Illinois 2023-2024 Regular Session

Illinois House Bill HB3338 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3338 Introduced , by Rep. Theresa Mah SYNOPSIS AS INTRODUCED: New Act210 ILCS 85/10.10210 ILCS 85/50-15.15 new Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in Act. Provides that nothing in the Act precludes the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act; however, the maximum patient assignments in the Act may not be exceeded, regardless of the use and application of any patient acuity system. Provides that the Department of Public Health shall adopt rules governing the implementation and operation of the Act. Provides that all facilities shall adopt written policies and procedures for training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides specified requirements for the Act's implementation by a facility. Establishes recordkeeping requirements. Provides that the written policies and procedures for the training and orientation of nursing staff shall require that all temporary personnel receive the same amount and type of training and orientation that is required for permanent staff. Provides specified nurse rights and protections. Provides that the Act's provisions are severable. Contains other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Amends the Nurse Practice Act. Provides that the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice shall be provided in the exclusive interests of the patient. LRB103 30963 CPF 57543 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3338 Introduced , by Rep. Theresa Mah SYNOPSIS AS INTRODUCED: New Act210 ILCS 85/10.10210 ILCS 85/50-15.15 new New Act 210 ILCS 85/10.10 210 ILCS 85/50-15.15 new Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in Act. Provides that nothing in the Act precludes the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act; however, the maximum patient assignments in the Act may not be exceeded, regardless of the use and application of any patient acuity system. Provides that the Department of Public Health shall adopt rules governing the implementation and operation of the Act. Provides that all facilities shall adopt written policies and procedures for training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides specified requirements for the Act's implementation by a facility. Establishes recordkeeping requirements. Provides that the written policies and procedures for the training and orientation of nursing staff shall require that all temporary personnel receive the same amount and type of training and orientation that is required for permanent staff. Provides specified nurse rights and protections. Provides that the Act's provisions are severable. Contains other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Amends the Nurse Practice Act. Provides that the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice shall be provided in the exclusive interests of the patient. LRB103 30963 CPF 57543 b LRB103 30963 CPF 57543 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3338 Introduced , by Rep. Theresa Mah SYNOPSIS AS INTRODUCED:
3	3	New Act210 ILCS 85/10.10210 ILCS 85/50-15.15 new New Act 210 ILCS 85/10.10 210 ILCS 85/50-15.15 new
4	4	New Act
5	5	210 ILCS 85/10.10
6	6	210 ILCS 85/50-15.15 new
7	7	Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in Act. Provides that nothing in the Act precludes the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act; however, the maximum patient assignments in the Act may not be exceeded, regardless of the use and application of any patient acuity system. Provides that the Department of Public Health shall adopt rules governing the implementation and operation of the Act. Provides that all facilities shall adopt written policies and procedures for training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides specified requirements for the Act's implementation by a facility. Establishes recordkeeping requirements. Provides that the written policies and procedures for the training and orientation of nursing staff shall require that all temporary personnel receive the same amount and type of training and orientation that is required for permanent staff. Provides specified nurse rights and protections. Provides that the Act's provisions are severable. Contains other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Amends the Nurse Practice Act. Provides that the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice shall be provided in the exclusive interests of the patient.
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10	10	A BILL FOR
11	11	HB3338LRB103 30963 CPF 57543 b HB3338 LRB103 30963 CPF 57543 b
12	12	HB3338 LRB103 30963 CPF 57543 b
13	13	1 AN ACT concerning regulation.
14	14	2 Be it enacted by the People of the State of Illinois,
15	15	3 represented in the General Assembly:
16	16	4 Section 1. Short title. This Act may be cited as the Safe
17	17	5 Patient Limits Act.
18	18	6 Section 5. Definitions. In this Act:
19	19	7 "Couplet" means one postpartum patient and one baby.
20	20	8 "Critical trauma patient" means a patient who has an
21	21	9 injury to an anatomic area that (i) requires life-saving
22	22	10 interventions, or (ii) in conjunction with unstable vital
23	23	11 signs, poses an immediate threat to life or limb.
24	24	12 "Department" means the Department of Public Health.
25	25	13 "Direct care registered professional nurse" means a
26	26	14 registered professional nurse who has accepted a hands-on,
27	27	15 in-person patient care assignment and whose primary role is to
28	28	16 provide hands-on, in-person patient care.
29	29	17 "Facility" means a hospital licensed under the Hospital
30	30	18 Licensing Act or organized under the University of Illinois
31	31	19 Hospital Act, a private or State-owned and State-operated
32	32	20 general acute care hospital, an LTAC hospital as defined in
33	33	21 Section 10 of the Long Term Acute Care Hospital Quality
34	34	22 Improvement Transfer Program Act, an ambulatory surgical
35	35	23 treatment center as defined in Section 3 of the Ambulatory
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39	39	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3338 Introduced , by Rep. Theresa Mah SYNOPSIS AS INTRODUCED:
40	40	New Act210 ILCS 85/10.10210 ILCS 85/50-15.15 new New Act 210 ILCS 85/10.10 210 ILCS 85/50-15.15 new
41	41	New Act
42	42	210 ILCS 85/10.10
43	43	210 ILCS 85/50-15.15 new
44	44	Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in Act. Provides that nothing in the Act precludes the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act; however, the maximum patient assignments in the Act may not be exceeded, regardless of the use and application of any patient acuity system. Provides that the Department of Public Health shall adopt rules governing the implementation and operation of the Act. Provides that all facilities shall adopt written policies and procedures for training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides specified requirements for the Act's implementation by a facility. Establishes recordkeeping requirements. Provides that the written policies and procedures for the training and orientation of nursing staff shall require that all temporary personnel receive the same amount and type of training and orientation that is required for permanent staff. Provides specified nurse rights and protections. Provides that the Act's provisions are severable. Contains other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Amends the Nurse Practice Act. Provides that the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice shall be provided in the exclusive interests of the patient.
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46	46	LRB103 30963 CPF 57543 b
47	47	A BILL FOR
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53	53	New Act
54	54	210 ILCS 85/10.10
55	55	210 ILCS 85/50-15.15 new
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74	74	1 Surgical Treatment Center Act, a freestanding emergency center
75	75	2 licensed under the Emergency Medical Services Systems Act, a
76	76	3 birth center licensed under the Birth Center Licensing Act, an
77	77	4 acute psychiatric hospital, an acute care specialty hospital,
78	78	5 or an acute care unit within a health care facility.
79	79	6 "Health care emergency" means an emergency that is
80	80	7 declared by an authorized person within federal, state or
81	81	8 local government and is related to circumstances that are
82	82	9 unpredictable and unavoidable and that affect the delivery of
83	83	10 medical care and require an immediate or exceptional level of
84	84	11 emergency or other medical services at the specific facility.
85	85	12 The term does not include a state of emergency that results
86	86	13 from a labor dispute in the health care industry or consistent
87	87	14 understaffing.
88	88	15 "Health care workforce" means personnel employed by or
89	89	16 contracted to work at a facility that have an effect upon the
90	90	17 delivery of quality care to patients, including, but not
91	91	18 limited to, registered nurses, licensed practical nurses,
92	92	19 unlicensed assistive personnel, service, maintenance,
93	93	20 clerical, professional, and technical workers, and other
94	94	21 health care workers.
95	95	22 "Immediate postpartum patients" means those patients who
96	96	23 have given birth within the previous 2 hours.
97	97	24 "Nursing care" means care that falls within the scope of
98	98	25 practice as described in Section 55-30 or 60-35 of the Nurse
99	99	26 Practice Act or is otherwise encompassed within recognized
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110	110	1 standards of nursing practice.
111	111	2 "Rapid response team" means a team of health care
112	112	3 providers that provide care to patients with early signs of
113	113	4 deterioration to prevent respiratory or cardiac arrest.
114	114	5 "Registered nurse" or "registered professional nurse"
115	115	6 means a person who is licensed as a registered professional
116	116	7 nurse under the Nurse Practice Act and practices nursing as
117	117	8 described in Section 60-35 of the Nurse Practice Act.
118	118	9 "Specialty care unit" means a unit which is organized,
119	119	10 operated, and maintained to provide care for a specific
120	120	11 medical condition or a specific patient population.
121	121	12 For the purposes of this Act, a patient is considered
122	122	13 assigned to a registered nurse if the registered nurse accepts
123	123	14 responsibility for the patient's nursing care.
124	124	15 Section 10. Maximum patient assignments for registered
125	125	16 nurses.
126	126	17 (a) The maximum number of patients assigned to a
127	127	18 registered nurse in a facility shall not exceed the limits
128	128	19 provided in this Section. However, nothing shall preclude a
129	129	20 facility from assigning fewer patients to a registered nurse
130	130	21 than the limits provided in this Section. The requirements of
131	131	22 this Section apply at all times during each shift within each
132	132	23 clinical unit and each patient care area.
133	133	24 (b) In all units with critical care or intensive care
134	134	25 patients, including, but not limited to, coronary care, acute
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145	145	1 respiratory care, medical, burn, pediatric, or neonatal
146	146	2 intensive care patients, the maximum patient assignment of
147	147	3 critical care patients to a registered nurse is 1.
148	148	4 (c) In all units with step-down or intermediate intensive
149	149	5 care patients, the maximum patient assignment of step-down or
150	150	6 intermediate intensive care patients to a registered nurse is
151	151	7 3.
152	152	8 (d) In all units with post-anesthesia care patients,
153	153	9 regardless of the type of anesthesia administered, the maximum
154	154	10 patient assignment of post-anesthesia care patients or
155	155	11 patients being monitored for the effects of any anesthetizing
156	156	12 agent to a registered nurse is 1.
157	157	13 (e) In all units with operating room patients, the maximum
158	158	14 patient assignment of operating room patients to a registered
159	159	15 nurse is one, provided that a minimum of one additional person
160	160	16 serves as a scrub assistant for each patient.
161	161	17 (f) In the emergency department:
162	162	18 (1) In a unit providing basic emergency services or
163	163	19 comprehensive emergency services, the maximum patient
164	164	20 assignment at any time to a registered nurse is 3.
165	165	21 (2) The maximum assignment of critical care emergency
166	166	22 patients to a registered nurse is 1. A patient in the
167	167	23 emergency department shall be considered a critical care
168	168	24 patient when the patient meets the criteria for admission
169	169	25 to a critical care service area within the facility.
170	170	26 (3) The maximum assignment of critical trauma patients
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181	181	1 in an emergency unit to a registered nurse is one.
182	182	2 (4) At least one direct care registered professional
183	183	3 nurse shall be assigned to triage patients. The direct
184	184	4 care registered professional nurse assigned to triage
185	185	5 patients shall be immediately available at all times to
186	186	6 triage patients when they arrive in the emergency
187	187	7 department. The direct care registered professional nurse
188	188	8 assigned to triage patients shall perform triage functions
189	189	9 only and may not be assigned the responsibility of the
190	190	10 base radio. Triage, radio, or flight registered nurses
191	191	11 shall not be counted in the calculation of direct care
192	192	12 registered nurse staffing levels.
193	193	13 (g) In all units with maternal child care patients:
194	194	14 (1) The maximum patient assignment to a registered
195	195	15 nurse of antepartum patients requiring continuous fetal
196	196	16 monitoring is 2.
197	197	17 (2) The maximum patient assignment of other antepartum
198	198	18 patients who are not in active labor to a registered nurse
199	199	19 is 3.
200	200	20 (3) The maximum patient assignment of active labor
201	201	21 patients to a registered nurse is one.
202	202	22 (4) The maximum patient assignment of patients with
203	203	23 medical or obstetrical complications, during the
204	204	24 initiation of epidural anesthesia, or during circulation
205	205	25 for a caesarean section delivery to a registered nurse is
206	206	26 one.
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217	217	1 (5) The maximum patient assignment during birth is one
218	218	2 registered nurse responsible for the patient in labor and,
219	219	3 for each newborn, one registered nurse whose sole
220	220	4 responsibility is that newborn patient.
221	221	5 (6) The maximum patient assignment of postpartum
222	222	6 patients when the parent has given birth within the
223	223	7 previous two hours is one couplet to one registered nurse,
224	224	8 and in the case of multiple births, one registered nurse
225	225	9 for each additional newborn.
226	226	10 (7) The maximum patient assignment of couplets to a
227	227	11 registered nurse is 2.
228	228	12 (8) The maximum patient assignment of patients
229	229	13 receiving postpartum or postoperative gynecological care
230	230	14 to a registered nurse is 4 when the registered nurse has
231	231	15 been assigned only to patients receiving postpartum or
232	232	16 postoperative gynecological care.
233	233	17 (9) The maximum patient assignment of newborn patients
234	234	18 when the patient is unstable, as assessed by a direct care
235	235	19 registered professional nurse, to a registered nurse is
236	236	20 one.
237	237	21 (10) The maximum patient assignment of newborn
238	238	22 patients to a registered nurse is 2 when the patients are
239	239	23 receiving intermediate care or the nurse has been assigned
240	240	24 to a patient care unit that receives newborn patients
241	241	25 requiring intermediate care, including, but not limited
242	242	26 to, an intermediate care nursery.
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253	253	1 (h) In all units with pediatric patients, the maximum
254	254	2 patient assignment of pediatric patients to a registered nurse
255	255	3 is 3.
256	256	4 (i) In all units with psychiatric patients, the maximum
257	257	5 patient assignment of psychiatric patients to a registered
258	258	6 nurse is 4.
259	259	7 (j) In all units with medical and surgical patients, the
260	260	8 maximum patient assignment of medical or surgical patients to
261	261	9 a registered nurse is 4.
262	262	10 (k) In all units with telemetry patients, the maximum
263	263	11 patient assignment of telemetry patients to a registered nurse
264	264	12 is 3.
265	265	13 (l) In all units with observational patients, the maximum
266	266	14 patient assignment of observational patients to a registered
267	267	15 nurse is 3.
268	268	16 (m) In all units with acute rehabilitation patients, the
269	269	17 maximum patient assignment of acute rehabilitation patients to
270	270	18 a registered nurse is 4.
271	271	19 (n) In all units with conscious sedation patients, the
272	272	20 maximum patient assignment of conscious sedation patients to a
273	273	21 registered nurse is one.
274	274	22 (o) In any unit not otherwise listed in this Section,
275	275	23 including all specialty care units not otherwise listed in
276	276	24 this Section, the maximum patient assignment to a registered
277	277	25 nurse is 4.
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288	288	1 Section 15. Use of rapid response teams as first
289	289	2 responders prohibited. A rapid response team registered nurse
290	290	3 shall not be given direct care patient assignments while
291	291	4 assigned as a registered nurse responsible for responding to a
292	292	5 rapid response team request.
293	293	6 Section 20. Implementation by a facility.
294	294	7 (a) A facility shall implement the patient limits
295	295	8 established by Section 10 without diminishing the staffing
296	296	9 levels of the facility's health care workforce, as defined in
297	297	10 Section 5. A facility may not lay off licensed practical
298	298	11 nurses, licensed psychiatric technicians, certified nursing
299	299	12 assistants, or other ancillary support staff to meet the
300	300	13 patient limits under Section 10.
301	301	14 (b) Each patient shall be assigned to a direct care
302	302	15 registered professional nurse who shall directly provide the
303	303	16 comprehensive patient assessment, development of a plan of
304	304	17 care, supervision, implementation, and evaluation of the
305	305	18 nursing care provided to the patient at least every shift and
306	306	19 who has the responsibility for the provision of care to a
307	307	20 particular patient within the registered nurse's scope of
308	308	21 practice.
309	309	22 (c) There shall be no averaging of the number of patients
310	310	23 and the total number of registered nurses in each clinical
311	311	24 unit or patient care area in order to meet the patient limits
312	312	25 under Section 10.
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323	323	1 (d) Only registered nurses providing direct patient care
324	324	2 shall be considered when evaluating compliance with the
325	325	3 patient limits under Section 10. Ancillary staff and
326	326	4 unlicensed personnel shall not be considered when evaluating
327	327	5 compliance with the patient limits under Section 10.
328	328	6 (e) The hours in which a nurse administrator, nurse
329	329	7 supervisor, nurse manager, charge nurse, and other licensed
330	330	8 nurse provides patient care shall not be considered when
331	331	9 evaluating compliance with the patient limits under Section 10
332	332	10 and with the patient assignment requirement under subsection
333	333	11 (b) of Section 20 unless the registered nurse:
334	334	12 (1) has a current and active direct patient care
335	335	13 assignment;
336	336	14 (2) provides direct patient care in compliance with
337	337	15 the requirements of this section and Section 45;
338	338	16 (3) has demonstrated to the facility current
339	339	17 competence in providing care on the particular unit; and
340	340	18 (4) has the principal responsibility of providing
341	341	19 direct patient care and has no additional job duties
342	342	20 during the time period during which the nurse has a
343	343	21 patient assignment.
344	344	22 (f) The hours in which a nurse administrator, nurse
345	345	23 supervisor, nurse manager, charge nurse, and other licensed
346	346	24 nurse provides direct patient care may be considered when
347	347	25 evaluating compliance with the patient limits under Section 10
348	348	26 and with the patient assignment requirement under subsection
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359	359	1 (b) of Section 20 only if the nurse is providing relief for a
360	360	2 direct care registered professional nurse during breaks,
361	361	3 meals, and other routine and expected absences from the unit.
362	362	4 (g) At all times during each shift within a facility unit,
363	363	5 clinical unit, or patient care area of a facility, and with the
364	364	6 full complement of ancillary support staff, at least two
365	365	7 direct care registered nurses shall be physically present in
366	366	8 each facility unit, clinical unit, or patient care area where
367	367	9 there are patients present.
368	368	10 (h) Identifying a clinical unit or patient care area by a
369	369	11 name or term other than those listed in this Act does not
370	370	12 affect a facility's requirement to staff the unit consistent
371	371	13 with the patient limits identified for the level of intensity
372	372	14 or type of care described in this Act.
373	373	15 (i) A registered nurse providing direct care to a patient
374	374	16 has the authority to determine if a change in the patient's
375	375	17 status places the patient in a different category requiring a
376	376	18 different patient limit under Section 10.
377	377	19 (j) A facility shall assign direct care professional
378	378	20 registered nurses in a patient care unit in accordance with
379	379	21 subsection 10 in order to meet the highest level of intensity
380	380	22 and type of care provided in the patient care unit. If multiple
381	381	23 paragraphs of subsection 10 apply to a patient, a facility
382	382	24 shall assign a direct care professional registered nurse in
383	383	25 accordance with the lowest numerical patient assignment.
384	384	26 (k) A facility shall provide additional staffing of direct
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395	395	1 care registered professional nurses, above the number of
396	396	2 direct care registered professional nurses required to comply
397	397	3 with the patient levels under Section 10, or additional
398	398	4 staffing of licensed practical nurses, certified nursing
399	399	5 assistants, or other licensed or unlicensed ancillary support
400	400	6 staff based on the direct care registered professional nurse's
401	401	7 assessment of each assigned individual patient, the individual
402	402	8 patient's nursing care requirements, and the individual
403	403	9 patient's nursing care plan.
404	404	10 (l) A facility shall not employ video monitors, remote
405	405	11 patient monitoring, or any form of electronic visualization of
406	406	12 a patient as a substitute for the direct in-person observation
407	407	13 required for patient assessment by the registered nurse or for
408	408	14 patient protection. Video monitors or any form of electronic
409	409	15 visualization of a patient shall not constitute compliance
410	410	16 with the patient limits under Section 10.
411	411	17 (m) A facility must provide relief by a direct care
412	412	18 registered professional nurse with unit-specific education,
413	413	19 training, and competence during another direct care registered
414	414	20 professional nurse's meal periods, breaks, and routine
415	415	21 absences as part of the facility's obligation to meet the
416	416	22 patient limits under Section 10 at all times.
417	417	23 Section 25. Changes in patient census.
418	418	24 (a) A facility shall plan for routine fluctuations in its
419	419	25 patient census, including, but not limited to, admissions,
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430	430	1 discharges, and transfers.
431	431	2 (b) If a health care emergency causes a change in the
432	432	3 number of patients in a clinical care unit or patient care
433	433	4 area, a facility must be able to demonstrate that immediate
434	434	5 and diligent efforts were made to maintain required staffing
435	435	6 levels under this Act.
436	436	7 (c) A facility shall immediately notify the Department if
437	437	8 a health care emergency under Section (b) causes a change in
438	438	9 the number of patients in a clinical care unit or patient care
439	439	10 area and shall report to the Department efforts made to
440	440	11 maintain required staffing levels under this Act.
441	441	12 Section 30. Record of staff assignments.
442	442	13 (a) A facility shall keep a record of the actual direct
443	443	14 care registered professional nurse, licensed practical nurse,
444	444	15 certified nursing assistant, and other ancillary staff
445	445	16 assignments to individual patients documented on a day-to-day,
446	446	17 shift-by-shift basis and shall submit copies of its records to
447	447	18 the Department quarterly and keep copies of its staff
448	448	19 assignments on file for a period of 7 years.
449	449	20 (b) The documentation required by subsection (a) shall be
450	450	21 submitted to the Department as a mandatory condition of
451	451	22 licensure, with a certification by the chief nursing officer
452	452	23 of the facility that the documentation completely and
453	453	24 accurately reflects registered nurse staffing levels by the
454	454	25 facility for each shift in each facility unit, clinical unit,
455	455
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465	465	1 and patient care area in which patients receive care. The
466	466	2 chief nursing officer shall execute the certification under
467	467	3 penalty of perjury, and the certification must contain an
468	468	4 expressed acknowledgment that any false statement constitutes
469	469	5 fraud and is subject to criminal and civil prosecution and
470	470	6 penalties.
471	471	7 Section 35. Implementation by the Department. The
472	472	8 Department shall adopt rules governing the implementation and
473	473	9 operation of this Act, including methods for facility staff,
474	474	10 facility staff's collective bargaining representatives, and
475	475	11 the public to file complaints regarding violations of this Act
476	476	12 with the Department. The Department shall conduct periodic
477	477	13 audits to ensure implementation of this Act.
478	478	14 Section 40. Education.
479	479	15 (a) All facilities shall adopt written policies including:
480	480	16 (1) procedures for the education, training, and orientation of
481	481	17 nursing staff to each clinical area where the staff will work;
482	482	18 and (2) criteria for the facility to use in determining if a
483	483	19 registered nurse has demonstrated current competence in
484	484	20 providing care in a clinical area.
485	485	21 (b) No registered nurse shall be assigned to a facility
486	486	22 unit, clinical unit, or patient care area unless that
487	487	23 registered nurse has first received education, training, and
488	488	24 orientation in that clinical area that is sufficient to
489	489
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499	499	1 provide safe, therapeutic, and competent care to patients in
500	500	2 that clinical area and has demonstrated competence in
501	501	3 providing care in that clinical area.
502	502	4 (c) No registered nurse shall be assigned to relieve a
503	503	5 direct care professional registered nurse during breaks,
504	504	6 meals, and routine absences from a facility unit, clinical
505	505	7 unit, or patient care area unless that registered nurse has
506	506	8 first received education, training, and orientation in that
507	507	9 clinical area that is sufficient to provide safe, therapeutic,
508	508	10 and competent care to patients in that clinical area and has
509	509	11 demonstrated competence in providing care in that clinical
510	510	12 area.
511	511	13 (d) A health care facility may not assign any nursing
512	512	14 personnel from temporary nursing agencies to a facility unit,
513	513	15 clinical unit, or patient care area unless the nursing
514	514	16 personnel have first received education, training, and
515	515	17 orientation in that clinical area that is sufficient to
516	516	18 provide safe, therapeutic, and competent care to patients in
517	517	19 that clinical area and have demonstrated competence in
518	518	20 providing care in that clinical area.
519	519	21 Section 45. Enforcement.
520	520	22 (a) In addition to any other penalty prescribed by law,
521	521	23 the Department may impose a civil penalty against a facility
522	522	24 that violates this Act of up to $25,000 for each violation,
523	523	25 except that the Department shall impose a civil penalty of at
524	524
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526	526
527	527
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531	531
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534	534	1 least $25,000 for each violation if the Department determines
535	535	2 that the health care facility has a pattern of such violation.
536	536	3 A separate and distinct violation shall be deemed to have been
537	537	4 committed on each day during which any violation continues
538	538	5 after receipt of written notice of the violation from the
539	539	6 Department by the facility.
540	540	7 (b) The Department shall post on its website the names of
541	541	8 facilities against which civil penalties have been imposed
542	542	9 under this Act, the violation for which such penalty was
543	543	10 imposed, and such additional information as the Department
544	544	11 deems necessary.
545	545	12 (c) A facility's failure to adhere to the limits set by
546	546	13 Section 10, any other violation of this Act, or any violation
547	547	14 of Section 10.10 of the Hospital Licensing Act shall be
548	548	15 reported by the Department to the Attorney General for
549	549	16 enforcement, for which the Attorney General may bring action
550	550	17 in a court of competent jurisdiction seeking injunctive relief
551	551	18 and civil penalties.
552	552	19 (d) It is a defense to an enforcement action under this Act
553	553	20 if the facility demonstrates that a health care emergency was
554	554	21 in force at the time of the alleged violation and that the
555	555	22 facility made immediate and diligent efforts to maintain
556	556	23 required staffing levels under this Act.
557	557	24 Section 50. Nurse rights and protections.
558	558	25 (a) A registered professional nurse may object to or
559	559
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569	569	1 refuse to participate in any activity, practice, assignment,
570	570	2 or task if:
571	571	3 (1) in good faith, the registered nurse reasonably
572	572	4 believes it to be a violation of the direct care
573	573	5 registered professional nurse maximum patient assignments
574	574	6 or other provision established under this Act or a rule
575	575	7 adopted by the Department implementing this Act; or
576	576	8 (2) the registered nurse, based on the registered
577	577	9 nurse's nursing judgment, reasonably believes the
578	578	10 registered nurse is not prepared by education, training,
579	579	11 or experience to fulfill the assignment without
580	580	12 compromising the safety of any patient or jeopardizing the
581	581	13 license of the registered nurse.
582	582	14 (3) in the registered nurse's nursing judgment, the
583	583	15 activity, policy, practice, assignment or task would be
584	584	16 outside the registered nurse's scope of practice or would
585	585	17 otherwise compromise the safety of any patient or the
586	586	18 registered nurse.
587	587	19 (b) A facility shall not retaliate, discriminate, or
588	588	20 otherwise take adverse action in any manner with respect to
589	589	21 any aspect of a nurse's employment, including discharge,
590	590	22 promotion, compensation, or terms, conditions, or privileges
591	591	23 of employment, based on the nurse's refusal to complete an
592	592	24 assignment under subsection (a).
593	593	25 (c) A facility shall not file a complaint against a
594	594	26 registered professional nurse with the Board of Nursing based
595	595
596	596
597	597
598	598
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605	605	1 on the nurse's refusal to complete an assignment under
606	606	2 subsection (a).
607	607	3 (d) A facility shall not retaliate, discriminate, or
608	608	4 otherwise take adverse action in any manner against any person
609	609	5 or with respect to any aspect of a nurse's employment,
610	610	6 including discharge, promotion, compensation, or terms,
611	611	7 conditions, or privileges of employment, based on that nurse's
612	612	8 or that person's opposition to any facility policy, practice,
613	613	9 or action that the nurse in good faith believes violates this
614	614	10 Act.
615	615	11 (e) A facility shall not retaliate, discriminate, or
616	616	12 otherwise take adverse action against any patient or employee
617	617	13 of the facility or any other individual on the basis that the
618	618	14 patient, employee, or individual, in good faith, individually
619	619	15 or in conjunction with another person or persons, has
620	620	16 presented a grievance or complaint, or has initiated or
621	621	17 cooperated in any investigation or proceeding of any
622	622	18 governmental entity, regulatory agency, or private
623	623	19 accreditation body, made a civil claim or demand, or filed an
624	624	20 action relating to the care, services, or conditions of the
625	625	21 facility or of any affiliated or related facilities.
626	626	22 (f) A facility shall not do either of the following:
627	627	23 (1) Interfere with, restrain, or deny the exercise of,
628	628	24 or attempt to deny the exercise of, a right conferred
629	629	25 under this Act.
630	630	26 (2) Coerce or intimidate any individual regarding the
631	631
632	632
633	633
634	634
635	635
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637	637
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641	641	1 exercise of, or an attempt to exercise, a right conferred
642	642	2 by this Act.
643	643	3 Section 55. Severability. The provisions of this Act are
644	644	4 severable under Section 1.31 of the Statute on Statutes.
645	645	5 Section 60. The Hospital Licensing Act is amended by
646	646	6 changing Section 10.10 and by adding Section 50-15.15 as
647	647	7 follows:
648	648	8 (210 ILCS 85/10.10)
649	649	9 Sec. 10.10. Nurse Staffing by Patient Acuity.
650	650	10 (a) Findings. The Legislature finds and declares all of
651	651	11 the following:
652	652	12 (1) The State of Illinois has a substantial interest
653	653	13 in promoting quality care and improving the delivery of
654	654	14 health care services.
655	655	15 (2) Evidence-based studies have shown that the basic
656	656	16 principles of staffing in the acute care setting should be
657	657	17 based on the complexity of patients' care needs aligned
658	658	18 with available nursing skills to promote quality patient
659	659	19 care consistent with professional nursing standards.
660	660	20 (3) Compliance with this Section promotes an
661	661	21 organizational climate that values registered nurses'
662	662	22 input in meeting the health care needs of hospital
663	663	23 patients.
664	664
665	665
666	666
667	667
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670	670
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674	674	1 (b) Definitions. As used in this Section:
675	675	2 "Acuity model" means an assessment tool selected and
676	676	3 implemented by a hospital, as recommended by a nursing care
677	677	4 committee, that assesses the complexity of patient care needs
678	678	5 requiring professional nursing care and skills and aligns
679	679	6 patient care needs and nursing skills consistent with
680	680	7 professional nursing standards.
681	681	8 "Department" means the Department of Public Health.
682	682	9 "Direct patient care" means care provided by a registered
683	683	10 professional nurse with direct responsibility to oversee or
684	684	11 carry out medical regimens or nursing care for one or more
685	685	12 patients.
686	686	13 "Nursing care committee" means a hospital-wide committee
687	687	14 or committees of nurses whose functions, in part or in whole,
688	688	15 contribute to the development, recommendation, and review of
689	689	16 the hospital's nurse staffing plan established pursuant to
690	690	17 subsection (d).
691	691	18 "Registered professional nurse" means a person licensed as
692	692	19 a Registered Nurse under the Nurse Practice Act.
693	693	20 "Written staffing plan for nursing care services" means a
694	694	21 written plan for the assignment of patient care nursing staff
695	695	22 based on multiple nurse and patient considerations that yield
696	696	23 minimum staffing levels for inpatient care units and the
697	697	24 adopted acuity model aligning patient care needs with nursing
698	698	25 skills required for quality patient care consistent with
699	699	26 professional nursing standards.
700	700
701	701
702	702
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710	710	1 (c) Written staffing plan.
711	711	2 (1) Every hospital shall implement a written
712	712	3 hospital-wide staffing plan, prepared by a nursing care
713	713	4 committee or committees, that provides for minimum direct
714	714	5 care professional registered nurse-to-patient staffing
715	715	6 needs for each inpatient care unit, including inpatient
716	716	7 emergency departments. If the staffing plan prepared by
717	717	8 the nursing care committee is not adopted by the hospital,
718	718	9 or if substantial changes are proposed to it, the chief
719	719	10 nursing officer shall either: (i) provide a written
720	720	11 explanation to the committee of the reasons the plan was
721	721	12 not adopted; or (ii) provide a written explanation of any
722	722	13 substantial changes made to the proposed plan prior to it
723	723	14 being adopted by the hospital. The written hospital-wide
724	724	15 staffing plan shall include, but need not be limited to,
725	725	16 the following considerations:
726	726	17 (A) The complexity of complete care, assessment on
727	727	18 patient admission, volume of patient admissions,
728	728	19 discharges and transfers, evaluation of the progress
729	729	20 of a patient's problems, ongoing physical assessments,
730	730	21 planning for a patient's discharge, assessment after a
731	731	22 change in patient condition, and assessment of the
732	732	23 need for patient referrals.
733	733	24 (B) The complexity of clinical professional
734	734	25 nursing judgment needed to design and implement a
735	735	26 patient's nursing care plan, the need for specialized
736	736
737	737
738	738
739	739
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746	746	1 equipment and technology, the skill mix of other
747	747	2 personnel providing or supporting direct patient care,
748	748	3 and involvement in quality improvement activities,
749	749	4 professional preparation, and experience.
750	750	5 (C) Patient acuity and the number of patients for
751	751	6 whom care is being provided.
752	752	7 (D) The ongoing assessments of a unit's patient
753	753	8 acuity levels and nursing staff needed shall be
754	754	9 routinely made by the unit nurse manager or his or her
755	755	10 designee.
756	756	11 (E) The identification of additional registered
757	757	12 nurses available for direct patient care when
758	758	13 patients' unexpected needs exceed the planned workload
759	759	14 for direct care staff.
760	760	15 (2) In order to provide staffing flexibility to meet
761	761	16 patient needs, every hospital shall identify an acuity
762	762	17 model for adjusting the staffing plan for each inpatient
763	763	18 care unit.
764	764	19 (2.5) Each hospital shall implement the staffing plan
765	765	20 and assign nursing personnel to each inpatient care unit,
766	766	21 including inpatient emergency departments, in accordance
767	767	22 with the staffing plan.
768	768	23 (A) A registered nurse may report to the nursing
769	769	24 care committee any variations where the nurse
770	770	25 personnel assignment in an inpatient care unit is not
771	771	26 in accordance with the adopted staffing plan and may
772	772
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778	778
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782	782	1 make a written report to the nursing care committee
783	783	2 based on the variations.
784	784	3 (B) Shift-to-shift adjustments in staffing levels
785	785	4 required by the staffing plan may be made by the
786	786	5 appropriate hospital personnel overseeing inpatient
787	787	6 care operations. If a registered nurse in an inpatient
788	788	7 care unit objects to a shift-to-shift adjustment, the
789	789	8 registered nurse may submit a written report to the
790	790	9 nursing care committee.
791	791	10 (C) The nursing care committee shall develop a
792	792	11 process to examine and respond to written reports
793	793	12 submitted under subparagraphs (A) and (B) of this
794	794	13 paragraph (2.5), including the ability to determine if
795	795	14 a specific written report is resolved or should be
796	796	15 dismissed.
797	797	16 (3) The written staffing plan shall be posted, either
798	798	17 by physical or electronic means, in a conspicuous and
799	799	18 accessible location for both patients and direct care
800	800	19 staff, as required under the Hospital Report Card Act. A
801	801	20 copy of the written staffing plan shall be provided to any
802	802	21 member of the general public upon request.
803	803	22 (d) Nursing care committee.
804	804	23 (1) Every hospital shall have a nursing care committee
805	805	24 that meets at least 6 times per year. A hospital shall
806	806	25 appoint members of a committee whereby at least 55% of the
807	807	26 members are registered professional nurses providing
808	808
809	809
810	810
811	811
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814	814
815	815
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818	818	1 direct inpatient care, one of whom shall be selected
819	819	2 annually by the direct inpatient care nurses to serve as
820	820	3 co-chair of the committee.
821	821	4 (2) (Blank).
822	822	5 (2.5) A nursing care committee shall prepare and
823	823	6 recommend to hospital administration the hospital's
824	824	7 written hospital-wide staffing plan. If the staffing plan
825	825	8 is not adopted by the hospital, the chief nursing officer
826	826	9 shall provide a written statement to the committee prior
827	827	10 to a staffing plan being adopted by the hospital that: (A)
828	828	11 explains the reasons the committee's proposed staffing
829	829	12 plan was not adopted; and (B) describes the changes to the
830	830	13 committee's proposed staffing or any alternative to the
831	831	14 committee's proposed staffing plan.
832	832	15 (3) A nursing care committee's or committees' written
833	833	16 staffing plan for the hospital shall be based on the
834	834	17 principles from the staffing components set forth in
835	835	18 subsection (c). In particular, a committee or committees
836	836	19 shall provide input and feedback on the following:
837	837	20 (A) Selection, implementation, and evaluation of
838	838	21 minimum staffing levels for inpatient care units.
839	839	22 (B) Selection, implementation, and evaluation of
840	840	23 an acuity model to provide staffing flexibility that
841	841	24 aligns changing patient acuity with nursing skills
842	842	25 required.
843	843	26 (C) Selection, implementation, and evaluation of a
844	844
845	845
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847	847
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854	854	1 written staffing plan incorporating the items
855	855	2 described in subdivisions (c)(1) and (c)(2) of this
856	856	3 Section.
857	857	4 (D) Review the nurse staffing plans for all
858	858	5 inpatient areas and current acuity tools and measures
859	859	6 in use. The nursing care committee's review shall
860	860	7 consider:
861	861	8 (i) patient outcomes;
862	862	9 (ii) complaints regarding staffing, including
863	863	10 complaints about a delay in direct care nursing or
864	864	11 an absence of direct care nursing;
865	865	12 (iii) the number of hours of nursing care
866	866	13 provided through an inpatient hospital unit
867	867	14 compared with the number of inpatients served by
868	868	15 the hospital unit during a 24-hour period;
869	869	16 (iv) the aggregate hours of overtime worked by
870	870	17 the nursing staff;
871	871	18 (v) the extent to which actual nurse staffing
872	872	19 for each hospital inpatient unit differs from the
873	873	20 staffing specified by the staffing plan; and
874	874	21 (vi) any other matter or change to the
875	875	22 staffing plan determined by the committee to
876	876	23 ensure that the hospital is staffed to meet the
877	877	24 health care needs of patients.
878	878	25 (4) A nursing care committee must issue a written
879	879	26 report addressing the items described in subparagraphs (A)
880	880
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882	882
883	883
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890	890	1 through (D) of paragraph (3) semi-annually. A written copy
891	891	2 of this report shall be made available to direct inpatient
892	892	3 care nurses by making available a paper copy of the
893	893	4 report, distributing it electronically, or posting it on
894	894	5 the hospital's website.
895	895	6 (5) A nursing care committee must issue a written
896	896	7 report at least annually to the hospital governing board
897	897	8 that addresses items including, but not limited to: the
898	898	9 items described in paragraph (3); changes made based on
899	899	10 committee recommendations and the impact of such changes;
900	900	11 and recommendations for future changes related to nurse
901	901	12 staffing.
902	902	13 (e) Nothing in this Section 10.10 shall be construed to
903	903	14 limit, alter, or modify any of the terms, conditions, or
904	904	15 provisions of a collective bargaining agreement entered into
905	905	16 by the hospital.
906	906	17 (f) No hospital may discipline, discharge, or take any
907	907	18 other adverse employment action against an employee solely
908	908	19 because the employee expresses a concern or complaint
909	909	20 regarding an alleged violation of this Section or concerns
910	910	21 related to nurse staffing.
911	911	22 (g) Any employee of a hospital may file a complaint with
912	912	23 the Department regarding an alleged violation of this Section.
913	913	24 The Department must forward notification of the alleged
914	914	25 violation to the hospital in question within 10 business days
915	915	26 after the complaint is filed. Upon receiving a complaint of a
916	916
917	917
918	918
919	919
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922	922
923	923
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926	926	1 violation of this Section, the Department may take any action
927	927	2 authorized under Sections 7 or 9 of this Act.
928	928	3 (h) Delegation of nursing interventions by a registered
929	929	4 professional nurse must be in accordance with the Nurse
930	930	5 Practice Act.
931	931	6 (i) A hospital shall not mandate that a registered
932	932	7 professional nurse delegate any element of the nursing
933	933	8 process, including, but not limited to: nursing interventions,
934	934	9 medication administration, nursing judgment, comprehensive
935	935	10 patient assessment, development of the plan of care, or
936	936	11 evaluation of care. A delegation of a nursing intervention
937	937	12 granted by a registered professional nurse shall not be
938	938	13 re-delegated to another.
939	939	14 (j) The Department shall establish procedures to ensure
940	940	15 that the documentation submitted under this Section is
941	941	16 available for public inspection in its entirety.
942	942	17 (k) Nothing in this Section shall be construed to limit,
943	943	18 alter, or modify the requirements of the Safe Patient Limits
944	944	19 Act.
945	945	20 (Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
946	946	21 102-813, eff. 5-13-22.)
947	947	22 (210 ILCS 85/50-15.15 new)
948	948	23 Sec. 50-15.15. Nursing judgment.
949	949	24 (a) Performance of the scope of practice of a direct care
950	950	25 registered professional nurse requires the exercise of nursing
951	951
952	952
953	953
954	954
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957	957
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961	961	1 judgment in the exclusive interests of the patient. The
962	962	2 exercise of such nursing judgment, unencumbered by the
963	963	3 commercial or revenue-generation priorities of a hospital,
964	964	4 long term acute care hospital, or ambulatory surgical
965	965	5 treatment center or other employing entity of a direct care
966	966	6 registered professional nurse, is necessary to ensure safe,
967	967	7 therapeutic, effective, and competent treatment of patients
968	968	8 and is essential to protect the health and safety of the people
969	969	9 of Illinois.
970	970	10 (b) The exercise of nursing judgment by a direct care
971	971	11 registered professional nurse in the performance of the scope
972	972	12 of practice of the registered professional nurse under Section
973	973	13 60-35 or the scope of practice of the advanced practice
974	974	14 registered nurse under Section 65-30 shall be provided in the
975	975	15 exclusive interests of the patient and shall not, for any
976	976	16 purpose, be considered, relied upon, or represented as a job
977	977	17 function, authority, responsibility, or activity undertaken in
978	978	18 any respect for the purpose of serving the business,
979	979	19 commercial, operational, or other institutional interests of
980	980	20 the employer.
981	981	21 (c) No hospital, long term acute care hospital, ambulatory
982	982	22 surgical treatment center, or other health care facility shall
983	983	23 adopt policies that:
984	984	24 (1) limit a direct care registered professional nurse
985	985	25 in performing duties that are part of the nursing process,
986	986	26 including full exercise of nursing judgment in assessment,
987	987
988	988
989	989
990	990
991	991
992	992	HB3338 - 27 - LRB103 30963 CPF 57543 b
993	993
994	994
995	995	HB3338- 28 -LRB103 30963 CPF 57543 b HB3338 - 28 - LRB103 30963 CPF 57543 b
996	996	HB3338 - 28 - LRB103 30963 CPF 57543 b
997	997	1 planning, implementation and evaluation of care;
998	998	2 (2) Substitute recommendations, decisions, or outputs
999	999	3 of health information technology, algorithms used to a
1000	1000	4 achieve a medical or nursing care objective at a facility,
1001	1001	5 systems based on artificial intelligence or machine
1002	1002	6 learning, or clinical practice guidelines for the
1003	1003	7 independent nursing judgment of a direct care registered
1004	1004	8 professional nurse or penalize a direct care registered
1005	1005	9 professional nurse for overriding such technology or
1006	1006	10 guidelines if, in that registered nurse's judgment, and in
1007	1007	11 accordance with that registered nurse's scope of practice,
1008	1008	12 it is in the best interest of the patient to do so; or
1009	1009	13 (3) limit a direct care registered professional nurse
1010	1010	14 in acting as a patient advocate in the exclusive interests
1011	1011	15 of the patient.
1012	1012
1013	1013
1014	1014
1015	1015
1016	1016
1017	1017	HB3338 - 28 - LRB103 30963 CPF 57543 b