Establishes minimum registered professional nurse staffing standards for hospitals and ambulatory surgery facilities and certain DHS facilities.

A1971

ASSEMBLY, No. 1971

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman ANNETTE QUIJANO

District 20 (Union)

Assemblyman CLINTON CALABRESE

District 36 (Bergen and Passaic)

Assemblyman ANTHONY S. VERRELLI

District 15 (Hunterdon and Mercer)

Co-Sponsored by:

Assemblywomen Reynolds-Jackson, Drulis, Murphy, Assemblyman
Freiman and Assemblywoman Park

SYNOPSIS

���� Establishes minimum registered professional nurse
staffing standards for hospitals and ambulatory surgery facilities and certain
DHS facilities.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act

concerning nurse staffing standards in inpatient health care facilities and
certain State facilities and supplementing Titles 26

and 30 of the
Revised Statutes.

����
Be It Enacted

by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� The Legislature finds
and declares that:

���� a.��� Because of recent
changes in the health care delivery system, patients in general and special
hospitals and

ambulatory surgery facilities in the State, and in State
developmental centers and psychiatric hospitals, generally have higher acuity
levels than in the past;

���� b.��� Recent studies
demonstrate the link between adequate registered professional nurse staffing
and improved mortality rates and quality of care among patients in health care
facilities;

���� c.��� Inadequate nurse
staffing can result in dangerous medical errors, patient infections, and
increased injuries to patients and caregivers;

���� d.��� Inadequate and poorly
monitored nurse staffing practices jeopardize the delivery of health care
services and adversely impact the health of patients;

���� e.��� The establishment of
staffing standards for registered professional nurses in hospitals, ambulatory
surgery facilities, and State developmental centers and psychiatric hospitals

should not be construed as justifying understaffing with respect to other
critical health care workers; safe staffing practices recognize the importance
of all health care workers in providing quality patient care because the
availability of these other health care workers enables registered professional
nurses to focus on the nursing care functions that only these nurses, by law,
are permitted to perform; and

���� f.���� Understaffing at
hospitals, ambulatory surgery facilities, and State developmental centers and
psychiatric hospitals has been demonstrated to be an underlying cause of the
current nursing shortage, because higher patient assignments create higher
levels of job dissatisfaction, burnout, and turnover rates among nurses.

���� 2.��� a.� In addition to
staffing requirements provided by law or regulation on the effective date of
this act, the Commissioner of Health shall adopt regulations that provide
minimum direct care registered professional nurse-to-patient staffing ratios
for all patient units in general and special hospitals, State psychiatric
hospitals, and ambulatory surgical facilities in accordance with the
requirements of this act.� The regulations shall not decrease any
nurse-to-patient staffing ratios in effect on the effective date of this act.

���� b.��� The regulations adopted
pursuant to this section shall, at a minimum, provide for the following
nurse-to-patient ratios:

���� (1)� one registered
professional nurse for every five patients on a medical/surgical unit;

���� (2)� one registered
professional nurse for every four patients in a step down, telemetry, or
intermediate care unit;

���� (3)� one registered
professional nurse for every four patients in an emergency department, one
registered professional nurse for every two patients in a critical care service
of an emergency department, and one registered professional nurse for every
patient in a trauma service of an emergency department;

���� (4)� one registered
professional nurse for every five patients in a behavioral health or
psychiatric unit;

���� (5)� one registered
professional nurse for every two patients in a critical care, intensive care,
neonatal, or burn unit;

���� (6)� one registered
professional nurse for every patient under anesthesia in an operating room,

and
one registered professional nurse for every two post-anesthesia patients in a
recovery room or post-anesthesia care unit;

���� (7)� one registered
professional nurse for every two patients in a labor and delivery unit; one
registered professional nurse for every four patients, including infants, in a
postpartum unit in which the mother and infant share the same room; and one
registered professional nurse for every six patients in a mothers-only unit;
and

���� (8)� one registered
professional nurse for every four patients in a pediatric or intermediate care
nursery unit, and one registered professional nurse for every six patients in a
well-baby nursery.

���� c.��� As used in this section
and section 3 of this act, "direct care registered professional
nurse" means a registered professional nurse who is assigned to provide
care for one or more patients in a specific unit, service, or department and is
directly responsible for carrying out procedures, assessments, or other nursing
protocols.

���� 3.��� a.� The Commissioner of
Health shall require all general and special hospitals, State psychiatric
hospitals, and ambulatory surgical facilities to employ an acuity and staffing
system, approved by the commissioner, for the purpose of increasing direct care
registered professional nurse staffing levels above the minimum levels
established in section 2 of this act, or otherwise provided by law or
regulation, to ensure adequate staffing of each unit, service, or department,
as applicable.�

���� b.��� The acuity and staffing
system required pursuant to subsection a. of this section shall meet the
following requirements:

���� (1)� The system shall be based
on:

���� (a)�� patient classification
or acuity;

���� (b)� professional nurse
staffing standards adopted by nurse specialty organizations;

���� (c)�� skill mix; and

���� (d)� the staffing levels of
other health care personnel and the use of agency or temporary staff.

���� (2)� The system shall be
established in the facility by the department of nursing with a majority of the
unit staff nurses' approval, or with the approval of the bargaining agent for
registered professional nurses at the facility.

���� (3)� The system shall allow
forecasting of staffing levels and provide a method to adjust staff for each
patient care unit based on objective criteria, including, but not limited to:

���� (a)�� documented skills,
training, and competency of staff to plan and provide nursing services in the
nursing areas where they

function;

���� (b)� a patient database
incorporating objective factors such as the case mix index, specific or
aggregate patient diagnostic classifications or acuity levels, patient
profiles, critical pathways or care progression plans, length of stay, and
discharge plans;

���� (c)�� operational factors,
such as unit size, design, and capacity, the admission/discharge/transfer
index, and support service availability;

���� (d)� contingency plans to
address critical departures from the staffing plan, including policies and
procedures to regulate closure of available beds if staffing levels fall below
specified levels; and

���� (e)�� policies and procedures
for the reassignment of staff, including float and agency staff.

���� (4)� The system shall permit
waiver of minimum staffing level requirements in the event of an unforeseen
emergent circumstance which causes significant changes in the patient census
for a regular shift.� Waiver shall not be permitted unless the facility has made
reasonable efforts to provide sufficient additional staff to meet the required
minimum staffing levels, including seeking volunteers and making use of on-call
staff, per-diem staff, agency staff, and float pools. As used in this
subsection, �unforeseeable emergent circumstance� means an unpredictable or
unavoidable occurrence requiring immediate action.

���� c.��� A hospital shall
maintain a float pool of qualified registered professional nurses to
accommodate changes in staffing needs.

���� d.��� A nurse who is assigned
the duty of maintaining unit census for patients and staff

or
supervisory functions, or who spends a significant amount of time on
non-nursing tasks, shall not be factored into the required staffing levels.

���� e.��� A registered
professional nurse shall not be assigned to a unit, service, or department, or
considered in the count of nursing staff in a unit, service, or department,
unless that nurse has received prior orientation in the applicable clinical
area and has demonstrated current competence in providing care in that unit,
service, or department.

���� 4.��� a.� The Department of
Health shall monitor and enforce the minimum staffing level requirements
established by this act through periodic inspection and in response to any
complaint filed pursuant to subsection b. of this section.

���� b.��� A registered
professional nurse or other staff member who believes that the hospital or
facility in which the nurse or staff

member is employed is in violation
of the staffing requirements or the staffing and acuity system required
pursuant to this act, or a member of the public who believes that a hospital or
facility is in

violation of the staffing requirements required under
this act, may file a complaint with the Commissioner of Health.� The complaint
shall be filed in a form and manner determined by the commissioner.� The
commissioner shall conduct an investigation of the complaint to determine
whether or not a hospital or facility is in violation and take such action as
may be necessary to ensure compliance with the requirements of this act.

���� c.��� The Commissioner of
Health may waive the minimum staffing level requirements established by this
act for any hospital or facility that the commissioner determines is in
financial distress.� The commissioner may revoke a waiver granted pursuant to
this subsection if the commissioner determines that the hospital or facility is
no longer in financial distress.

���� 5.��� The Commissioner of
Health shall, pursuant to the "Administrative Procedure Act,"
P.L.1968, c.410 (C.52:14B-1 et seq.), adopt regulations, within 90 days of the
effective date of this act, as necessary to carry out the provisions of this
act.� The commissioner shall hold a public hearing on the proposed regulations
within 30 days of their publication in the New Jersey Register.

���� 6.��� The Commissioner of
Human Services shall conduct a review of Department of Human Services
regulations concerning registered professional nurse staffing standards in
developmental centers, and shall revise the regulations, as appropriate, to
reflect safe staffing practices and assure adequate staffing at the facilities.

���� 7.��� This act shall take
effect on the first day of the 12th month after enactment, but the
Commissioners of Health and Human Services may take such anticipatory
administrative action in advance as shall be necessary for the implementation
of this act.

STATEMENT

���� This bill establishes staffing
standards for registered professional nurses in State hospitals, ambulatory
surgical facilities, psychiatric hospitals, and developmental centers.

���� Specifically, the bill
provides that, in addition to existing staffing requirements provided by law or
regulation, the Commissioner of Health is to adopt regulations that provide
minimum direct care registered professional nurse-to-patient staffing ratios
for all patient units in general and special hospitals, State psychiatric
hospitals, and ambulatory surgical facilities, in accordance with the minimum
staffing requirements that are established by the bill.� As specified in the
bill, minimum nurse-to-patient ratios will vary depending on the type of unit,
and will range from one registered professional nurse for every five patients
in a behavioral health or psychiatric or a medical/surgical unit, to one
registered professional nurse for every patient under anesthesia in an
operating room. �The regulations adopted by the Commissioner of Health are not
to decrease any nurse-to-patient staffing ratios that are already in effect on
the bill�s effective date.

���� The bill provides that the
Commissioner of Health is to require all general and special hospitals, State
psychiatric hospitals, and ambulatory surgical facilities to employ an acuity
and staffing system for the purpose of increasing direct care registered
professional nurse staffing levels above the minimum levels established in the
bill, or otherwise provided by law or regulation, in order to ensure adequate
staffing of each unit, service, or department.� The acuity and staffing system
will be based on:� patient classification or acuity; professional nurse
staffing standards adopted by nurse specialty organizations; skill mix; and the
staffing levels of other health care personnel and the use of agency or
temporary staff.� The system is to be established in the facility by the
facility�s department of nursing, with the approval of a majority of the unit
staff nurses or their bargaining agent.� The bill requires the acuity and
staffing system to allow for the forecasting of staffing levels, and to provide
a method to adjust staffing levels for each patient care unit based on
objective criteria currently set forth at N.J.A.C.8:43G-17.1(a)3, including,
but not limited to:

���� (1)� the documented skills,
training, and competency of staff to plan and provide nursing services in the
nursing areas where they function;

���� (2)� a patient database
incorporating objective factors such as the case mix index, specific or
aggregate patient diagnostic classifications or acuity levels, patient
profiles, critical pathways or care progression plans, length of stay, and
discharge plans;

���� (3)� operational factors, such
as unit size, design, and capacity, the admission/discharge/transfer index, and
support service availability;

���� (4)� contingency plans to
address critical departures from the staffing plan, including policies and
procedures to regulate the closure of available beds if staffing levels fall
below specified levels; and

���� (5)� policies and procedures
for the reassignment of staff, including float and agency staff.

���� The acuity and staffing system
will additionally be required to permit waiver of minimum staffing level
requirements in the event of an unforeseen emergent circumstance which causes
significant changes in the patient census for a regular shift.� Waiver will not
be permitted unless the facility has made reasonable efforts to provide
sufficient additional staff to meet the required minimum staffing levels,
including seeking volunteers and making use of on-call staff, per-diem staff,
agency staff, and float pools.� The bill defines �unforeseeable emergent
circumstance� to mean an unpredictable or unavoidable occurrence requiring
immediate action.

���� The Commissioner of Health
will also be permitted to waive the minimum staffing level requirements for any
hospital or facility that the commissioner determines is in financial
distress.� A waiver may be revoked upon a determination that the facility is no
longer in financial distress.

���� The bill requires the
Department of Health to enforce minimum staffing ratios by conducting periodic
inspections and responding to complaints.� The bill provides a system, pursuant
to which a registered professional nurse, other staff member, or member of the
public, believing that a facility is in violation of the staffing requirements
or the staffing and acuity system, may file a complaint with the Commissioner
of Health.� In responding to a complaint, the commissioner will be required to
conduct an investigation to determine whether or not a hospital or facility is
in violation, and to take such other action as may be necessary to ensure
compliance with the requirements of the bill.�

���� Finally, in addition to the
above-described requirements applicable to the Commissioner of Health, the bill
requires the Commissioner of Human Services to conduct a review of Department
of Human Services regulations concerning registered professional nurse staffing
standards in developmental centers, and to revise the regulations, as
appropriate, to reflect safe staffing practices and assure adequate staffing at
the facilities.