Establishes "Patient Protection and Safe Staffing Act."

A1974

ASSEMBLY, No. 1974

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman ANNETTE QUIJANO

District 20 (Union)

Assemblywoman CAROL A. MURPHY

District 7 (Burlington)

Assemblyman WILLIAM B. SAMPSON, IV

District 31 (Hudson)

Co-Sponsored by:

Assemblyman Danielsen, Assemblywomen Reynolds-Jackson,
Haider, Assemblyman G.Rodriguez, Assemblywoman Drulis, Assemblymen Calabrese,
Clifton, Verrelli, Assemblywomen Bagolie, Peterpaul, Donlon, Park, Swain,
Assemblyman Tully, Assemblywoman Collazos-Gill, Assemblymen Freiman, Singh,
Miller, Hutchison and Assemblywoman Brennan

SYNOPSIS

���� Establishes "Patient Protection and Safe
Staffing Act."

CURRENT VERSION OF TEXT

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

��

An Act

concerning staffing standards in certain health
care 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.� This act shall be known
and may be cited as the �Patient Protection and Safe Staffing Act.�

���� 2.� 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, since higher patient assignments create higher levels
of job dissatisfaction, burnout, and turnover rates among nurses.

���� 3.� As used in this act:

���� �Commissioner� means the
Commissioner of Health.

���� �Department� means the
Department of Health.

���� �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.

���� �Unlicensed assistive
personnel� means any unlicensed or uncertified personnel employed by a licensed
health care facility that perform nursing tasks which do not require the skill
or judgment of a registered professional nurse and which are assigned to them
by, and carried out under the supervision of, a registered professional nurse,
in accordance with regulations promulgated by the Commissioner of Health
pursuant to section 2 of P.L.1999, c.436 (C.26:2H-12.15).

���� 4.��� 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
and unlicensed assistive personnel-to-patient staffing ratios for all patient
units in general and special hospitals and ambulatory surgical facilities in
accordance with the requirements of this act.� The regulations shall not
decrease any nurse-to-patient staffing ratios or unlicensed assistive
personnel-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 staffing ratios:

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

���� (2)�� one registered
professional nurse for every three patients in a step down, telemetry,
progressive care, 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 one post-anesthesia patient in a
recovery room or post-anesthesia care unit;

���� (7)�� one registered
professional nurse for every three 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.���� The regulations adopted
pursuant to this section shall, at a minimum, provide for the following
unlicensed assistive personnel-to-patient staffing ratios:

���� (1)� one unlicensed assistive
personnel for every seven patients for the day shift of any patient unit; and

���� (2)� one unlicensed assistive
personnel for every 11 patients for the night shift of any patient unit.

���� 5.� a.� The Commissioner of
Health shall require all general and special 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 and unlicensed assistive personnel 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.

���� The acuity and staffing system
shall meet the following requirements:

���� �(1)� 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;

���� (2)� 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 collective bargaining agent for
registered professional nurses at the facility;

���� �(3)� 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; and

���� (4)� 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.

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

���� c.���� 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.

���� d.��� 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.

���� e.� A hospital or facility
shall not reduce the number of ancillary nursing personnel, which shall
include, but not be limited to, nurse assistants, unit clerks, monitor
technicians, and transport teams, on duty to meet the required staffing levels.

���� 6.��� a.� The Department of
Health shall monitor and enforce the minimum staffing level requirements or the
staffing and acuity system 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, a collective bargaining agent of a
staff member, or a member of the public, who believes that the hospital or
facility in which the nurse or staff member is employed is in violation of the
staffing level requirements or the staffing and acuity system requirements

established
pursuant to this act, may file a complaint with the Commissioner of Health.�
The complaint shall be filed no later than 60 days after the date of the
alleged violation, in a form and manner determined by the commissioner.�

���� c.� No later than 14 days
after the filing of a complaint pursuant to subsection b. of this section, the
department shall send a copy of the complaint to the collective bargaining
agent of the staff member, who filed a complaint, if applicable.

���� d.� (1)� Within 30 days of the
filing of a complaint pursuant to subsection b. of this section, the
commissioner shall:

���� (a)� commence an investigation
of the complaint to determine whether or not a hospital or facility is in
violation of the provisions of this act; and

���� (b) provide a notice of the
investigation to the hospital or facility and any collective bargaining agent
of any staff member employed� at the hospital or facility, if applicable.

���� (2)� In conducting the
investigation, the department may conduct on-site inspections of the patient
unit identified in the complaint, conduct interviews, compel the production of
documents and records pertaining to the complaint, and take any other action as
may be necessary to ensure compliance with the provisions of this act.

���� (3)� The department shall
conclude any investigation conducted pursuant to this subsection no later than
60 days after the commencement of such investigation.

���� (4)� Following the completion
of an investigation conducted pursuant to this subsection, in which
investigation the department determines a hospital or facility to be in
violation of the staffing level requirements or the staffing and acuity system
requirements established pursuant to this act, the hospital or facility shall
be issued a warning for a first offense and liable to a civil penalty of no
more than $1,750 for a second offense occurring within a four-year period, no
more than $2,5000 for a third offense occurring within a four-year period, and
no more than $5,000 for a fourth offense or subsequent offense occurring within
a four-year period.� For the purposes of this paragraph, each violation shall
constitute a separate offense.� The civil penalty shall be collected in a
summary proceeding, brought in the name of the State in a court of competent
jurisdiction pursuant to the "Penalty Enforcement Law of 1999,"
P.L.1999, c.274 (C.2A:58-10 et seq.).� Any money collected by the court in
payment of a civil penalty imposed pursuant to this paragraph shall be conveyed
to the State Treasurer for deposit into the Patient Protection and Staffing
Fund, established pursuant to section 7 of this act.� Nothing in this act shall
be construed to limit the ability to bring any civil, criminal, or
administrative action for conduct constituting a violation of any other
provision of law.

���� (5)� The department shall
prepare and provide to the complainant and the complainant�s collective
bargaining agent, if applicable, a written report of the department�s findings
from the investigation, which report shall include a summary of the complaint,
the department�s findings and the factual basis of those findings, any
penalties imposed on the hospital or facility, and any other information the
department determines to be necessary to include in the report.� The report
shall not include any personally identifiable information.

���� The department shall post on
its Internet website any report prepared pursuant to this paragraph for any
investigation, in which investigation the department found a violation of the
staffing levels requirements or the staffing and acuity system requirements established
pursuant to this act.

���� 7.� a.� There is created in
the Department of the Treasury a dedicated, non-lapsing fund to be known as the
�Patient Protection and Staffing Fund.�

���� b.��� The fund shall be
credited with monies collected by the court in payment of any civil penalty
imposed pursuant to paragraph (4) of subsection d. of section 6 of this act.

���� c.� The State Treasurer shall
be the custodian of the fund and all disbursements from the fund shall be made
by the State Treasurer upon vouchers signed by the Commissioner of Health.� The
monies in the fund shall be invested and reinvested by the Director of the
Division of Investment in the Department of the Treasury as are other trust
funds in the custody of the State Treasurer in the manner provided by law.�
Interest received on the monies in the fund shall be credited to the fund.

���� d.� Moneys in the fund shall
be dedicated and used only for the purposes of:� increasing the number of
inspectors employed by the Department of Health to enforce the provisions of
this act; advancing nursing recruitment and retentions programs; supporting
student loan forgiveness for nursing students; and increasing pay for nursing
teaching staff.

���� 8.��� 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.

���� 9.��� 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 State psychiatric hospitals, and shall revise the
regulations, as appropriate, to reflect safe staffing practices and assure
adequate staffing at the facilities.

���� 10.� 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 the
�Patient Protection and Safe Staffing Act,� which provides certain staffing
standards in State hospitals, ambulatory surgical facilities, developmental
centers, and psychiatric hospitals.

���� 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 and
unlicensed assistive personnel-to-patient staffing ratios for all patient units
in general and special hospitals and ambulatory surgical facilities, in
accordance with the minimum staffing requirements that are established by the
bill.� The regulations adopted by the Commissioner of Health are not to
decrease any 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 and
ambulatory surgical facilities to employ an acuity and staffing system for the
purpose of increasing 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 bill requires the
Department of Health to enforce the bill�s requirements by conducting periodic
inspections and responding to complaints.� A registered professional nurse or
other staff member, a collective bargaining agent of a staff member, or a
member of the public, who believes that the hospital or facility in which the
nurse or staff member is employed is in violation of the requirements established
by the bill, 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.

���� Following the completion of an
investigation, in which investigation the department determines a hospital or
facility to be in violation of the requirements established by the bill, the
hospital or facility may be issued a civil penalty in increasing amounts for
repeat violations.� Any money collected by the court in payment of a civil
penalty imposed will be conveyed to the State Treasurer for deposit into the
Patient Protection and Staffing Fund (fund) established by the bill.�

���� �Moneys in the fund will be
dedicated and used only for the purposes of increasing the number of inspectors
employed by the Department of Health to enforce the provisions of the bill,
advancing nursing recruitment and retentions programs, supporting student loan
forgiveness for nursing students, and increasing pay for nursing teaching
staff.

���� 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 State psychiatric hospitals, and to
revise the regulations, as appropriate, to reflect safe staffing practices and
assure adequate staffing at the facilities.