SAFE STAFFING ACT & NURSING HOMES

HB0172

HOUSE BILL 172

57th legislature - STATE OF NEW MEXICO - second session, 2026

INTRODUCED BY

Eleanor Chávez
and
Joanne J. Ferrary
and
Reena Szczepanski

and
Elizabeth "Liz" Thomson
and
Kathleen Cates

AN ACT

RELATING TO HEALTH; ENACTING THE SAFE STAFFING ACT; REQUIRING
THE HEALTH CARE AUTHORITY TO PROMULGATE AND ENFORCE MINIMUM
NURSE-TO-PATIENT STAFFING RATIOS IN HOSPITALS; CREATING THE
STAFFING ADVISORY COMMITTEE; REQUIRING HOSPITALS TO DEVELOP AND
IMPLEMENT POLICIES AND PROCEDURES; PROVIDING ADMINISTRATIVE
PENALTIES; DECLARING AN EMERGENCY.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

SECTION 1.
A new section of the Health Care Code

is
enacted to read:

"[
NEW MATERIAL
] SHORT TITLE.--This act may be cited as the
"Safe Staffing Act"."

SECTION 2.
A new section of the Health Care Code

is
enacted to read:

"[
NEW MATERIAL
] DEFINITIONS.--As used in the Safe Staffing
Act:

A. "critical access hospital" means a hospital
that:

(1) provides twenty-four-hour emergency
department services;

(2) has an average length of stay of no longer
than ninety-six hours;

(3) has fewer than twenty-five acute care
inpatient beds; and

(4) is located at least thirty-five miles from
the closest hospital;

B. "critical care unit" means a unit that is
established to treat patients whose severity of medical
conditions require continuous monitoring and complex
intervention by nurses;

C. "hospital" means a public, private for-profit or
not-for-profit acute care, rehabilitation, limited service,
critical access, general or special health facility offering
inpatient services, nursing and overnight care seven days per
week on a twenty-four-hour basis that is capable of treating no
fewer than three patients for the purposes of diagnosing,
treating and providing medical, psychological or surgical care
for physical or mental illness, disease, injury, rehabilitative
conditions and pregnancies. "Hospital" does not include
clinics or outpatient departments that do not provide inpatient
or emergency services;

D. "hospital network committee" means a staffing
committee established in a network of hospitals that are owned
or operated by the same entity;

E. "hospital staffing committee" means a staffing
committee established in a single hospital;

F. "hospital unit" includes critical care units,
burn units, labor and delivery rooms, post-anesthesia service
areas, emergency departments, operating rooms, pediatric units,
step-down or intermediate care units, specialty care units,
telemetry units, general medical care units, subacute care
units and transitional inpatient care units;

G. "rural" means a rural county or the area of a
partially rural county that is not a municipality as designated
by the health resources and services administration of the
United States department of health and human services; and

H. "staffing committee" means nurse-led groups that
create staffing plans for hospital units based on patient
population, acuity and needs and the skills and experience of
the hospital's staff."

SECTION 3.
A new section of the Health Care Code is
enacted to read:

"[
NEW MATERIAL
] HOSPITAL STAFFING RATIOS--STATEWIDE
STAFFING ADVISORY COMMITTEE--CREATION--ORGANIZATION.--

A. The "statewide staffing advisory committee" is
created to advise the authority on matters related to nurse
staffing. The committee consists of fifteen members who
represent geographic areas of the state, appointed by the
secretary as follows:

(1) two members shall be private hospital
directors of nursing or chief nursing officers;

(2) two members shall be public hospital
directors of nursing or chief nursing officers;

(3) two members shall be rural hospital
directors of nursing or chief nursing officers;

(4) two members, at least one of whom shall be
a nurse, shall be nonmanagerial and nonsupervisory employees of
private hospitals
who are primarily involved in direct patient
care;

(5) two members, at least one of whom shall be
a nurse, shall be nonmanagerial and nonsupervisory employees of
public hospitals who are primarily involved in direct patient
care;

(6) two members, at least one of whom shall be
a nurse, shall be nonmanagerial and nonsupervisory employees of
rural hospitals who are primarily involved in direct patient
care;

(7) two members shall represent labor
organizations that represent employees in public or private
hospitals; and

(8) one member shall represent the authority
and serve as chair.

B. The initial committee shall be appointed so that
six members serve for three years, five members serve for two
years and four members serve for one year; thereafter, terms
shall be for three years. Members, except the representative
of the authority, shall serve no more than three terms. A
member shall serve until the member's successor has been
appointed and qualified. The secretary shall fill a vacancy by
appointment of a member from the same membership category, and
that member shall serve the remainder of the unexpired term.

C. The secretary shall appoint the committee
members by September 1, 2026. The committee shall elect
officers, other than the chair, as the committee determines to
be necessary.

D. The committee shall meet as often as necessary
for the committee to advise and provide data for the authority
to use in promulgating rules pursuant to Section 5 of the Safe
Staffing Act. The initial meeting of the committee shall occur
no later than October 1, 2026.

E. A majority of members currently serving
constitutes a quorum. A majority of members present is needed
for the conduct of business. Members who are not otherwise
eligible for travel reimbursement from government funds are
entitled to be reimbursed for per diem and mileage as provided
in the Per Diem and Mileage Act and shall receive no other
compensation, perquisite or allowance for service on the
committee.

F. The secretary may remove a member for neglect of
duty."

SECTION 4
. A new section of the Health Care Code

is
enacted to read:

"[
NEW MATERIAL
] NURSING STAFFING RATIOS.--

A. All hospitals are subject to the following
minimum nurse staffing provisions:

(1) in an emergency department:

(a) a direct care registered nurse shall
be assigned to not more than one trauma patient;

(b) the ratio of direct care registered
nurses to patients shall average no more than one-to-four over
a twelve-hour shift and a single direct care registered nurse
may not be assigned more than five patients at a time; and

(c) direct care registered nurses
assigned to trauma patients may not be taken into account in
determining the average ratio;

(2) in an intensive care unit, a direct care
registered nurse shall be assigned to no more than two
patients;

(3) in a labor and delivery unit, a direct
care registered nurse shall be assigned no more than:

(a) two patients, if the patients are
not in active labor or experiencing complications; or

(b) one patient, if the patient is in
active labor or is at any stage of labor and is experiencing
complications;

(4) in a postpartum, antepartum or well-baby
nursery, a direct care registered nurse shall be assigned to no
more than six patients, counting mother and baby as separate
patients;

(5) in a mother-baby unit, a direct care
registered nurse shall be assigned to no more than eight
patients, counting mother and baby as separate patients;

(6) in an operating room, a direct care
registered nurse shall be assigned to no more than one patient;

(7) in an oncology unit, a direct care
registered nurse shall be assigned to no more than four
patients;

(8) in a post-anesthesia service unit, a
direct care registered nurse shall be assigned to no more than
two patients;

(9) in an intermediate care unit, a direct
care registered nurse shall be assigned to no more than three
patients;

(10) in a medical-surgical unit, a direct care
registered nurse shall be assigned to no more than four
patients;

(11) in a cardiac telemetry unit, a direct
care registered nurse shall be assigned to no more than four
patients;

(12) in a pediatric unit, a direct care
registered nurse shall be assigned to no more than four
patients;

(13) in a behavioral health unit, a direct
care registered nurse shall be assigned to no more than four
patients; and

(14) in a psychiatric unit, a direct care
registered nurse shall be assigned to no more than four
patients.

B. A charge nurse shall not be counted toward any
ratio set in this section.

C. The ratios set forth in Subsection A of this
section shall constitute the minimum number of registered
nurses involved in direct patient care. Additional staff shall
be assigned in accordance with a documented patient
classification system for determining nursing care
requirements, including the severity of the condition; the need
for specialized equipment and technology; the complexity of
clinical judgment needed to design, implement and evaluate the
patient care plan; the ability for patient self-care; and the
type of licensure required for care.

D. The ratios set forth in Subsection A of this
section shall not supersede ratios that require higher levels
of nurse staffing set in collective bargaining agreements."

SECTION 5.
A new section of the Health Care Code is

enacted to read:

"[
NEW MATERIAL
] HOSPITALS--NURSE-TO-PATIENT STAFFING
RATIOS--AUTHORITY--COMMITTEE--POWERS AND DUTIES.--

A. Each hospital or hospital network shall
establish a staffing committee to evaluate the hospital's
staffing needs and make a hospital staffing plan.

B. To create the hospital staffing plan, a hospital
staffing committee shall ensure that minimum nurse-to-patient
staffing ratios set in Section 4 of the Safe Staffing Act are
maintained by a hospital.

C. By October 1, 2027, the authority, with the
advice of the statewide staffing advisory committee, shall hold
hearings to promulgate rules regarding:

(1) minimum, specific and numerical licensed
or certified staff-to-patient staffing ratios for hospitals for
employees other than nurses in units set forth in Section 4 of
the Safe Staffing Act;

(2) rural general acute care and critical
access hospital staffing needs; provided that the ratios
promulgated pursuant to Paragraph (1) of this subsection may be
adjusted to accommodate these needs;

(3) emergency department staffing, which shall
include the ratios provided pursuant to Paragraph (1) of this
subsection but shall distinguish between regularly scheduled
core staff nurses and additional nurses required to treat
critical care patients. The authority may consider unlicensed
personnel who provide direct patient care as a factor when
setting nurse-to-patient staffing ratios;

(4) the documented patient classification
systems to be used by hospitals in determining nursing care
requirements, including the:

(a) severity of the illness to be
treated;

(b) need for specialized equipment and
technology;

(c) complexity of clinical judgment
needed to design, implement and evaluate the patient care plan
and the ability for self-care; and

(d) licensure of the personnel required
for care; and

(5) circumstances in which it is permissible
for a hospital to be outside of the established nurse-to-patient staffing ratios, including:

(a) when the number of patients in a
hospital exceeds the nurse-to-patient staffing ratios, but only
due to there being patients who: 1) have been cleared for
discharge but have not yet been discharged; or 2) are awaiting
transfer to another facility;

(b) when a nurse is unable to report for
a scheduled shift or must leave a shift early; and

(c) the duration of time in which a
hospital unit may be outside of the established nurse-to-patient staffing ratios in one shift to allow time to bring in
on-call nurses and other employees to meet the hospital unit's
licensed nurse-to-patient staffing ratio.

D. The authority, in consultation with the
statewide staffing advisory committee, shall review the rules
promulgated in accordance with Subsection C of this section
every five years."

SECTION 6
. A new section of the Health Care Code

is
enacted to read:

"[
NEW MATERIAL
] HOSPITAL STAFFING RATIOS--HOSPITAL
POLICIES AND PROCEDURES--TRAINING.--

A. A hospital shall:

(1) be staffed at a level to meet the staffing
ratios established pursuant to the Safe Staffing Act and the
hospital staffing plan set by its staffing committee, which
shall be the minimum number of registered and licensed nurses
involved in direct patient care;

(2) adopt written policies and procedures for
nursing staff and other employees involved in direct patient
care and temporary personnel, which shall require:

(a) training and orientation for
providing direct patient care;

(b) orientation for registered nurses
and other employees sufficient to provide competent care to
patients in a nursing unit or clinical area prior to assigning
the registered nurse or other employees to those areas;
provided that the registered nurse or other employee also
demonstrates competency in providing care in the assigned area;
and

(c) temporary personnel orientation and
competency evaluation; and

(3) submit a semiannual report, completed by
the hospital's director of nursing or chief nursing officer, to
the statewide advisory staffing committee and the authority.
The report shall document the hospital's plans and efforts to
meet staffing ratios recommended by the statewide staffing
advisory committee.

B. A hospital may have additional staff in
accordance with a documented patient classification system.

C. A hospital shall not:

(1) assign unlicensed personnel to perform
nursing functions in lieu of a registered nurse; or

(2) allow unlicensed personnel under the
direct clinical supervision of a registered nurse to perform
functions that require a substantial amount of scientific
knowledge and technical skills, including:

(a) administration of medication;

(b) intravenous therapy;

(c) parenteral or tube feedings;

(d) invasive procedures, including
inserting nasogastric tubes and tracheal suctioning;

(e) assessment of the condition of a
patient; and

(f) educating patients and their
families concerning the patient's health care problems,
including post-discharge care.

D. All hospitals shall adopt written policies and
procedures for training and orientation of nursing staff and
other employees involved in direct patient care. No registered
nurse or other employee involved in direct patient care shall
be assigned to a nursing unit or clinical area unless that
nurse or other employee involved in direct patient care has
first received orientation in that clinical area sufficient to
provide competent care to patients in that area and has
demonstrated current competence in providing care in that area.
The written policies and procedures for orientation of nursing
staff and other employees involved in direct patient care shall
require that all temporary personnel shall receive orientation
and be subject to competency validation.

E. Nothing in this section precludes a registered
or licensed nurse from working within that person's scope of
practice."

SECTION 7.
A new section of the Health Care Code

is
enacted to read:

"[
NEW MATERIAL
] HOSPITAL STAFFING RATIOS--VIOLATION--ENFORCEMENT--REMEDIES.--

A. A hospital shall provide written notice to the
authority and the statewide staffing advisory committee
whenever there are seven deviations from any staffing ratios
established in the Safe Staffing Act during a rolling ninety-day period. The written notice shall:

(1) be provided within ten days of a seventh
deviation from the staffing ratios established pursuant to the
Safe Staffing Act;

(2) explain the cause of the deviations; and

(3) provide a plan to prevent future
deviations.

B. No later than October 1, 2027, the authority,
with the advice of the statewide staffing advisory committee,
shall hold a hearing to promulgate rules that establish a
process for investigating and remedying any violation of
hospital staffing requirements. The rules shall:

(1) specify reporting requirements for
deviations consistent with this section;

(2) allow for the acceptance, investigation
and resolution of complaints from hospital staff, exclusive
representatives of hospital staff or members of the public; and

(3) provide an administrative appeals process
for hospitals that are determined by the authority to be in
violation of the hospital staffing requirements. A hospital
shall have the right to judicial review of any final decision
made by the authority pursuant to this section. A person
aggrieved of a final agency decision by the secretary may
appeal the decision to the district court as provided in
Section 39-3-1.1 NMSA 1978.

C. If the authority determines, whether through a
complaint process, hospital reporting or the authority's own
independent investigation, that a hospital has engaged in a
violation of staffing requirements, the authority shall:

(1) issue a warning for the first violation in
a one-year period;

(2) impose a civil penalty on a sliding scale
based on the number of beds in the hospital in an amount to be
determined by the authority by rule, but not to exceed seventy
dollars ($70.00) per bed for the second violation of the same
provision in a one-year period;

(3) impose a civil penalty on a sliding scale
based on the number of beds in the hospital in an amount to be
determined by the authority by rule, but not to exceed one
hundred dollars ($100) per bed for the third violation of the
same provision in a one-year period; and

(4) impose a civil penalty on a sliding scale
based on the number of beds in the hospital in an amount to be
determined by the authority by rule, but not to exceed two
hundred dollars ($200) per bed for the fourth and subsequent
violations of the same provision in a one-year period.

D. If the authority finds that a hospital has
committed multiple violations of the staffing ratio
requirements of a similar nature, the authority shall require
the hospital to submit a corrective action plan for approval.
If a hospital does not follow the corrective action plan
approved by the authority, the hospital shall be fined in an
amount not to exceed fifty thousand dollars ($50,000) every
thirty days until the hospital complies.

E. The requirements of this section or any rules
adopted in accordance with this section may be enforced by a
civil action brought by any interested person or organization
for injunctive relief. In the event such a suit is at least
partially successful, the court may award the interested person
or organization litigation costs and reasonable attorney fees.

F. A hospital is not required to follow the
staffing ratios established by the authority or the Safe
Staffing Act in the event of:

(1) a national or state emergency requiring
the implementation of a facility disaster plan;

(2) sudden and unforeseen adverse weather
conditions;

(3) mass casualty incidents;

(4) pandemic, epidemic or endemic illnesses;
or

(5) a staffing ratio conflicting with federal
or state law regarding the governance requirements of a
hospital.

G. The authority may grant waivers to rural or
critical access hospitals for portions of the Safe Staffing Act
if the hospital is able to document reasonable efforts to
obtain adequate staff."

SECTION 8.
A new section of the Health Care Code

is
enacted to read:

"[
NEW MATERIAL
] AUTHORITY RULEMAKING AND DATA
COLLECTION.--

A. The authority shall collect and maintain the
following information on an annual basis beginning July 1,
2026:

(1) registered nurse retention rate, which is
the hospital's number of registered nurses on staff by using
the last four digits of each registered nurse's license number;

(2) agency and traveler nurse utilization,
which are the number of agency or travel registered nurses
employed by the hospital and the duration of each contract.
The authority shall use these statistics to substantiate the
status of the state's registered nurse workforce shortage and
to track short staffing data trends;

(3) retention and turnover rates, which
includes hospital staff retention, turnover, voluntary turnover
and involuntary turnover rates and used by the authority to
determine the effectiveness of the Safe Staffing Act; and

(4) hospital staff position openings.

B. The authority shall conduct a comprehensive
assessment of the Nurse Licensure Compact and determine its
effect on the registered nurse workforce in New Mexico
hospitals. This assessment shall determine, among other
things, the number of registered nurses working in New Mexico
hospitals who hold New Mexico licenses but practice or live in
other states. The authority shall provide recommendations to
the governor and the legislature on improvements necessary to
address the registered nurse shortage in New Mexico.

C. The authority shall maintain a publicly
accessible website posting each hospital's annual retention
statistics, staffing levels, use of temporary contract staff,
financial expenditure reports and audit findings."

SECTION 9.
EMERGENCY.--It is necessary for the public
peace, health and safety that this act take effect immediately.

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