Carson City — The Assembly Ways and Means Committee heard hours of testimony on SB182, a proposal to establish nurse staffing ratios and new enforcement mechanisms for hospitals in counties above the population and bed thresholds set in the bill.

Supporters — represented by National Nurses United, SEIU Local 1107 and other labor groups — presented national studies and state experience (notably California) showing improved nurse recruitment, reduced burnout and lower preventable mortality after ratios were imposed. Nurse witnesses described frequent “assignments despite objection” (ADO) forms that document unsafe assignments; proponents said thousands of ADOs had been filed at just two hospitals over the prior four years and that higher patient counts per nurse increase 30‑day mortality in peer studies.

Opponents — including the Nevada Hospital Association, HCA Healthcare, Renown, Carson Tahoe and Dignity Health — said mandatory ratios would reduce bed capacity, force service closures and or trigger reliance on expensive travel nurses that would push hospitals into negative operating margins. Hospital witnesses supplied system‑level cost estimates (tens of millions per system) and argued Nevada still faces workforce constraints; hospitals said 40 percent of nurses hold out‑of‑state addresses and many licensed RNs are older, projecting substantial replacement needs in coming years.

Key issues the committee raised

- Workforce availability: Opponents argued Nevada lacks sufficient practicing bedside RNs to hire the number the bill would require; proponents said the bill would retain and attract nurses and cited California experience showing increases in RN applications and active licenses.
- Operational flexibility and emergency surges: Hospitals warned mandatory ratios would block admissions during surges and force diversions, while proponents said exceptions exist for declared emergencies and that better staffing prevents readmissions and saves money in the long run.
- Enforcement and investigations: The bill creates a complaint and investigation pathway involving the Labor Commissioner; committee members asked about the Labor Commission’s fiscal note (the bill carries a fiscal note for a full‑time investigator) and whether that funding had been incorporated into the bill’s appropriation.
- Data gaps: Members asked for more granular licensing and practice data (where licensed RNs actually work) and for substantiation rates for ADOs; proponents said the current data do not fully capture on‑the‑ground safety concerns and offered to provide individual nurse testimony and additional datasets.

Fiscal considerations and process

The Labor Commissioner’s office provided a fiscal estimate to hire staff to investigate alleged violations; sponsors said the fiscal note remained accurate and necessary for enforcement. Hospitals and system CFOs estimated multi‑million and multi‑tens‑of‑millions annual cost impacts to their systems; several systems said those costs would force program reductions and bed closures, especially for behavioral health services and in smaller rural markets.

Outcome of the hearing

The committee closed public comment after the allotted time. Members asked departments to confer on the Labor Commissioner fiscal note and expressed interest in more data on substantiated ADOs and workforce distribution. No formal committee action (vote) was taken in the hearing recorded in the transcript.

What comes next

Lawmakers signaled they will continue to press for data and to reconcile enforcement costs; the Labor Commissioner will need to work with the committee on an appropriation for the investigatory function should lawmakers choose to advance the policy.