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Bill

A 1974

Establishes "Patient Protection and Safe Staffing Act."

2026-2027 Regular Session Introduced by Rosy Bagolie and 17 co-sponsors

Establishes minimum RN and UAP staffing ratios for hospitals and ambulatory facilities, plus an acuity-based system to adjust staffing as needed to improve patient safety.

Introduced, Referred to Assembly Health Infrastructure Committee
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Bill Summary · A 1974

Summary of Bill A 1974 (Session 222, New Jersey)

Purpose and intent

  • Establishes the “Patient Protection and Safe Staffing Act” to set minimum direct care staffing standards for registered professional nurses (RNs) and unlicensed assistive personnel (UAP) in general and special hospitals and ambulatory surgical facilities, with additional considerations for state developmental centers and psychiatric hospitals.
  • Aims to address patient acuity and safety concerns by linking staffing levels to patient outcomes and by enabling acuity-based adjustments above minimum levels.

Key provisions and changes

  • Definitions:
    • Clarifies terms such as Commissioner (Health), Department (Health), Direct care RN, and UAP.
  • Minimum staffing ratios (to be adopted as regulations by the Commissioner of Health):
    • RN-to-patient ratios by unit, including:
    • Medical/Surgical: 1 RN per 4 patients
    • Step-down/Telemetry/Progressive Care/ICU variants: 1 RN per 3–4 patients depending on unit
    • Emergency Department: 1 RN per 4 patients (and higher in critical/trauma services)
    • Behavioral health/psychiatric: 1 RN per 5 patients
    • Critical/ICU/Neonatal/Burn units: 1 RN per 2–4 patients
    • Operating room (anesthesia): 1 RN per patient under anesthesia; 1 RN per patient in PACU
    • Labor and delivery: 1 RN per 3 patients; postpartum and mother-infant shared room specifics; mothers-only unit: 1 RN per 6 patients
    • Pediatric/ICU nursery: 1 RN per 3–4 patients; well-baby nursery: 1 RN per 6 patients
    • UAP-to-patient ratios:
    • Day shift: 1 UAP per 7 patients
    • Night shift: 1 UAP per 11 patients
  • Acuity and staffing system (Section 5):
    • Hospitals and facilities must implement an acuity and staffing system to increase staffing above minimums as needed for unit-level adequacy.
    • System elements include:
    • Based on patient classification/acuity, professional staffing standards, skill mix, and use of agency/temporary staff
    • Facility-wide establishment by the department of nursing with unit staff nurse (or bargaining agent) approval
    • Forecasting capabilities using objective criteria (case mix index, acuity, length of stay, discharge plans, unit design/capacity, admission/discharge/transfer indices)
    • Contingency plans for deviations (may include bed closures if staffing is too low)
    • Procedures for reassignment of staff, including floats and agency staff
    • Waivers: allowed only for unforeseen emergent circumstances after reasonable efforts to obtain additional staff
    • Float pool: hospitals must maintain a pool of qualified RNs
    • Non-nursing roles should not count toward nursing staffing levels; nurses must be oriented and demonstrated competent before counting toward staffing
    • Ancillary nursing personnel (e.g., nurse assistants, clerks, transport) cannot be reduced to meet staffing requirements
  • Enforcement and penalties (Section 6):
    • The Department of Health will monitor and enforce minimums and acuity-system requirements via inspections and complaint responses.
    • Complaint process:
    • Any nurse, staff member, collective bargaining agent, or member of the public can file a complaint within 60 days of alleged violation.
    • The Department must investigate within 30 days of filing and conclude within 60 days of investigation start.
    • Penalties for violations (per violation, with cumulative offenses within four years):
    • First offense: warning
    • Second offense: up to $1,750
    • Third offense: up to $2,500
    • Fourth or subsequent offense: up to $5,000
    • Civil penalties collected go to the Patient Protection and Staffing Fund.
    • A written investigative report must be provided to the complainant and, if applicable, their bargaining agent; reports on violations must be posted on the Department’s website.
  • Fund and uses (Section 7):
    • Establishes the Patient Protection and Staffing Fund in the Treasury.
    • Penalty proceeds are deposited into this fund and used to:
    • Increase Department of Health inspector capacity
    • Support nursing recruitment and retention programs
    • Fund nursing student loan forgiveness
    • Increase pay for nursing teaching staff
  • Administrative action and implementation (Section 8):
    • Health Department to adopt regulations within 90 days of enactment and hold a public hearing within 30 days of regulatory publication.
  • Additional review (Section 9):
    • Commissioner of Human Services to review DHS regulations for staffing in developmental centers and state psychiatric hospitals and revise to reflect safe staffing practices.
  • Effective date (Section 10):
    • Act takes effect on the first day of the 12th month after enactment, with anticipatory administrative action allowed.

Who and what is affected

  • General and special hospitals, ambulatory surgical facilities: subject to minimum RN-to-patient and UAP-to-patient ratios and acuity-based staffing systems.
  • State developmental centers and psychiatric hospitals: targeted for review and alignment with safe staffing practices by the DHS regulatory review.
  • Nursing staff, unlicensed assistive personnel, hospital administrators, and collective bargaining agents for nurses: impacted by staffing requirements, acuity-system implementation, and enforcement processes.
  • The Department of Health and the Department of Human Services: responsible for regulation, enforcement, investigations, and interagency coordination.
  • The Patient Protection and Staffing Fund: finances enforcement, recruitment, retention, loan forgiveness, and salary enhancements for nursing education staff.

Procedural and timeline notes

  • Regulations must be adopted within 90 days post-enactment; public hearing within 30 days of regulatory publication.
  • Complaints and investigations have specific timelines (60-day filing window, 30-day initiation, 60-day conclusion).
  • Effective date set for the first day of the 12th month after enactment; anticipatory action allowed for implementation.
  • Penalties are civil and enforceable under the Penalty Enforcement Law; proceeds flow to a dedicated state fund.

Compiled from official sources — confirm details with the bill’s official record.

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