Requires hospitals to establish nurse staffing committees.

A2418

ASSEMBLY, No. 2418

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman TENNILLE R. MCCOY

District 14 (Mercer and Middlesex)

Co-Sponsored by:

Assemblyman Danielsen

SYNOPSIS

���� Requires hospitals to establish nurse staffing
committees.

CURRENT VERSION OF TEXT

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

��

An Act

concerning nurse staffing committees at
hospitals and supplementing
Title 26 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.���� The State of New Jersey
has a substantial interest in promoting quality care and improving the delivery
of health care services;

���� b.��� Evidenced-based studies
have shown that adequate nurse staffing based on research findings and the
intensity of patient care is directly related to positive patient outcomes,
such as reducing errors and complications;

���� c.���� Appropriate staffing of
hospital personnel, including registered nurses, can also improve staff safety
and satisfaction, and reduce incidences of workplace injuries;

���� d.��� Hospitals and nurses
share a mutual interest in patient safety initiatives that create a healthy
environment for nurses and appropriate care for patients; and

���� e.���� In order to protect
patients, support greater retention of registered nurses, and promote adequate
nurse staffing, it is in the State�s interest to establish a mechanism whereby
nurses and hospital management shall participate in a joint process regarding
decisions about nurse staffing.

���� 2.��� As
used in this act:

���� "Hospital"
means a hospital that is licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et
seq.).

���� "Intensity"
means the level of patient need for nursing care, as determined by the nursing
assessment.

���� "Nursing
personnel" means registered nurses, licensed practical nurses, and
unlicensed assistive nursing personnel providing direct patient care.

���� "Nurse
staffing committee" means the committee established by a hospital pursuant
to section 3 of this act.

���� "Patient
care unit" means any unit or area of the hospital that provides patient
care by registered nurses.

���� "Skill
mix" means the number and relative percentages of registered nurses,
licensed practical nurses, and unlicensed assistive personnel among the total
number of nursing personnel.

���� �Unforeseeable
emergency circumstance" means any unforeseen national, State, or municipal
emergency; when a hospital disaster plan is activated; any unforeseen disaster
or other catastrophic event that substantially affects or increases the need
for health care services; or when a hospital is diverting patients to another
hospital or hospitals for treatment or the hospital is receiving patients who
are from another hospital or hospitals.

���� 3.��� a.� The Department of
Health shall require a hospital,
as a condition of
licensure, to establish a nurse staffing committee, either by creating a new
committee or assigning the functions of a nurse staffing committee to an
existing committee.� At least 55 percent of the members of the nurse staffing
committee shall be registered nurses currently providing direct patient care at
the hospital, and no more than 45 percent of the members of the committee shall
be hospital administrative staff.
�The
selection of the registered nurses shall be according to the collective
bargaining agreement, if there is one in effect at the hospital. �If there is
no applicable collective bargaining agreement, the members of the nurse
staffing committee who are registered nurses shall be selected by their peers.�
The members of the nurse staffing committee who are hospital administrative
staff shall be appointed by the hospital�s chief executive officer.

����
b.��� Participation in the nurse staffing committee by a hospital employee
shall be on scheduled work time and compensated at the appropriate rate of pay.
�Nurse staffing committee members shall be relieved of all other work duties
during meetings of the committee.

���� c.����
Primary responsibilities of the nurse staffing committee shall include:

����
(1)�� The development and oversight of an annual patient care unit and
shift-based nurse staffing plan, which shall be based on the needs of patients,
and which shall be used as the primary component of the staffing budget. �The
nurse staffing plan shall establish upwardly adjustable minimum ratios of
direct care registered nurses to patients for each unit and for each shift of
the hospital.� Factors to be considered in the development of the nurse
staffing plan shall include, but need not be limited to:

����
(i)��� hospital census data, including total numbers of patients on the
unit on each shift;

���� (ii)�� hospital
admission, discharge, and transfer data;

���� (iii) the
level of intensity and the nature of the care to be
delivered to patients on each shift;

����
(iv) skill mix;

����
(v)�� the level of experience and specialty certification or training of
nursing personnel providing care;

����
(vi)� the need for specialized or intensive equipment;

����
(vii) the architecture and geography of the patient care unit, including,
but not limited to, the placement of patient rooms, treatment areas, nursing
stations, medication preparation areas, and equipment;

����
(viii) staffing guidelines adopted or published by national nursing
professional associations, specialty nursing organizations, and other health
professional organizations;

����
(ix) the availability of other personnel supporting nursing services on
the unit;

���� (x)�� unit
and facility level staffing, quality and patient outcomes data, and national
comparisons, as available;

���� (xi)� hospital
finances and resources; and

����
(xii) strategies to enable registered nurses to take meal and rest breaks
as required by law or the terms of an applicable collective bargaining
agreement, if any, between the hospital and a representative of the nursing
staff;

����
(2)�� A semiannual review of the staffing plan against patient need and
known evidence-based staffing information; and

����
(3)�� The review, assessment, and response to staffing variations or
concerns presented to the committee.

����
d.��� The nurse staffing plan shall:

���� (1)�� not
diminish other standards contained in State or federal law and rules, or the
terms of an applicable collective bargaining agreement, if any, between the
hospital and a representative of the nursing staff;

���� (2)�� ensure
that a registered nurse shall not be assigned to work in a particular unit of
the hospital without first having established the ability to provide
professional care in such unit; and

���� (3)�� provide
for exemptions for some or all requirements of the nurse staffing plan during a
state of emergency, as defined in section 23 of P.L.2011, c.19 (C.5:12-45.3),
if the hospital is requested or expected to provide an exceptional level of
emergency or other medical services.

����
e.���� The nurse staffing committee shall provide the annual nurse
staffing plan to the hospital�s chief executive officer for review. �If this nurse
staffing plan is not adopted by the hospital, the chief executive officer of
the hospital shall provide a written explanation of the reasons why the plan
was not adopted to the committee and either:� identify those elements of the
proposed plan being changed prior to adoption of the plan by the hospital; or
prepare and submit to the committee an alternate annual staffing plan, as
adopted by the hospital.

���� f.���� One
year after the enactment of
P.L.��� , c.���
(C.������� ) (pending before the Legislature as this bill)
, each hospital shall:

���� (1)�� submit
its adopted nurse staffing plan to the Department of Health and, thereafter, on
an annual basis, and at any time that the plan is updated; and

���� (2)�� implement
the adopted nurse staffing plan and assign nursing personnel to each patient
care unit in accordance with the plan.

���� g.��� Each nurse
staffing committee shall develop a process to: �examine
and respond to complaints regarding the hospital�s implementation of the
adopted nurse staffing plan; determine if a specific complaint is resolved; and
dismiss a complaint based on unsubstantiated data.� A registered nurse, a
member of the nurse staffing committee, a hospital staff member, a hospital
patient, or any other person may submit to the Department of Health any
complaint that remains unresolved upon examination by the nurse staffing
committee, as outlined in section 4 of this act, for further investigation.

���� h.���
Each hospital shall post, in a public area on each patient care unit, the
adopted nurse staffing plan and the nurse staffing schedule for that shift on
the unit, as well as the relevant clinical staffing levels for that shift. The nurse
staffing plan and current staffing levels shall also be made available to
patients and visitors upon request.

���� i.����
A hospital shall not retaliate against or engage in any form of
intimidation of:

���� (1)��
an employee for performing any duties or responsibilities in connection
with a nurse staffing committee; or

���� (2)��
an employee, patient, or other individual who notifies the nurse staffing
committee, the hospital administration, or the Department of Health of concerns
regarding nurse staffing.

���� 4.���
a. �The Commissioner of Health shall establish procedures that enable
persons to file complaints regarding the hospital�s implementation of the
adopted nurse staffing plan; and that provide for the investigation of such
complaints.� The department shall only investigate a complaint that was
previously submitted to the nursing staff committee, and that provides evidence
indicating a continuing pattern of unresolved violations for a minimum of a 60-day
continuous period leading up to receipt of the complaint by the department.�
The department shall not investigate a complaint:

���� (1)�� that
is determined by a nurse staffing committee to be resolved or dismissed;

���� (2)�� in
the event of unforeseeable emergency circumstances; or

���� (3)�� if
a hospital, after consultation with a nurse staffing committee, documents it
has made reasonable efforts to obtain staffing to meet required assignments,
but has been unable to do so.

���� b.��� After
an investigation, if the department determines that there has been a violation,
the department shall require the hospital to submit a corrective plan of action
within 45 days of the presentation of findings from the department to the
hospital.

���� In
the event that a hospital fails to submit, or submits but fails to follow, such
a corrective plan of action in response to a violation or violations found by
the department, the department may impose, for all violations asserted against
a hospital at any time, in addition to any other penalties prescribed under
State law, a civil penalty of $1,000 per day until the hospital submits or
begins to follow the corrective plan of action or takes other action agreed to
by the department.

���� The
department shall maintain, for public inspection, records of any civil
penalties, administrative actions, or license suspensions or revocations
imposed on hospitals under this section.

���� c.���� The
department shall
submit to the Governor, and
to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1),
a report regarding the implementation of this
section within 18 months of the enactment of
P.L.���
, c.��� (C.������� ) (pending before the Legislature as this bill)
.� This report shall include the number of
complaints submitted to the department, the disposition of these complaints,
the number of investigations conducted, the associated costs for complaint
investigations, and recommendations for any needed statutory changes.

���� 5.���
The
Commissioner of Health, pursuant to the �Administrative Procedure Act,�
P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations as may
be necessary to implement the provisions of this act.�

���� 6.��� This act shall take
effect immediately.

STATEMENT

����
This
bill requires hospitals to
establish nurse staffing committees.�
Specifically, the bill directs the Department of Health to require a hospital
licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et
seq.)
,
as a condition of licensure, to
establish a nurse staffing committee, either by creating a new committee or
assigning the functions of a nurse staffing committee to an existing
committee.� At least 55 percent of the members of the nurse staffing committee
are to be registered nurses currently providing direct patient care at the
hospital, and no more than 45 percent of the members of the committee are to be
hospital administrative staff.
�The
selection of the registered nurses are to be according to the collective
bargaining agreement, if there is one in effect at the hospital. �If there is
no applicable collective bargaining agreement, the members of the nurse
staffing committee who are registered nurses are to be selected by their peers.�
The members of the nurse staffing committee who are hospital administrative
staff are to be appointed by the hospital�s chief executive officer.

����
Participation in the nurse staffing committee by a hospital employee is to
be on scheduled work time and compensated at the appropriate rate of pay. Nurse
staffing committee members are to be relieved of all other work duties during
meetings of the committee.

���� Under the bill, the
primary responsibilities of the nurse staffing
committee include:

����
(1)�� The development and oversight of an annual patient care unit and
shift-based nurse staffing plan, which is to be based on the needs of patients,
and which is to be used as the primary component of the staffing budget. �The
nurse staffing plan is to establish upwardly adjustable minimum ratios of
direct care registered nurses to patients for each unit and for each shift of
the hospital.� Factors to be considered in the development of the nurse
staffing plan include, but need not be limited to:
� hospital
census data;

hospital admission, discharge, and transfer data;
the
level of intensity and the nature of the care to be
delivered to patients on each shift;
s
kill
mix, defined as the number and relative percentages of registered nurses,
licensed practical nurses, and unlicensed assistive personnel among the total
number of nursing personnel;
the
level
of experience and specialty certification or training of nursing personnel
providing care;
t
he need for
specialized or intensive equipment;
t
he
architecture and geography of the patient care unit; staffing guidelines
adopted or published by health professional organizations;
the a
vailability of other personnel supporting nursing
services on the unit; unit and facility level staffing, quality and patient
outcomes data, and national comparisons, as available;
h
ospital finances and resources; and
s
trategies to enable registered nurses to take meal
and rest breaks as required by law or the terms of an applicable collective
bargaining agreement, if any, between the hospital and a representative of the
nursing staff;

����
(2)�� A semiannual review of the staffing plan against patient need and
known evidence-based staffing information; and

����
(3)�� The review, assessment, and response to staffing variations or
concerns presented to the committee.

����
Furthermore, the staffing plan is required to:� (1) not diminish other
standards contained in State or federal law and rules, or the terms of an
applicable collective bargaining agreement, if any, between the hospital and a
representative of the nursing staff; (2) ensure that a registered nurse is not
assigned to work in a particular unit of the hospital without first having
established the ability to provide professional care in such unit; and (3)
provide for exemptions for some or all requirements of the nurse staffing plan
during a state of emergency, as defined in section 23 of P.L.2011, c.19 (C.5:12-45.3),
if the hospital is requested or expected to provide an exceptional level of
emergency or other medical services.

����
The nurse staffing committee is required provide the annual nurse staffing
plan to the hospital�s chief executive officer for review. �If this nurse staffing
plan is not adopted by the hospital, the chief executive officer of the
hospital is to provide a written explanation to the committee of the reasons
why the plan was not adopted. �The chief executive officer must then either: �identify
those elements of the proposed plan being changed prior to adoption of the plan
by the hospital; or prepare an alternate annual staffing plan that must be
adopted by the hospital.

���� One
year after the of enactment of
the bill,
each hospital is to: 1) submit its adopted nurse
staffing plan to the Department of Health and, thereafter, on an annual basis,
and at any time that the plan is updated; 2) implement the adopted nurse staffing
plan and assign nursing personnel to each patient care unit in accordance with
the plan.

���� Each nurse
staffing committee is to develop a process to: �examine
and respond to a complaint regarding the hospital�s implementation of the
adopted nurse staffing plan; determine if a specific complaint is resolved; and
dismiss a complaint based on unsubstantiated data.� A registered nurse, a
member of the nurse staffing committee, a hospital staff member, a hospital
patient, or any other person may submit to the Department of Health any
complaint that remains unresolved upon examination by the nurse staffing
committee for further investigation.

����
Each hospital is required to post, in a public area on each patient care
unit, the nurse staffing plan and the nurse staffing schedule for that shift on
the unit, as well as the relevant clinical staffing levels for that shift. The nurse
staffing plan and current staffing levels are also to be made available to
patients and visitors upon request.

���� Finally,
a hospital is prohibited from retaliating against or
engaging in any form of intimidation of:
� (1)
an employee for performing any duties or responsibilities in connection
with the nurse staffing committee; or
(2) a
n employee, patient, or other individual who notifies the nurse staffing
committee, the hospital administration, or the Department of Health of concerns
regarding nurse staffing.

����
The Commissioner of Health is directed to establish procedures that enable
persons to file complaints regarding the hospital�s implementation of the
adopted nurse staffing plan; and that provide for the investigation of such
complaints.� The department is only to investigate a complaint that was
previously submitted to the nursing staff committee, and that provides evidence
indicating a continuing pattern of unresolved violations for a minimum of a 60-day
continuous period leading up to receipt of the complaint by the department.�
The department is not to investigate a complaint:� that is determined by the
nurse staffing committee to be resolved or dismissed; in the event of
unforeseeable emergency circumstances; �or if a hospital, after consultation
with a nurse staffing committee, documents it has made reasonable efforts to
obtain staffing to meet required assignments, but has been unable to do so. �Under
the bill, "unforeseeable emergency circumstance" means any unforeseen
national, State, or municipal emergency; when a hospital disaster plan is
activated; any unforeseen disaster or other catastrophic event that
substantially affects or increases the need for health care services; or when a
hospital is diverting patients to another hospital or hospitals for treatment
or the hospital is receiving patients who are from another hospital or
hospitals.

���� After
an investigation, if the department determines that there has been a violation,
the department is to require the hospital to submit a corrective plan of action
within 45 days of the presentation of findings from the department to the
hospital.� In the event that a hospital fails to submit, or submits but fails
to follow, such a corrective plan of action in response to a violation or
violations found by the department, the department may impose, for all
violations asserted against a hospital at any time, in addition to any other
penalties prescribed under State law, a civil penalty of $1,000 per day until
the hospital submits or begins to follow the corrective plan of action or takes
other action agreed to by the department.� The department is required to
maintain, for public inspection records, of any civil penalties, administrative
actions, or license suspensions or revocations imposed on hospitals under this
section.

���� Finally,
the bill directs the department to
submit to
the Governor and to the Legislature a report
regarding the department�s investigation of such complaints within 18
months of the enactment of
the bill
. �This report is to include the number of
complaints submitted to the department, the disposition of these complaints,
the number of investigations conducted, the associated costs for complaint
investigations, and recommendations for any needed statutory changes.

���� It
is the sponsor�s belief that the creation of nurse staffing committees will
empower direct care nurses to determine the unique and variable needs of their
patients to ensure quality care.�
Evidenced-based studies have shown
that adequate nurse staffing based on research findings and the intensity of
patient care is directly related to positive patient outcomes and assists in
reducing errors and complications.� Furthermore, appropriate staffing of
hospital personnel improve staff safety and satisfaction, and reduce incidences
of workplace injuries.
�