NRS449.2423. Certain health care facilities in larger counties to adopt written policy to allow nurse or certified nursing assistant to refuse or object to work assignments; requirements of policy; maintenance of records of refusals of and objections to work assignments.

      1.  As a condition of licensure, a health care facility which is located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds must adopt and disseminate to each licensed nurse and certified nursing assistant employed by the health care facility a written policy that sets forth the circumstances under which a licensed nurse or certified nursing assistant may refuse or object to a work assignment.

      2.  The written policy concerning work assignments must, at a minimum, allow a licensed nurse or certified nursing assistant to:

      (a) Refuse a work assignment for any reason for refusal set forth in paragraph (b) of subsection 1 of NRS 449.205; and

      (b) File an objection to a work assignment if the work assignment violates any provision of NRS 449.241 to 449.2428, inclusive.

      3.  For the purposes of refusing a work assignment pursuant to paragraph (a) of subsection 2, the written policy concerning work assignments must contain:

      (a) Reasonable requirements for prior notice to the supervisor of the licensed nurse or certified nursing assistant of the request by the licensed nurse or certified nursing assistant to be relieved of the work assignment, including, without limitation, the reasons supporting the request;

      (b) Reasonable requirements which provide, if feasible, an opportunity for the supervisor to review a request by the licensed nurse or certified nursing assistant to be relieved of the work assignment, including any specific conditions supporting the request, and based upon that review:

             (1) Relieve the licensed nurse or certified nursing assistant of the work assignment as requested; or

             (2) Deny the request; and

      (c) A process pursuant to which a licensed nurse or certified nursing assistant may exercise his or her right to refuse a work assignment if the supervisor does not approve the request to be relieved of the work assignment if:

             (1) The supervisor failed to approve the request without proposing a remedy or, if a remedy is proposed, the proposed remedy would be inadequate or untimely;

             (2) The process for filing a complaint with the Division or any other appropriate regulatory entity, including any investigation that would be required, would be untimely to address the concerns of the licensed nurse or certified nursing assistant in refusing a work assignment; and

             (3) The licensed nurse or certified nursing assistant in good faith believes that the work assignment meets the conditions established in the written policy justifying refusal.

      4.  For the purposes of objecting to a work assignment pursuant to paragraph (b) of subsection 2, the written policy concerning work assignments must contain:

      (a) A process for a licensed nurse or certified nursing assistant to file an objection with the health care facility, but still accept the work assignment despite the objection; and

      (b) A requirement that the health care facility respond to the objection as soon as practicable, but not later than 45 days after receiving the objection.

      5.  The health care facility shall:

      (a) Maintain records for at least 2 years of each request to be relieved of a work assignment, each refusal of a work assignment and each objection to a work assignment that is filed with the health care facility pursuant to the written policy adopted pursuant to this section;

      (b) If the health care facility has established a staffing committee pursuant to NRS 449.242, provide to the staffing committee:

             (1) The number of requests to be relieved of a work assignment and refusals of a work assignment made by a licensed nurse or a certified nursing assistant at the health care facility pursuant to this section;

             (2) The number of objections to a work assignment filed by a licensed nurse or a certified nursing assistant at the health care facility pursuant to this section; and

             (3) An explanation of how the health care facility addressed the requests, refusals and objections; and

      (c) Ensure that the health care facility complies with the written policy adopted pursuant to this section.

      (Added to NRS by 2013, 2143)