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
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
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
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A BILL FOR
HB3338LRB103 30963 CPF 57543 b HB3338 LRB103 30963 CPF 57543 b
HB3338 LRB103 30963 CPF 57543 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the Safe
5 Patient Limits Act.
6 Section 5. Definitions. In this Act:
7 "Couplet" means one postpartum patient and one baby.
8 "Critical trauma patient" means a patient who has an
9 injury to an anatomic area that (i) requires life-saving
10 interventions, or (ii) in conjunction with unstable vital
11 signs, poses an immediate threat to life or limb.
12 "Department" means the Department of Public Health.
13 "Direct care registered professional nurse" means a
14 registered professional nurse who has accepted a hands-on,
15 in-person patient care assignment and whose primary role is to
16 provide hands-on, in-person patient care.
17 "Facility" means a hospital licensed under the Hospital
18 Licensing Act or organized under the University of Illinois
19 Hospital Act, a private or State-owned and State-operated
20 general acute care hospital, an LTAC hospital as defined in
21 Section 10 of the Long Term Acute Care Hospital Quality
22 Improvement Transfer Program Act, an ambulatory surgical
23 treatment center as defined in Section 3 of the Ambulatory
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
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
LRB103 30963 CPF 57543 b
A BILL FOR
New Act
210 ILCS 85/10.10
210 ILCS 85/50-15.15 new
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1 Surgical Treatment Center Act, a freestanding emergency center
2 licensed under the Emergency Medical Services Systems Act, a
3 birth center licensed under the Birth Center Licensing Act, an
4 acute psychiatric hospital, an acute care specialty hospital,
5 or an acute care unit within a health care facility.
6 "Health care emergency" means an emergency that is
7 declared by an authorized person within federal, state or
8 local government and is related to circumstances that are
9 unpredictable and unavoidable and that affect the delivery of
10 medical care and require an immediate or exceptional level of
11 emergency or other medical services at the specific facility.
12 The term does not include a state of emergency that results
13 from a labor dispute in the health care industry or consistent
14 understaffing.
15 "Health care workforce" means personnel employed by or
16 contracted to work at a facility that have an effect upon the
17 delivery of quality care to patients, including, but not
18 limited to, registered nurses, licensed practical nurses,
19 unlicensed assistive personnel, service, maintenance,
20 clerical, professional, and technical workers, and other
21 health care workers.
22 "Immediate postpartum patients" means those patients who
23 have given birth within the previous 2 hours.
24 "Nursing care" means care that falls within the scope of
25 practice as described in Section 55-30 or 60-35 of the Nurse
26 Practice Act or is otherwise encompassed within recognized
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1 standards of nursing practice.
2 "Rapid response team" means a team of health care
3 providers that provide care to patients with early signs of
4 deterioration to prevent respiratory or cardiac arrest.
5 "Registered nurse" or "registered professional nurse"
6 means a person who is licensed as a registered professional
7 nurse under the Nurse Practice Act and practices nursing as
8 described in Section 60-35 of the Nurse Practice Act.
9 "Specialty care unit" means a unit which is organized,
10 operated, and maintained to provide care for a specific
11 medical condition or a specific patient population.
12 For the purposes of this Act, a patient is considered
13 assigned to a registered nurse if the registered nurse accepts
14 responsibility for the patient's nursing care.
15 Section 10. Maximum patient assignments for registered
16 nurses.
17 (a) The maximum number of patients assigned to a
18 registered nurse in a facility shall not exceed the limits
19 provided in this Section. However, nothing shall preclude a
20 facility from assigning fewer patients to a registered nurse
21 than the limits provided in this Section. The requirements of
22 this Section apply at all times during each shift within each
23 clinical unit and each patient care area.
24 (b) In all units with critical care or intensive care
25 patients, including, but not limited to, coronary care, acute
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1 respiratory care, medical, burn, pediatric, or neonatal
2 intensive care patients, the maximum patient assignment of
3 critical care patients to a registered nurse is 1.
4 (c) In all units with step-down or intermediate intensive
5 care patients, the maximum patient assignment of step-down or
6 intermediate intensive care patients to a registered nurse is
7 3.
8 (d) In all units with post-anesthesia care patients,
9 regardless of the type of anesthesia administered, the maximum
10 patient assignment of post-anesthesia care patients or
11 patients being monitored for the effects of any anesthetizing
12 agent to a registered nurse is 1.
13 (e) In all units with operating room patients, the maximum
14 patient assignment of operating room patients to a registered
15 nurse is one, provided that a minimum of one additional person
16 serves as a scrub assistant for each patient.
17 (f) In the emergency department:
18 (1) In a unit providing basic emergency services or
19 comprehensive emergency services, the maximum patient
20 assignment at any time to a registered nurse is 3.
21 (2) The maximum assignment of critical care emergency
22 patients to a registered nurse is 1. A patient in the
23 emergency department shall be considered a critical care
24 patient when the patient meets the criteria for admission
25 to a critical care service area within the facility.
26 (3) The maximum assignment of critical trauma patients
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1 in an emergency unit to a registered nurse is one.
2 (4) At least one direct care registered professional
3 nurse shall be assigned to triage patients. The direct
4 care registered professional nurse assigned to triage
5 patients shall be immediately available at all times to
6 triage patients when they arrive in the emergency
7 department. The direct care registered professional nurse
8 assigned to triage patients shall perform triage functions
9 only and may not be assigned the responsibility of the
10 base radio. Triage, radio, or flight registered nurses
11 shall not be counted in the calculation of direct care
12 registered nurse staffing levels.
13 (g) In all units with maternal child care patients:
14 (1) The maximum patient assignment to a registered
15 nurse of antepartum patients requiring continuous fetal
16 monitoring is 2.
17 (2) The maximum patient assignment of other antepartum
18 patients who are not in active labor to a registered nurse
19 is 3.
20 (3) The maximum patient assignment of active labor
21 patients to a registered nurse is one.
22 (4) The maximum patient assignment of patients with
23 medical or obstetrical complications, during the
24 initiation of epidural anesthesia, or during circulation
25 for a caesarean section delivery to a registered nurse is
26 one.
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1 (5) The maximum patient assignment during birth is one
2 registered nurse responsible for the patient in labor and,
3 for each newborn, one registered nurse whose sole
4 responsibility is that newborn patient.
5 (6) The maximum patient assignment of postpartum
6 patients when the parent has given birth within the
7 previous two hours is one couplet to one registered nurse,
8 and in the case of multiple births, one registered nurse
9 for each additional newborn.
10 (7) The maximum patient assignment of couplets to a
11 registered nurse is 2.
12 (8) The maximum patient assignment of patients
13 receiving postpartum or postoperative gynecological care
14 to a registered nurse is 4 when the registered nurse has
15 been assigned only to patients receiving postpartum or
16 postoperative gynecological care.
17 (9) The maximum patient assignment of newborn patients
18 when the patient is unstable, as assessed by a direct care
19 registered professional nurse, to a registered nurse is
20 one.
21 (10) The maximum patient assignment of newborn
22 patients to a registered nurse is 2 when the patients are
23 receiving intermediate care or the nurse has been assigned
24 to a patient care unit that receives newborn patients
25 requiring intermediate care, including, but not limited
26 to, an intermediate care nursery.
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1 (h) In all units with pediatric patients, the maximum
2 patient assignment of pediatric patients to a registered nurse
3 is 3.
4 (i) In all units with psychiatric patients, the maximum
5 patient assignment of psychiatric patients to a registered
6 nurse is 4.
7 (j) In all units with medical and surgical patients, the
8 maximum patient assignment of medical or surgical patients to
9 a registered nurse is 4.
10 (k) In all units with telemetry patients, the maximum
11 patient assignment of telemetry patients to a registered nurse
12 is 3.
13 (l) In all units with observational patients, the maximum
14 patient assignment of observational patients to a registered
15 nurse is 3.
16 (m) In all units with acute rehabilitation patients, the
17 maximum patient assignment of acute rehabilitation patients to
18 a registered nurse is 4.
19 (n) In all units with conscious sedation patients, the
20 maximum patient assignment of conscious sedation patients to a
21 registered nurse is one.
22 (o) In any unit not otherwise listed in this Section,
23 including all specialty care units not otherwise listed in
24 this Section, the maximum patient assignment to a registered
25 nurse is 4.
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1 Section 15. Use of rapid response teams as first
2 responders prohibited. A rapid response team registered nurse
3 shall not be given direct care patient assignments while
4 assigned as a registered nurse responsible for responding to a
5 rapid response team request.
6 Section 20. Implementation by a facility.
7 (a) A facility shall implement the patient limits
8 established by Section 10 without diminishing the staffing
9 levels of the facility's health care workforce, as defined in
10 Section 5. A facility may not lay off licensed practical
11 nurses, licensed psychiatric technicians, certified nursing
12 assistants, or other ancillary support staff to meet the
13 patient limits under Section 10.
14 (b) Each patient shall be assigned to a direct care
15 registered professional nurse who shall directly provide the
16 comprehensive patient assessment, development of a plan of
17 care, supervision, implementation, and evaluation of the
18 nursing care provided to the patient at least every shift and
19 who has the responsibility for the provision of care to a
20 particular patient within the registered nurse's scope of
21 practice.
22 (c) There shall be no averaging of the number of patients
23 and the total number of registered nurses in each clinical
24 unit or patient care area in order to meet the patient limits
25 under Section 10.
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1 (d) Only registered nurses providing direct patient care
2 shall be considered when evaluating compliance with the
3 patient limits under Section 10. Ancillary staff and
4 unlicensed personnel shall not be considered when evaluating
5 compliance with the patient limits under Section 10.
6 (e) The hours in which a nurse administrator, nurse
7 supervisor, nurse manager, charge nurse, and other licensed
8 nurse provides patient care shall not be considered when
9 evaluating compliance with the patient limits under Section 10
10 and with the patient assignment requirement under subsection
11 (b) of Section 20 unless the registered nurse:
12 (1) has a current and active direct patient care
13 assignment;
14 (2) provides direct patient care in compliance with
15 the requirements of this section and Section 45;
16 (3) has demonstrated to the facility current
17 competence in providing care on the particular unit; and
18 (4) has the principal responsibility of providing
19 direct patient care and has no additional job duties
20 during the time period during which the nurse has a
21 patient assignment.
22 (f) The hours in which a nurse administrator, nurse
23 supervisor, nurse manager, charge nurse, and other licensed
24 nurse provides direct patient care may be considered when
25 evaluating compliance with the patient limits under Section 10
26 and with the patient assignment requirement under subsection
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1 (b) of Section 20 only if the nurse is providing relief for a
2 direct care registered professional nurse during breaks,
3 meals, and other routine and expected absences from the unit.
4 (g) At all times during each shift within a facility unit,
5 clinical unit, or patient care area of a facility, and with the
6 full complement of ancillary support staff, at least two
7 direct care registered nurses shall be physically present in
8 each facility unit, clinical unit, or patient care area where
9 there are patients present.
10 (h) Identifying a clinical unit or patient care area by a
11 name or term other than those listed in this Act does not
12 affect a facility's requirement to staff the unit consistent
13 with the patient limits identified for the level of intensity
14 or type of care described in this Act.
15 (i) A registered nurse providing direct care to a patient
16 has the authority to determine if a change in the patient's
17 status places the patient in a different category requiring a
18 different patient limit under Section 10.
19 (j) A facility shall assign direct care professional
20 registered nurses in a patient care unit in accordance with
21 subsection 10 in order to meet the highest level of intensity
22 and type of care provided in the patient care unit. If multiple
23 paragraphs of subsection 10 apply to a patient, a facility
24 shall assign a direct care professional registered nurse in
25 accordance with the lowest numerical patient assignment.
26 (k) A facility shall provide additional staffing of direct
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1 care registered professional nurses, above the number of
2 direct care registered professional nurses required to comply
3 with the patient levels under Section 10, or additional
4 staffing of licensed practical nurses, certified nursing
5 assistants, or other licensed or unlicensed ancillary support
6 staff based on the direct care registered professional nurse's
7 assessment of each assigned individual patient, the individual
8 patient's nursing care requirements, and the individual
9 patient's nursing care plan.
10 (l) A facility shall not employ video monitors, remote
11 patient monitoring, or any form of electronic visualization of
12 a patient as a substitute for the direct in-person observation
13 required for patient assessment by the registered nurse or for
14 patient protection. Video monitors or any form of electronic
15 visualization of a patient shall not constitute compliance
16 with the patient limits under Section 10.
17 (m) A facility must provide relief by a direct care
18 registered professional nurse with unit-specific education,
19 training, and competence during another direct care registered
20 professional nurse's meal periods, breaks, and routine
21 absences as part of the facility's obligation to meet the
22 patient limits under Section 10 at all times.
23 Section 25. Changes in patient census.
24 (a) A facility shall plan for routine fluctuations in its
25 patient census, including, but not limited to, admissions,
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1 discharges, and transfers.
2 (b) If a health care emergency causes a change in the
3 number of patients in a clinical care unit or patient care
4 area, a facility must be able to demonstrate that immediate
5 and diligent efforts were made to maintain required staffing
6 levels under this Act.
7 (c) A facility shall immediately notify the Department if
8 a health care emergency under Section (b) causes a change in
9 the number of patients in a clinical care unit or patient care
10 area and shall report to the Department efforts made to
11 maintain required staffing levels under this Act.
12 Section 30. Record of staff assignments.
13 (a) A facility shall keep a record of the actual direct
14 care registered professional nurse, licensed practical nurse,
15 certified nursing assistant, and other ancillary staff
16 assignments to individual patients documented on a day-to-day,
17 shift-by-shift basis and shall submit copies of its records to
18 the Department quarterly and keep copies of its staff
19 assignments on file for a period of 7 years.
20 (b) The documentation required by subsection (a) shall be
21 submitted to the Department as a mandatory condition of
22 licensure, with a certification by the chief nursing officer
23 of the facility that the documentation completely and
24 accurately reflects registered nurse staffing levels by the
25 facility for each shift in each facility unit, clinical unit,
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1 and patient care area in which patients receive care. The
2 chief nursing officer shall execute the certification under
3 penalty of perjury, and the certification must contain an
4 expressed acknowledgment that any false statement constitutes
5 fraud and is subject to criminal and civil prosecution and
6 penalties.
7 Section 35. Implementation by the Department. The
8 Department shall adopt rules governing the implementation and
9 operation of this Act, including methods for facility staff,
10 facility staff's collective bargaining representatives, and
11 the public to file complaints regarding violations of this Act
12 with the Department. The Department shall conduct periodic
13 audits to ensure implementation of this Act.
14 Section 40. Education.
15 (a) All facilities shall adopt written policies including:
16 (1) procedures for the education, training, and orientation of
17 nursing staff to each clinical area where the staff will work;
18 and (2) criteria for the facility to use in determining if a
19 registered nurse has demonstrated current competence in
20 providing care in a clinical area.
21 (b) No registered nurse shall be assigned to a facility
22 unit, clinical unit, or patient care area unless that
23 registered nurse has first received education, training, and
24 orientation in that clinical area that is sufficient to
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1 provide safe, therapeutic, and competent care to patients in
2 that clinical area and has demonstrated competence in
3 providing care in that clinical area.
4 (c) No registered nurse shall be assigned to relieve a
5 direct care professional registered nurse during breaks,
6 meals, and routine absences from a facility unit, clinical
7 unit, or patient care area unless that registered nurse has
8 first received education, training, and orientation in that
9 clinical area that is sufficient to provide safe, therapeutic,
10 and competent care to patients in that clinical area and has
11 demonstrated competence in providing care in that clinical
12 area.
13 (d) A health care facility may not assign any nursing
14 personnel from temporary nursing agencies to a facility unit,
15 clinical unit, or patient care area unless the nursing
16 personnel have first received education, training, and
17 orientation in that clinical area that is sufficient to
18 provide safe, therapeutic, and competent care to patients in
19 that clinical area and have demonstrated competence in
20 providing care in that clinical area.
21 Section 45. Enforcement.
22 (a) In addition to any other penalty prescribed by law,
23 the Department may impose a civil penalty against a facility
24 that violates this Act of up to $25,000 for each violation,
25 except that the Department shall impose a civil penalty of at
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1 least $25,000 for each violation if the Department determines
2 that the health care facility has a pattern of such violation.
3 A separate and distinct violation shall be deemed to have been
4 committed on each day during which any violation continues
5 after receipt of written notice of the violation from the
6 Department by the facility.
7 (b) The Department shall post on its website the names of
8 facilities against which civil penalties have been imposed
9 under this Act, the violation for which such penalty was
10 imposed, and such additional information as the Department
11 deems necessary.
12 (c) A facility's failure to adhere to the limits set by
13 Section 10, any other violation of this Act, or any violation
14 of Section 10.10 of the Hospital Licensing Act shall be
15 reported by the Department to the Attorney General for
16 enforcement, for which the Attorney General may bring action
17 in a court of competent jurisdiction seeking injunctive relief
18 and civil penalties.
19 (d) It is a defense to an enforcement action under this Act
20 if the facility demonstrates that a health care emergency was
21 in force at the time of the alleged violation and that the
22 facility made immediate and diligent efforts to maintain
23 required staffing levels under this Act.
24 Section 50. Nurse rights and protections.
25 (a) A registered professional nurse may object to or
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1 refuse to participate in any activity, practice, assignment,
2 or task if:
3 (1) in good faith, the registered nurse reasonably
4 believes it to be a violation of the direct care
5 registered professional nurse maximum patient assignments
6 or other provision established under this Act or a rule
7 adopted by the Department implementing this Act; or
8 (2) the registered nurse, based on the registered
9 nurse's nursing judgment, reasonably believes the
10 registered nurse is not prepared by education, training,
11 or experience to fulfill the assignment without
12 compromising the safety of any patient or jeopardizing the
13 license of the registered nurse.
14 (3) in the registered nurse's nursing judgment, the
15 activity, policy, practice, assignment or task would be
16 outside the registered nurse's scope of practice or would
17 otherwise compromise the safety of any patient or the
18 registered nurse.
19 (b) A facility shall not retaliate, discriminate, or
20 otherwise take adverse action in any manner with respect to
21 any aspect of a nurse's employment, including discharge,
22 promotion, compensation, or terms, conditions, or privileges
23 of employment, based on the nurse's refusal to complete an
24 assignment under subsection (a).
25 (c) A facility shall not file a complaint against a
26 registered professional nurse with the Board of Nursing based
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1 on the nurse's refusal to complete an assignment under
2 subsection (a).
3 (d) A facility shall not retaliate, discriminate, or
4 otherwise take adverse action in any manner against any person
5 or with respect to any aspect of a nurse's employment,
6 including discharge, promotion, compensation, or terms,
7 conditions, or privileges of employment, based on that nurse's
8 or that person's opposition to any facility policy, practice,
9 or action that the nurse in good faith believes violates this
10 Act.
11 (e) A facility shall not retaliate, discriminate, or
12 otherwise take adverse action against any patient or employee
13 of the facility or any other individual on the basis that the
14 patient, employee, or individual, in good faith, individually
15 or in conjunction with another person or persons, has
16 presented a grievance or complaint, or has initiated or
17 cooperated in any investigation or proceeding of any
18 governmental entity, regulatory agency, or private
19 accreditation body, made a civil claim or demand, or filed an
20 action relating to the care, services, or conditions of the
21 facility or of any affiliated or related facilities.
22 (f) A facility shall not do either of the following:
23 (1) Interfere with, restrain, or deny the exercise of,
24 or attempt to deny the exercise of, a right conferred
25 under this Act.
26 (2) Coerce or intimidate any individual regarding the
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1 exercise of, or an attempt to exercise, a right conferred
2 by this Act.
3 Section 55. Severability. The provisions of this Act are
4 severable under Section 1.31 of the Statute on Statutes.
5 Section 60. The Hospital Licensing Act is amended by
6 changing Section 10.10 and by adding Section 50-15.15 as
7 follows:
8 (210 ILCS 85/10.10)
9 Sec. 10.10. Nurse Staffing by Patient Acuity.
10 (a) Findings. The Legislature finds and declares all of
11 the following:
12 (1) The State of Illinois has a substantial interest
13 in promoting quality care and improving the delivery of
14 health care services.
15 (2) Evidence-based studies have shown that the basic
16 principles of staffing in the acute care setting should be
17 based on the complexity of patients' care needs aligned
18 with available nursing skills to promote quality patient
19 care consistent with professional nursing standards.
20 (3) Compliance with this Section promotes an
21 organizational climate that values registered nurses'
22 input in meeting the health care needs of hospital
23 patients.
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1 (b) Definitions. As used in this Section:
2 "Acuity model" means an assessment tool selected and
3 implemented by a hospital, as recommended by a nursing care
4 committee, that assesses the complexity of patient care needs
5 requiring professional nursing care and skills and aligns
6 patient care needs and nursing skills consistent with
7 professional nursing standards.
8 "Department" means the Department of Public Health.
9 "Direct patient care" means care provided by a registered
10 professional nurse with direct responsibility to oversee or
11 carry out medical regimens or nursing care for one or more
12 patients.
13 "Nursing care committee" means a hospital-wide committee
14 or committees of nurses whose functions, in part or in whole,
15 contribute to the development, recommendation, and review of
16 the hospital's nurse staffing plan established pursuant to
17 subsection (d).
18 "Registered professional nurse" means a person licensed as
19 a Registered Nurse under the Nurse Practice Act.
20 "Written staffing plan for nursing care services" means a
21 written plan for the assignment of patient care nursing staff
22 based on multiple nurse and patient considerations that yield
23 minimum staffing levels for inpatient care units and the
24 adopted acuity model aligning patient care needs with nursing
25 skills required for quality patient care consistent with
26 professional nursing standards.
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1 (c) Written staffing plan.
2 (1) Every hospital shall implement a written
3 hospital-wide staffing plan, prepared by a nursing care
4 committee or committees, that provides for minimum direct
5 care professional registered nurse-to-patient staffing
6 needs for each inpatient care unit, including inpatient
7 emergency departments. If the staffing plan prepared by
8 the nursing care committee is not adopted by the hospital,
9 or if substantial changes are proposed to it, the chief
10 nursing officer shall either: (i) provide a written
11 explanation to the committee of the reasons the plan was
12 not adopted; or (ii) provide a written explanation of any
13 substantial changes made to the proposed plan prior to it
14 being adopted by the hospital. The written hospital-wide
15 staffing plan shall include, but need not be limited to,
16 the following considerations:
17 (A) The complexity of complete care, assessment on
18 patient admission, volume of patient admissions,
19 discharges and transfers, evaluation of the progress
20 of a patient's problems, ongoing physical assessments,
21 planning for a patient's discharge, assessment after a
22 change in patient condition, and assessment of the
23 need for patient referrals.
24 (B) The complexity of clinical professional
25 nursing judgment needed to design and implement a
26 patient's nursing care plan, the need for specialized
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1 equipment and technology, the skill mix of other
2 personnel providing or supporting direct patient care,
3 and involvement in quality improvement activities,
4 professional preparation, and experience.
5 (C) Patient acuity and the number of patients for
6 whom care is being provided.
7 (D) The ongoing assessments of a unit's patient
8 acuity levels and nursing staff needed shall be
9 routinely made by the unit nurse manager or his or her
10 designee.
11 (E) The identification of additional registered
12 nurses available for direct patient care when
13 patients' unexpected needs exceed the planned workload
14 for direct care staff.
15 (2) In order to provide staffing flexibility to meet
16 patient needs, every hospital shall identify an acuity
17 model for adjusting the staffing plan for each inpatient
18 care unit.
19 (2.5) Each hospital shall implement the staffing plan
20 and assign nursing personnel to each inpatient care unit,
21 including inpatient emergency departments, in accordance
22 with the staffing plan.
23 (A) A registered nurse may report to the nursing
24 care committee any variations where the nurse
25 personnel assignment in an inpatient care unit is not
26 in accordance with the adopted staffing plan and may
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1 make a written report to the nursing care committee
2 based on the variations.
3 (B) Shift-to-shift adjustments in staffing levels
4 required by the staffing plan may be made by the
5 appropriate hospital personnel overseeing inpatient
6 care operations. If a registered nurse in an inpatient
7 care unit objects to a shift-to-shift adjustment, the
8 registered nurse may submit a written report to the
9 nursing care committee.
10 (C) The nursing care committee shall develop a
11 process to examine and respond to written reports
12 submitted under subparagraphs (A) and (B) of this
13 paragraph (2.5), including the ability to determine if
14 a specific written report is resolved or should be
15 dismissed.
16 (3) The written staffing plan shall be posted, either
17 by physical or electronic means, in a conspicuous and
18 accessible location for both patients and direct care
19 staff, as required under the Hospital Report Card Act. A
20 copy of the written staffing plan shall be provided to any
21 member of the general public upon request.
22 (d) Nursing care committee.
23 (1) Every hospital shall have a nursing care committee
24 that meets at least 6 times per year. A hospital shall
25 appoint members of a committee whereby at least 55% of the
26 members are registered professional nurses providing
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1 direct inpatient care, one of whom shall be selected
2 annually by the direct inpatient care nurses to serve as
3 co-chair of the committee.
4 (2) (Blank).
5 (2.5) A nursing care committee shall prepare and
6 recommend to hospital administration the hospital's
7 written hospital-wide staffing plan. If the staffing plan
8 is not adopted by the hospital, the chief nursing officer
9 shall provide a written statement to the committee prior
10 to a staffing plan being adopted by the hospital that: (A)
11 explains the reasons the committee's proposed staffing
12 plan was not adopted; and (B) describes the changes to the
13 committee's proposed staffing or any alternative to the
14 committee's proposed staffing plan.
15 (3) A nursing care committee's or committees' written
16 staffing plan for the hospital shall be based on the
17 principles from the staffing components set forth in
18 subsection (c). In particular, a committee or committees
19 shall provide input and feedback on the following:
20 (A) Selection, implementation, and evaluation of
21 minimum staffing levels for inpatient care units.
22 (B) Selection, implementation, and evaluation of
23 an acuity model to provide staffing flexibility that
24 aligns changing patient acuity with nursing skills
25 required.
26 (C) Selection, implementation, and evaluation of a
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1 written staffing plan incorporating the items
2 described in subdivisions (c)(1) and (c)(2) of this
3 Section.
4 (D) Review the nurse staffing plans for all
5 inpatient areas and current acuity tools and measures
6 in use. The nursing care committee's review shall
7 consider:
8 (i) patient outcomes;
9 (ii) complaints regarding staffing, including
10 complaints about a delay in direct care nursing or
11 an absence of direct care nursing;
12 (iii) the number of hours of nursing care
13 provided through an inpatient hospital unit
14 compared with the number of inpatients served by
15 the hospital unit during a 24-hour period;
16 (iv) the aggregate hours of overtime worked by
17 the nursing staff;
18 (v) the extent to which actual nurse staffing
19 for each hospital inpatient unit differs from the
20 staffing specified by the staffing plan; and
21 (vi) any other matter or change to the
22 staffing plan determined by the committee to
23 ensure that the hospital is staffed to meet the
24 health care needs of patients.
25 (4) A nursing care committee must issue a written
26 report addressing the items described in subparagraphs (A)
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1 through (D) of paragraph (3) semi-annually. A written copy
2 of this report shall be made available to direct inpatient
3 care nurses by making available a paper copy of the
4 report, distributing it electronically, or posting it on
5 the hospital's website.
6 (5) A nursing care committee must issue a written
7 report at least annually to the hospital governing board
8 that addresses items including, but not limited to: the
9 items described in paragraph (3); changes made based on
10 committee recommendations and the impact of such changes;
11 and recommendations for future changes related to nurse
12 staffing.
13 (e) Nothing in this Section 10.10 shall be construed to
14 limit, alter, or modify any of the terms, conditions, or
15 provisions of a collective bargaining agreement entered into
16 by the hospital.
17 (f) No hospital may discipline, discharge, or take any
18 other adverse employment action against an employee solely
19 because the employee expresses a concern or complaint
20 regarding an alleged violation of this Section or concerns
21 related to nurse staffing.
22 (g) Any employee of a hospital may file a complaint with
23 the Department regarding an alleged violation of this Section.
24 The Department must forward notification of the alleged
25 violation to the hospital in question within 10 business days
26 after the complaint is filed. Upon receiving a complaint of a
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1 violation of this Section, the Department may take any action
2 authorized under Sections 7 or 9 of this Act.
3 (h) Delegation of nursing interventions by a registered
4 professional nurse must be in accordance with the Nurse
5 Practice Act.
6 (i) A hospital shall not mandate that a registered
7 professional nurse delegate any element of the nursing
8 process, including, but not limited to: nursing interventions,
9 medication administration, nursing judgment, comprehensive
10 patient assessment, development of the plan of care, or
11 evaluation of care. A delegation of a nursing intervention
12 granted by a registered professional nurse shall not be
13 re-delegated to another.
14 (j) The Department shall establish procedures to ensure
15 that the documentation submitted under this Section is
16 available for public inspection in its entirety.
17 (k) Nothing in this Section shall be construed to limit,
18 alter, or modify the requirements of the Safe Patient Limits
19 Act.
20 (Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
21 102-813, eff. 5-13-22.)
22 (210 ILCS 85/50-15.15 new)
23 Sec. 50-15.15. Nursing judgment.
24 (a) Performance of the scope of practice of a direct care
25 registered professional nurse requires the exercise of nursing
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1 judgment in the exclusive interests of the patient. The
2 exercise of such nursing judgment, unencumbered by the
3 commercial or revenue-generation priorities of a hospital,
4 long term acute care hospital, or ambulatory surgical
5 treatment center or other employing entity of a direct care
6 registered professional nurse, is necessary to ensure safe,
7 therapeutic, effective, and competent treatment of patients
8 and is essential to protect the health and safety of the people
9 of Illinois.
10 (b) The exercise of nursing judgment by a direct care
11 registered professional nurse in the performance of the scope
12 of practice of the registered professional nurse under Section
13 60-35 or the scope of practice of the advanced practice
14 registered nurse under Section 65-30 shall be provided in the
15 exclusive interests of the patient and shall not, for any
16 purpose, be considered, relied upon, or represented as a job
17 function, authority, responsibility, or activity undertaken in
18 any respect for the purpose of serving the business,
19 commercial, operational, or other institutional interests of
20 the employer.
21 (c) No hospital, long term acute care hospital, ambulatory
22 surgical treatment center, or other health care facility shall
23 adopt policies that:
24 (1) limit a direct care registered professional nurse
25 in performing duties that are part of the nursing process,
26 including full exercise of nursing judgment in assessment,
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1 planning, implementation and evaluation of care;
2 (2) Substitute recommendations, decisions, or outputs
3 of health information technology, algorithms used to a
4 achieve a medical or nursing care objective at a facility,
5 systems based on artificial intelligence or machine
6 learning, or clinical practice guidelines for the
7 independent nursing judgment of a direct care registered
8 professional nurse or penalize a direct care registered
9 professional nurse for overriding such technology or
10 guidelines if, in that registered nurse's judgment, and in
11 accordance with that registered nurse's scope of practice,
12 it is in the best interest of the patient to do so; or
13 (3) limit a direct care registered professional nurse
14 in acting as a patient advocate in the exclusive interests
15 of the patient.
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