or
facility which is required by the regulations adopted by the Board
pursuant to NRS 449.0303 to be licensed violat es any provision
related to its licensure, including any provision of NRS 439B.410 or
449.029 to 449.2428, inclusive, and sections 2 to 10, inclusive, of
this act, or any condition, standard or regulation adopted by the
Board, the Division, in accordance w ith the regulations adopted
pursuant to NRS 449.165, may:
(a) Prohibit the facility from admitting any patient until it
determines that the facility has corrected the violation;

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(b) Limit the occupancy of the facility to the number of beds
occupied when the violation occurred, until it determines that the
facility has corrected the violation;
(c) If the license of the facility limits the occupancy of the
facility and the facility has exceeded the approved occupancy,
require the facility, at its own expen se, to move patients to another
facility that is licensed;
(d) Except where a greater penalty is authorized by subsection 2,
impose an administrative penalty of not more than $5,000 per day
for each violation, together with interest thereon at a rate not to
exceed 10 percent per annum; and
(e) Appoint temporary management to oversee the operation of
the facility and to ensure the health and safety of the patients of the
facility, until:
(1) It determines that the facility has corrected the violation
and has management which is capable of ensuring continued
compliance with the applicable statutes, conditions, standards and
regulations; or
(2) Improvements are made to correct the violation.
2. If an off -campus location of a hospital fails to obtain a
national provider identifier that is distinct from the national provider
identifier used by the main campus and any other off -campus
location of the hospital in violation of NRS 449.1818, the Division
may impose against the hospital an administrative penalt y of not
more than $10,000 for each day of such failure, together with
interest thereon at a rate not to exceed 10 percent per annum, in
addition to any other action authorized by this chapter.
3. If the facility fails to pay any administrative penalty imposed
pursuant to paragraph (d) of subsection 1 or subsection 2, the
Division may:
(a) Suspend the license of the facility until the administrative
penalty is paid; and
(b) Collect court costs, reasonable attorney’s fees and other
costs incurred to collect the administrative penalty.
4. The Division may require any facility that violates any
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and
sections 2 to 10, inclusive, of this act or any condition, standard or
regulation adopted by t he Board to make any improvements
necessary to correct the violation.
5. Any money collected as administrative penalties pursuant to
paragraph (d) of subsection 1 or subsection 2 must be accounted for
separately and used to administer and carry out the provisions of
NRS 449.001 to 449.430, inclusive, and sections 2 to 10, inclusive,

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of this act, 449.435 to 449.531, inclusive, and chapter 449A of NRS
to protect the health, safety, well -being and property of the patients
and residents of facilities in acco rdance with applicable state and
federal standards or for any other purpose authorized by the
Legislature.
Sec. 14. (Deleted by amendment.)
Sec. 15. NRS 449.205 is hereby amended to read as follows:
449.205 1. A medical facility or any agent or employee
thereof shall not retaliate or discriminate unfairly against:
(a) An employee of the medical facility or a person acting on
behalf of the employee who in good faith:
(1) Reports to the Board of Medical Examiners or the State
Board of Osteopathic Medicine, as applicable, information relating
to the conduct of a physician which may constitute grounds for
initiating disciplinary action against the physician or which
otherwise raises a reaso nable question regarding the competence of
the physician to practice medicine with reasonable skill and safety
to patients;
(2) Reports a sentinel event to the Division pursuant to NRS
439.835; [or]
(3) Cooperates or otherwise participates in an invest igation
or proceeding conducted by the Board of Medical Examiners, the
State Board of Osteopathic Medicine or another governmental entity
relating to conduct described in subparagraph (1) or (2); or
(4) Reports to the Division or the Labor Commissioner a ny
information concerning a potential or actual violation of the
provisions of NRS 449.242 to 449.2428, inclusive, and sections 2
to 10, inclusive, of this act;
(b) A registered nurse, licensed practical nurse, nursing assistant
or medication aide - certified who is employed by or contracts to
provide nursing services for the medical facility and who:
(1) In accordance with the policy, if any, established by the
medical facility:
(I) Reports to his or her immediate supervisor, in writing,
that he or she does not possess the knowledge, skill or experience to
comply with an assignment to provide nursing services to a patient;
and
(II) Refuses to provide to a patient nursing services for
which, as verified by documentation in the personnel file of the
registered nurse, licensed practical nurse, nursing assistant or
medication aide - certified concerning his or her competence to
provide various nursing services, he or she does not possess the
knowledge, skill or experience to comply with the assignment t o

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provide nursing services to the patient, unless the refusal constitutes
unprofessional conduct as set forth in chapter 632 of NRS or any
regulations adopted pursuant thereto;
(2) In accordance with a policy adopted pursuant to NRS
449.2423, requests to be relieved of, refuses or objects to a work
assignment;
(3) In good faith, reports to the medical facility, the Board of
Medical Examiners, the State Board of Osteopathic Medicine, the
State Board of Nursing, the Legislature or any committee thereof or
any other governmental entity:
(I) Any information concerning the willful conduct of
another registered nurse, licensed practical nurse, nursing assistant
or medication aide - certified which violates any provision of
chapter 632 of NRS or which is req uired to be reported to the State
Board of Nursing;
(II) Any concerns regarding patients who may be exposed
to a substantial risk of harm as a result of the failure of the medical
facility or any agent or employee thereof to comply with minimum
professional or accreditation standards or applicable statutory or
regulatory requirements; or
(III) Any other concerns regarding the medical facility,
the agents and employees thereof or any situation that reasonably
could result in harm to patients; or
(4) Refuses to engage in conduct that would violate the duty
of the registered nurse, licensed practical nurse, nursing assistant or
medication aide - certified to protect patients from actual or
potential harm, conduct which would violate any provision of
chapter 632 of NRS or conduct which would subject the registered
nurse, licensed practical nurse, nursing assistant or medication aide -
certified to disciplinary action by the State Board of Nursing; or
(c) An employee or other provider of care who takes an action
described in subsection 3 of NRS 618.7315.
2. A medical facility or any agent or employee thereof shall not
retaliate or discriminate unfairly against an employee of the medical
facility or a registered nurse, licensed practical nurse, nursing
assistant or medication aide - certified who is employed by or
contracts to provide nursing services for the medical facility because
the employee, registered nurse, licensed practical nurse, nursing
assistant or medication aide - certified has taken an action described
in subsection 1.
3. A medical facility or any agent or employee thereof shall not
prohibit, restrict or attempt to prohibit or restrict by contract, policy,
procedure or any other manner the right of an employee of the

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medical facility or a registered nurse, licensed practical nurse,
nursing assistant or medication aide - certified who is employed by
or contracts to provide nursing services for the medical facility to
take an action described in subsection 1.
4. As used in this section:
(a) “Good faith” means honesty in fact in the reporting of the
information or in the cooperation in the investigation concerned.
(b) “Physician” means a person licensed to practice medicine
pursuant to chapter 630 or 633 of NRS.
(c) “Retaliate or discriminate”:
(1) Includes, without limitation, any of the following actions
if taken solely because the employee, registered nurse, licensed
practical nurse, nursing assistant or medication aide - certified took
an action described in subsection 1:
(I) Frequent or undesirable changes in the location where
the person works;
(II) Frequent or undesirable transfers or reassignments;
(III) The issuance of letters of reprimand, letters of
admonition or evaluations of poor performance;
(IV) A demotion;
(V) A reduction in pay;
(VI) The denial of a promotion;
(VII) A suspension;
(VIII) A dismissal;
(IX) A transfer; or
(X) Frequent changes in working hours or workdays.
(2) Does not include an action described in sub -
subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action
is taken in the normal course of employment or as a form of
discipline.
Sec. 16. NRS 449.240 is hereby amended to read as follows:
449.240 The district attorney of the county in which the facility
is located shall, upon application by the Division, institute and
conduct the prosecution of any action for violation of any provisions
of NRS 449.029 to 449.245, inclusive [.] and sections 2 to 10,
inclusive, of this act.
Sec. 17. NRS 449.241 is hereby amended to read as follows:
449.241 As used in NRS 449.241 to 449.2428, inclusive, and
sections 2 to 10, inclusive, of this act, unless the context otherwise
requires, the words and terms define d in NRS 449.2413 to
449.2418, inclusive, and sections 2, 3 and 4 of this act have the
meanings ascribed to them in those sections.

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Sec. 18. NRS 449.242 is hereby amended to read as follows:
449.242 1. Except as otherwise provided in subsection 4,
each hospital located in a county whose population is 100,000 or
more and which is licensed to have more than 70 beds shall
establish a nursing staffing committee . [to develop a written policy
as required purs uant to NRS 449.2423 and a documented staffing
plan as required pursuant to NRS 449.2421. ] Each nursing staffing
committee established pursuant to this subsection must consist of:
(a) Not less than one -half of the total regular members of the
nursing staffing committee from the licensed nursing staff and
certified nursing assistants who are providing direct patient care at
the hospital. The members described in this paragraph must consist
of:
(1) One member representing each unit of the hospital who is
a licensed nurse who provides direct patient care on that unit,
elected by the licensed nursing staff who provide direct patient care
on the unit that the member will represent.
(2) One member representing each unit of the hospital who is
a certified nursing assistant who provides direct patient care on that
unit, elected by the certified nursing assistants who provide direct
patient care on the unit that the member will represent.
(b) Not less than one -half of the total regular members of the
nursing staffing committee appointed by the administration of the
hospital.
(c) One alternate member representing each unit of the hospital
who is a licensed nurse or certified nursing assistant who provides
direct patient care on that unit, elected by the licensed nursing staff
and certified nursing assistants who provide direct patient care on
the unit that the member represents.
2. Each time a new nursing staffing committee is formed
pursuant to subsection 1, the administration of the hospital shall
hold an elec tion to select the members described in paragraphs (a)
and (c) of subsection 1. Each licensed nurse and certified staffing
assistant who provides direct patient care at the hospital must be
allowed at least 3 days to vote for:
(a) The regular member described in paragraph (a) of subsection
1 who will represent his or her unit and profession; and
(b) The alternate member described in paragraph (c) of
subsection 1 who will represent his or her unit.
3. If a vacancy occurs in a position on a nursing staffing
committee described in paragraph (a) or (c) of subsection 1, a new
regular or alternate member, as applicable, must be elected in the
same manner as his or her predecessor.

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4. If a nursing staffing committee is established for a health
care facility described in subsection 1 through collective bargaining
with an employee organization representing the licensed nursing
staff and certified nursing assistants of the health care facility:
(a) The health care facility is not required to form a nursing
staffing committee pursuant to that subsection; and
(b) The nursing staffing committee established pursuant to the
collective bargaining agreement shall be deemed to be the nursing
staffing committee established for the health care facility pursuant to
subsection 1.
5. In developing the written policy and the staffing plan [,] as
described in subsection 6, the nursing staffing committee shall
consider, without limitation, the information received pursuant to
paragraph (b) of subsection 5 of NRS 449.2423 regarding requests
to be relieved of a work assignment, refusals of a work assignment
and objections to a work assignment.
6. The nursing staffing committee shall:
(a) Collaborate with the technical staffing committee
established pursuant to se ction 5 of this act and the service
staffing committee established pursuant to section 6 of this act to
develop a documented staffing plan as required by NRS 449.2421;
and
(b) Develop a written policy as required by NRS 449.2423.
7. The nursing staffing committee of a hospital shall meet at
least quarterly.
[7. Each hospital that is required to establish a staffing
committee pursuant to this section shall prepare a written report
concerning the establishment of the staffing committee, the
activities and progress of the staffing committee and a determination
of the efficacy of the staffing committee. The hospital shall submit
the report on or before December 31 of each:
(a) Even-numbered year to the Director of the Legislative
Counsel Bureau for transmi ssion to the next regular session of the
Legislature.
(b) Odd-numbered year to the Joint Interim Standing Committee
on Health and Human Services.]
Sec. 19. NRS 449.2421 is hereby amended to read as follows:
449.2421 1. As a condition of licensing, a health care facility
located in a county whose population is 100,000 or more and which
is licensed to have more than 70 beds shall make available to the
Division a written policy adopted pursuant to NRS 449.2423 , a
documented staffing plan and a written certification that the written
policy and the documented staffing plan are adequate to meet the

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- 83rd Session (2025)
needs of the patients of the health care facility. If the health care
facility is a hospital [, the] :
(a) The written policy [and the documented staffing plan] must:
[(a)] (1) Be signed by each member of the nursing staffing
committee of the hospital established pursuant to NRS 449.242 to
indicate that the member has received a copy of the written policy
[and the staffing plan] and, if applicable, actively participated in the
development of the written policy ; [and the staffing plan;] and
[(b)] (2) Include a place where a member of the nursing staffing
committee may note any objections to the written policy . [or the
staffing plan.]
(b) The documented staffing plan must:
(1) Be signed by each member of the staffing committees of
the hospital established pursuant to NRS 449.242 and sections 5
and 6 of this act to indicate that the member has received a copy of
the s taffing plan and, if applicable, actively participated in the
development of the staffing plan; and
(2) Include a place where a member of a staffing committee
may note any objections to the staffing plan.
2. The documented staffing plan must include, w ithout
limitation:
(a) A detailed written plan setting forth:
(1) The number, skill mix and classification of licensed
nurses required in each unit in the health care facility, which must
[take] :
(I) Take into account the experience of the clinical and
nonclinical support staff with whom the licensed nurses collaborate,
supervise or otherwise delegate assignments; and
(II) If the health care facility is a hospital, conform to
the maximum ratios prescribed in section 8 of this act; and
(2) The nu mber of certified nursing assistants required in
each unit in the health care facility [;] , which must conform to the
maximum ratios prescribed in section 8 of this act if the health
care facility is a hospital;
(b) A description of the types of patients who are treated in each
unit, including, without limitation, the type of care required by the
patients;
(c) A description of the activities in each unit, including, without
limitation, discharges, transfers and admissions;
(d) A description of the size and geography of each unit;
(e) A description of any specialized equipment and technology
available for each unit;

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(f) Any foreseeable changes in the size or function of each unit;
[and]
(g) Protocols for adequately staffing the health care facility:
(1) In the event of an emergency, including, without
limitation, mass casualties and a significant change in the acuity or
number of patients;
(2) If applicable, in circumstances when a significant number
of patients are diverted from another facility; and
(3) If a licensed nurse or certified nursing assistant is absent
or refuses a work assignment pursuant to NRS 449.2423 [.] ;
(h) If the health care facility is a hospital, policies to provide
additional compensation for licensed nurses who:
(1) Are assigned to float between units;
(2) Perform duties that involve unusual hazards; or
(3) Serve as preceptors; and
(i) A plan for maintaining adequate staffing levels for the
technical and service staff of the health care facility as necessary
for the facility to:
(1) Minimize or reduce the potential for any disruption of
the physical or technical capabilities of the health care facility, for
which the availability of such capabilities are necessary to safely
and efficiently provide care to patients; and
(2) Ensure the efficient admission of patients and the timely
administration of care to patients.
3. A documented staffing plan must provide sufficient
flexibility to allow for adjustments based upon changes in a unit of
the health care facility.
4. [The] Except as otherwise provided in section 9.5 of this
act, the health care facility shall ensure that it is staffed in
accordance with the documented staffing plan.
Sec. 20. NRS 449.2423 is hereby amended to read as follows:
449.2423 1. As a condition of licensure, a health care facility
which is located in a county whose population is 100,000 or more
and which is licensed to have more than 70 beds must adopt and
disseminate to each licensed nurse and cert ified nursing assistant
employed by the health care facility a written policy that sets forth
the circumstances under which a licensed nurse or certified nursing
assistant may refuse or object to a work assignment.
2. The written policy concerning work a ssignments must, at a
minimum, allow a licensed nurse or certified nursing assistant to:
(a) Refuse a work assignment for any reason for refusal set forth
in paragraph (b) of subsection 1 of NRS 449.205; and

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- 83rd Session (2025)
(b) File an objection to a work assignment if the work
assignment violates any provision of NRS 449.241 to 449.2428,
inclusive [.] , and sections 2 to 10, inclusive, of this act.
3. For the purposes of refusing a work assignment pursuant to
paragraph (a) of subsection 2, the written policy concernin g work
assignments must contain:
(a) Reasonable requirements for prior notice to the supervisor of
the licensed nurse or certified nursing assistant of the request by the
licensed nurse or certified nursing assistant to be relieved of the
work assignment, including, without limitation, the reasons
supporting the request;
(b) Reasonable requirements which provide, if feasible, an
opportunity for the supervisor to review a request by the licensed
nurse or certified nursing assistant to be relieved of the wo rk
assignment, including any specific conditions supporting the
request, and based upon that review:
(1) Relieve the licensed nurse or certified nursing assistant of
the work assignment as requested; or
(2) Deny the request; and
(c) A process pursuant to which a licensed nurse or certified
nursing assistant may exercise his or her right to refuse a work
assignment if the supervisor does not approve the request to be
relieved of the work assignment if:
(1) The supervisor failed to approve the request without
proposing a remedy or, if a remedy is proposed, the proposed
remedy would be inadequate or untimely;
(2) The process for filing a complaint with the Division or
any other appropriate regulatory entity, including any investigation
that would be re quired, would be untimely to address the concerns
of the licensed nurse or certified nursing assistant in refusing a work
assignment; and
(3) The licensed nurse or certified nursing assistant in good
faith believes that the work assignment meets the cond itions
established in the written policy justifying refusal.
4. For the purposes of objecting to a work assignment pursuant
to paragraph (b) of subsection 2, the written policy concerning work
assignments must contain:
(a) A process for a licensed nurse or certified nursing assistant
to file an objection with the health care facility, but still accept the
work assignment despite the objection; and
(b) A requirement that the health care facility respond to the
objection as soon as practicable, but not la ter than 45 days after
receiving the objection.

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- 83rd Session (2025)
5. The health care facility shall:
(a) Maintain records for at least 2 years of each request to be
relieved of a work assignment, each refusal of a work assignment
and each objection to a work assignment t hat is filed with the health
care facility pursuant to the written policy adopted pursuant to this
section;
(b) If the health care facility has established a nursing staffing
committee pursuant to NRS 449.242, provide to the nursing staffing
committee:
(1) The number of requests to be relieved of a work
assignment and refusals of a work assignment made by a licensed
nurse or a certified nursing assistant at the health care facility
pursuant to this section;
(2) The number of objections to a work assignment filed by a
licensed nurse or a certified nursing assistant at the health care
facility pursuant to this section; and
(3) An explanation of how the health care facility addressed
the requests, refusals and objections; and
(c) Ensure that the health care facility complies with the written
policy adopted pursuant to this section.
Sec. 21. NRS 449.2425 is hereby amended to read as follows:
449.2425 1. The Division shall adopt regulations
establishing:
(a) A system for rating each health care facility located in a
county whose population is 100,000 or more and which is licensed
to have more than 70 beds on the compliance by the facility with the
provisions of this section and NRS 449.241 to 449.2428, inclusi ve,
and sections 2 to 10, inclusive, of this act, including, without
limitation, the number of resolved and unresolved violations and the
severity of those violations. The rating system must provide for the
assignment of a star rating of not more than five stars and not less
than one star to each such facility after:
(1) Each inspection conducted by the Division pursuant to
NRS 449.132 [;] and 449.2428.
(2) Each investigation conducted by the Division pursuant to
NRS 449.0307 and 449.2428 concerning a complaint that alleges a
violation of the provisions of this section and NRS 449.241 to
449.2428, inclusive [.] , and sections 2 to 10, inclusive, of this act.
(b) Procedures by which a health care facility located in a
county whose population is 100,000 or more and which is licensed
to have more than 70 beds may, not later than 30 days after an
investigation or inspection, appeal a finding concerning a violation
of the provisions of this section and NRS 449.241 to 449.2428,

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- 83rd Session (2025)
inclusive, and sections 2 to 10 , inclusive, of this act or request a
follow-up inspection.
2. A star rating assigned pursuant to subsection 1 becomes
final:
(a) Thirty days after the investigation or inspection on which the
star rating is based; or
(b) After the completion of any follow-up inspection or the final
determination of any appeal pursuant to subsection 1,
 whichever is later.
3. Not later than 5 days after a star rating becomes final
pursuant to subsection 2, the Division shall post on an Internet
website maintained by the Division a report which must include:
(a) The final star rating assigned to the facility pursuant to
subsection 1; and
(b) A report of each unresolved violation of an applicable statute
or regulation and all proposed actions to correct the violation.
4. A health care facility located in a county whose population
is 100,000 or more and which is licensed to have more than 70 beds
shall post the final star rating assigned to the facility pursuant to
subsection 1 after the most recent investigation or inspection in a
conspicuous place near each entrance to the facility that is regularly
used by the public and, if the facility maintains an Internet website
that is accessible to the public, on that Internet website.
Sec. 22. NRS 449.2428 is hereby amended to read as follows:
449.2428 For each health care facility which is located in a
county whose population is 100,000 or more and which is licensed
to have more than 70 beds, the Division shall:
1. Ensure the general compliance of the health care facility
with the provisions of NRS 449.241 to 449.2428, inclusive, and
sections 2 to 10, inclusive, of this act, including, without limitation,
those provisions relating to documented staffing plans and written
policies adopted pursuant to NRS 449.2421 and 449.2423 [;] ,
respectively; and
2. Adopt such regulations as are necessary or appropriate to
carry out the provisions of this section. The regulations must
provide:
(a) For unannounced, random visits at a health care facility to
determine whether the facility is in compliance with NRS 449.241
to 449.2428, inclusive, and sections 2 to 10, inclusive, of this act.
(b) An accessible and confidential system pursuant to wh ich
the nursing, technical and service staff of a hospital may report
the failure of the hospital to comply with the provisions of NRS

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- 83rd Session (2025)
449.241 to 449.2428, inclusive, and sections 2 to 10, inclusive, of
this act.
(c) Procedures for timely investigating an d resolving a report
received pursuant to the system described in paragraph (b). The
procedures must include, without limitation, a requirement that
the Division:
(1) Investigate and resolve a report within the applicable
maximum amount of time prescribe d for the investigation of
complaints or incidents by the Centers for Medicare and Medicaid
Services of the United States Department of Health and Human
Services, based on intake priority, in accordance with the State
Operations Manual published by the Cen ters for Medicare and
Medicaid Services , unless the applicable circumstances of an
investigation require additional time; and
(2) Take appropriate disciplinary action pursuant to NRS
449.160 or 449.163, as appropriate, against a health care facility
that is found to have violated the provisions of NRS 449.241 to
449.2428, inclusive, and sections 2 to 10, inclusive, of this act
pursuant to an investigation completed pursuant to the procedures
described in this paragraph.
(d) A systematic means for investi gating and correcting
violations of any provision of NRS 449.241 to 449.2428, inclusive,
and sections 2 to 10, inclusive, of this act.
Sec. 23. NRS 618.7312 is hereby amended to read as follows:
618.7312 1. A medical facility shall:
(a) Establish a committee on workplace safety, which must
consist of:
(1) If [a] staffing [committee has ] committees have been
established for the medical facility pursuant to NRS 449.242 and
sections 5 and 6 of this act or an applicable collective bargaining
agreement:
(I) The members of [the] each staffing committee; and
(II) Employees of the medical facility who work in areas
of the medical facility other than those represented on the staffing
[committee,] committees, appointed by the operator of the medical
facility.
(2) If [a staffing committee has ] staffing committees have
not been established for the medical facility pursuant to NRS
449.242 or sections 5 or 6 of this act or an applicable collective
bargaining agreement, employees of the medical facility appointed
by the operator of the medical facility. Such employees must
include, without limitation, employees who work in all major areas
of the medical facility.

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(b) Develop and maintain a plan for the pre vention of and
response to workplace violence. The plan must:
(1) Be in writing;
(2) Be in effect at all times;
(3) Be available to be viewed by each employee of the
medical facility or other provider of care at the medical facility at all
times;
(4) Be specific for each unit, area and location maintained by
the medical facility; and
(5) Be developed in collaboration with the committee on
workplace safety established pursuant to paragraph (a).
2. The plan developed pursuant to paragraph (b) of subsection
1 must include, without limitation:
(a) A requirement that all employees of the medical facility and
other providers of care at the medical facility receive the training
described in NRS 618.7313 concerning the prevention of workplace
violence:
(1) Upon the adoption of a new plan for the prevention of
workplace violence;
(2) Upon commencing employment and annually thereafter;
(3) Upon commencing new job duties in a new location of
the medical facility or a new assignment in a new location of the
medical facility; and
(4) When a previously unrecognized hazard is identified or
there is a material change in the facility requiring a change to the
plan.
(b) Procedures that meet the requirements of NRS 618.7314 for
responding to and investigating incidents of workplace violence.
(c) Procedures that meet the requirements of the regulations
adopted pursuant to NRS 618.7317 for assessing and responding to
situations that create the potential for workplace violence.
(d) Procedures for correcting hazards that increase the risk of
workplace violence, including, without limitation, using engineering
controls that are feasible and applicable to the medical facility and
work practice controls to eliminate or minimize exposure of
employees and other providers of care to such hazards.
(e) Procedures for obtaining assistance from security guards or
public safety agencies when appropriate.
(f) Procedures for responding to incidents involving an active
shooter and other threats of mass casualties through the use of plans
for evacuation and sheltering that are feasible and appropriate for
the medical facility.

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(g) Procedures for annually assessing, in collaboration with the
committee on workplace safety established pursuant to par agraph
(a) of subsection 1, the effectiveness of the plan.
Sec. 24. The provisions of NRS 354.599 do not apply to any
additional expenses of a local government that are related to the
provisions of this act.
Sec. 25. The provisions of subsection 1 of NRS 218D.380 do
not apply to any provision of this act which adds or revises a
requirement to submit a report to the Legislature.
Sec. 26. 1. This section becomes effective upon passage and
approval.
2. Sections 1 to 25, inclusive, of this act become effective:
(a) Upon passage and approval for the purpose of adopting any
regulations and performing any other preparatory administrative
tasks that are necessary to carry out the provisions of this act; and
(b) On October 1, 2025, for all other purposes.

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