Section 449.2421 - Certain health care facilities in larger counties required to make available to Division written policy that allows refusal of or objection to work assignments and documented staffing plan; requirements of staffing plan and flexibility for adjustments1. As a condition of licensing, a health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall make available to the Division a written policy adopted pursuant to NRS 449.2423, a documented staffing plan and a written certification that the written policy and the documented staffing plan are adequate to meet the needs of the patients of the health care facility. If the health care facility is a hospital, the written policy and the documented staffing plan must: (a) Be signed by each member of the staffing committee of the hospital established pursuant to NRS 449.242 to indicate that the member has received a copy of the written policy and the staffing plan and, if applicable, actively participated in the development of the written policy and the staffing plan; and(b) Include a place where a member of the staffing committee may note any objections to the written policy or the staffing plan.2. The documented staffing plan must include, without limitation:(a) A detailed written plan setting forth:(1) The number, skill mix and classification of licensed nurses required in each unit in the health care facility, which must take into account the experience of the clinical and nonclinical support staff with whom the licensed nurses collaborate, supervise or otherwise delegate assignments; and(2) The number of certified nursing assistants required in each unit in the health care facility;(b) A description of the types of patients who are treated in each unit, including, without limitation, the type of care required by the patients;(c) A description of the activities in each unit, including, without limitation, discharges, transfers and admissions;(d) A description of the size and geography of each unit;(e) A description of any specialized equipment and technology available for each unit;(f) Any foreseeable changes in the size or function of each unit; and(g) Protocols for adequately staffing the health care facility: (1) In the event of an emergency, including, without limitation, mass casualties and a significant change in the acuity or number of patients; (2) If applicable, in circumstances when a significant number of patients are diverted from another facility; and(3) If a licensed nurse or certified nursing assistant is absent or refuses a work assignment pursuant to NRS 449.2423.3. A documented staffing plan must provide sufficient flexibility to allow for adjustments based upon changes in a unit of the health care facility.4. The health care facility shall ensure that it is staffed in accordance with the documented staffing plan.Added to NRS by 2009, 2025; A 2013, 2151; 2017, 4172Amended by 2017, Ch. 578,§8.5, eff. 1/1/2018.Amended by 2013, Ch. 395,§30.9, eff. 10/1/2013.Added to NRS by 2009, 2025