Assembly Bill 1146 mandates that hospitals establish and maintain a nurse staffing plan that adheres to specific standards, including the formation of a nurse staffing committee predominantly composed of registered nurses in non-supervisory roles. The bill outlines minimum nurse-to-patient ratios for various hospital units, requiring hospitals to keep records of staffing ratios for at least three years. Hospitals that fail to comply with these requirements, such as submitting their staffing plans or adhering to the established ratios, may face civil penalties, including a $25,000 fine for late submissions and $5,000 for each day of non-compliance with corrective action plans.

Additionally, the bill grants registered nurses the right to refuse work assignments if they believe that fulfilling the assignment would compromise patient safety or their professional license. It prohibits hospitals from mandating overtime for registered nurses, with certain exceptions for critical situations. Nurses who face discrimination or adverse actions for exercising their rights under this bill can file complaints with the Department of Workforce Development, which will process these complaints similarly to employment discrimination cases.