Public Act 103-0211
HB3890 EnrolledLRB103 30120 CPF 56544 b HB3890 Enrolled LRB103 30120 CPF 56544 b
HB3890 Enrolled LRB103 30120 CPF 56544 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Hospital Licensing Act is amended by
changing Section 10.10 as follows:
(210 ILCS 85/10.10)
Sec. 10.10. Nurse Staffing by Patient Acuity.
(a) Findings. The Legislature finds and declares all of
the following:
(1) The State of Illinois has a substantial interest
in promoting quality care and improving the delivery of
health care services.
(2) Evidence-based studies have shown that the basic
principles of staffing in the acute care setting should be
based on the complexity of patients' care needs aligned
with available nursing skills to promote quality patient
care consistent with professional nursing standards.
(3) Compliance with this Section promotes an
organizational climate that values registered nurses'
input in meeting the health care needs of hospital
patients.
(b) Definitions. As used in this Section:
"Acuity model" means an assessment tool selected and
HB3890 Enrolled LRB103 30120 CPF 56544 b
implemented by a hospital, as recommended by a nursing care
committee, that assesses the complexity of patient care needs
requiring professional nursing care and skills and aligns
patient care needs and nursing skills consistent with
professional nursing standards.
"Department" means the Department of Public Health.
"Direct patient care" means care provided by a registered
professional nurse with direct responsibility to oversee or
carry out medical regimens or nursing care for one or more
patients.
"Nursing care committee" means a hospital-wide committee
or committees of nurses whose functions, in part or in whole,
contribute to the development, recommendation, and review of
the hospital's nurse staffing plan established pursuant to
subsection (d).
"Registered professional nurse" means a person licensed as
a Registered Nurse under the Nurse Practice Act.
"Written staffing plan for nursing care services" means a
written plan for the assignment of patient care nursing staff
based on multiple nurse and patient considerations that yield
minimum staffing levels for inpatient care units and the
adopted acuity model aligning patient care needs with nursing
skills required for quality patient care consistent with
professional nursing standards.
(c) Written staffing plan.
(1) Every hospital shall implement a written
hospital-wide staffing plan, prepared by a nursing care
committee or committees, that provides for minimum direct
care professional registered nurse-to-patient staffing
needs for each inpatient care unit, including inpatient
emergency departments. If the staffing plan prepared by
the nursing care committee is not adopted by the hospital,
or if substantial changes are proposed to it, the chief
nursing officer shall either: (i) provide a written
explanation to the committee of the reasons the plan was
not adopted; or (ii) provide a written explanation of any
substantial changes made to the proposed plan prior to it
being adopted by the hospital. The written hospital-wide
staffing plan shall include, but need not be limited to,
the following considerations:
(A) The complexity of complete care, assessment on
patient admission, volume of patient admissions,
discharges and transfers, evaluation of the progress
of a patient's problems, ongoing physical assessments,
planning for a patient's discharge, assessment after a
change in patient condition, and assessment of the
need for patient referrals.
(B) The complexity of clinical professional
nursing judgment needed to design and implement a
patient's nursing care plan, the need for specialized
equipment and technology, the skill mix of other
personnel providing or supporting direct patient care,
and involvement in quality improvement activities,
professional preparation, and experience.
(C) Patient acuity and the number of patients for
whom care is being provided.
(D) The ongoing assessments of a unit's patient
acuity levels and nursing staff needed shall be
routinely made by the unit nurse manager or his or her
designee.
(E) The identification of additional registered
nurses available for direct patient care when
patients' unexpected needs exceed the planned workload
for direct care staff.
(2) In order to provide staffing flexibility to meet
patient needs, every hospital shall identify an acuity
model for adjusting the staffing plan for each inpatient
care unit.
(2.5) Each hospital shall implement the staffing plan
and assign nursing personnel to each inpatient care unit,
including inpatient emergency departments, in accordance
with the staffing plan.
(A) A registered nurse may report to the nursing
care committee any variations where the nurse
personnel assignment in an inpatient care unit is not
in accordance with the adopted staffing plan and may
make a written report to the nursing care committee
based on the variations.
(B) Shift-to-shift adjustments in staffing levels
required by the staffing plan may be made by the
appropriate hospital personnel overseeing inpatient
care operations. If a registered nurse in an inpatient
care unit objects to a shift-to-shift adjustment, the
registered nurse may submit a written report to the
nursing care committee.
(C) The nursing care committee shall develop a
process to examine and respond to written reports
submitted under subparagraphs (A) and (B) of this
paragraph (2.5), including the ability to determine if
a specific written report is resolved or should be
dismissed.
(3) The written staffing plan shall be posted, either
by physical or electronic means, in a conspicuous and
accessible location for both patients and direct care
staff, as required under the Hospital Report Card Act. A
copy of the written staffing plan shall be provided to any
member of the general public upon request.
(d) Nursing care committee.
(1) Every hospital shall have a nursing care committee
that meets at least 6 times per year. A hospital shall
appoint members of a committee whereby at least 55% of the
members are registered professional nurses providing
direct inpatient care, one of whom shall be selected
annually by the direct inpatient care nurses to serve as
co-chair of the committee.
(2) (Blank).
(2.5) A nursing care committee shall prepare and
recommend to hospital administration the hospital's
written hospital-wide staffing plan. If the staffing plan
is not adopted by the hospital, the chief nursing officer
shall provide a written statement to the committee prior
to a staffing plan being adopted by the hospital that: (A)
explains the reasons the committee's proposed staffing
plan was not adopted; and (B) describes the changes to the
committee's proposed staffing or any alternative to the
committee's proposed staffing plan.
(3) A nursing care committee's or committees' written
staffing plan for the hospital shall be based on the
principles from the staffing components set forth in
subsection (c). In particular, a committee or committees
shall provide input and feedback on the following:
(A) Selection, implementation, and evaluation of
minimum staffing levels for inpatient care units.
(B) Selection, implementation, and evaluation of
an acuity model to provide staffing flexibility that
aligns changing patient acuity with nursing skills
required.
(C) Selection, implementation, and evaluation of a
written staffing plan incorporating the items
described in subdivisions (c)(1) and (c)(2) of this
Section.
(D) Review the nurse staffing plans for all
inpatient areas and current acuity tools and measures
in use. The nursing care committee's review shall
consider:
(i) patient outcomes;
(ii) complaints regarding staffing, including
complaints about a delay in direct care nursing or
an absence of direct care nursing;
(iii) the number of hours of nursing care
provided through an inpatient hospital unit
compared with the number of inpatients served by
the hospital unit during a 24-hour period;
(iv) the aggregate hours of overtime worked by
the nursing staff;
(v) the extent to which actual nurse staffing
for each hospital inpatient unit differs from the
staffing specified by the staffing plan; and
(vi) any other matter or change to the
staffing plan determined by the committee to
ensure that the hospital is staffed to meet the
health care needs of patients.
(4) A nursing care committee must issue a written
report addressing the items described in subparagraphs (A)
through (D) of paragraph (3) semi-annually. A written copy
of this report shall be made available to direct inpatient
care nurses by making available a paper copy of the
report, distributing it electronically, or posting it on
the hospital's website.
(5) A nursing care committee must issue a written
report at least annually to the hospital governing board
that addresses items including, but not limited to: the
items described in paragraph (3); changes made based on
committee recommendations and the impact of such changes;
and recommendations for future changes related to nurse
staffing.
(6) A nursing care committee must annually notify the
hospital nursing staff of the staff's rights under this
Section. The annual notice must provide a phone number and
an email address for staff to report noncompliance with
the nursing staff's rights as described in this Section.
The notice must be provided by email or by regular mail in
a manner that effectively facilitates receipt of the
notice. The Department shall monitor and enforce the
requirements of this paragraph (6).
(e) Nothing in this Section 10.10 shall be construed to
limit, alter, or modify any of the terms, conditions, or
provisions of a collective bargaining agreement entered into
by the hospital.
(f) No hospital may discipline, discharge, or take any
other adverse employment action against an employee solely
because the employee expresses a concern or complaint
regarding an alleged violation of this Section or concerns
related to nurse staffing.
(g) Any employee of a hospital may file a complaint with
the Department regarding an alleged violation of this Section.
The Department must forward notification of the alleged
violation to the hospital in question within 10 business days
after the complaint is filed. Upon receiving a complaint of a
violation of this Section, the Department may take any action
authorized under Sections 7 or 9 of this Act.
(Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
102-813, eff. 5-13-22.)