Illinois 2023-2024 Regular Session

Illinois Senate Bill SB2314 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 SB2314 Introduced 2/10/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED: New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 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 the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the 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 requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient. LRB103 30711 CPF 57186 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2314 Introduced 2/10/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED: New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 new New Act 210 ILCS 85/10.10 225 ILCS 65/50-15.15 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 the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the 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 requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient. LRB103 30711 CPF 57186 b LRB103 30711 CPF 57186 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2314 Introduced 2/10/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED:
3	3	New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 new New Act 210 ILCS 85/10.10 225 ILCS 65/50-15.15 new
4	4	New Act
5	5	210 ILCS 85/10.10
6	6	225 ILCS 65/50-15.15 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 the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the 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 requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient.
8	8	LRB103 30711 CPF 57186 b LRB103 30711 CPF 57186 b
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10	10	A BILL FOR
11	11	SB2314LRB103 30711 CPF 57186 b SB2314 LRB103 30711 CPF 57186 b
12	12	SB2314 LRB103 30711 CPF 57186 b
13	13	1 AN ACT concerning health.
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 SB2314 Introduced 2/10/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED:
40	40	New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 new New Act 210 ILCS 85/10.10 225 ILCS 65/50-15.15 new
41	41	New Act
42	42	210 ILCS 85/10.10
43	43	225 ILCS 65/50-15.15 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 the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the 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 requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient.
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46	46	LRB103 30711 CPF 57186 b
47	47	A BILL FOR
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53	53	New Act
54	54	210 ILCS 85/10.10
55	55	225 ILCS 65/50-15.15 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, affect the delivery of medical
83	83	10 care, and require an immediate or exceptional level of
84	84	11 emergency or other medical services at the specific facility.
85	85	12 "Health care emergency" does not include a state of emergency
86	86	13 that results from a labor dispute in the health care industry
87	87	14 or consistent 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 patient" means a patient who has
96	96	23 given birth within the previous 2 hours.
97	97	24 "Nursing care" means care that falls within the scope of
98	98	25 practice 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 that 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 Section 10. Maximum patient assignments for registered
122	122	13 nurses.
123	123	14 (a) The maximum number of patients assigned to a
124	124	15 registered nurse in a facility shall not exceed the limits
125	125	16 provided in this Section. However, nothing shall preclude a
126	126	17 facility from assigning fewer patients to a registered nurse
127	127	18 than the limits provided in this Section. The requirements of
128	128	19 this Section apply at all times during each shift within each
129	129	20 clinical unit and each patient care area. For the purposes of
130	130	21 this Act, a patient is assigned to a registered nurse if the
131	131	22 registered nurse accepts responsibility for the patient's
132	132	23 nursing care.
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 one.
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 postanesthesia care patients,
153	153	9 regardless of the type of anesthesia administered, the maximum
154	154	10 patient assignment of postanesthesia care patients or patients
155	155	11 being monitored for the effects of any anesthetizing agent to
156	156	12 a registered nurse is one.
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 one. 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 the
194	194	14 maximum patient assignment:
195	195	15 (1) to a registered nurse of antepartum patients
196	196	16 requiring continuous fetal monitoring is 2;
197	197	17 (2) of other antepartum patients who are not in active
198	198	18 labor to a registered nurse is 3;
199	199	19 (3) of active labor patients to a registered nurse is
200	200	20 one;
201	201	21 (4) of patients with medical or obstetrical
202	202	22 complications during the initiation of epidural anesthesia
203	203	23 or during circulation for a caesarean section delivery to
204	204	24 a registered nurse is one;
205	205	25 (5) during birth is one registered nurse responsible
206	206	26 for the patient in labor and, for each newborn, one
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217	217	1 registered nurse whose sole responsibility is that newborn
218	218	2 patient;
219	219	3 (6) of postpartum patients when the parent has given
220	220	4 birth within the previous 2 hours is one registered nurse
221	221	5 for each couplet, and in the case of multiple births, one
222	222	6 registered nurse for each additional newborn;
223	223	7 (7) of couplets to a registered nurse is 2;
224	224	8 (8) of patients receiving postpartum or postoperative
225	225	9 gynecological care to a registered nurse is 4 when the
226	226	10 registered nurse has been assigned only to patients
227	227	11 receiving postpartum or postoperative gynecological care;
228	228	12 (9) of newborn patients when the patient is unstable,
229	229	13 as assessed by a direct care registered professional
230	230	14 nurse, to a registered nurse is one; and
231	231	15 (10) of newborn patients to a registered nurse is 2
232	232	16 when the patients are receiving intermediate care or the
233	233	17 nurse has been assigned to a patient care unit that
234	234	18 receives newborn patients requiring intermediate care,
235	235	19 including, but not limited to, an intermediate care
236	236	20 nursery.
237	237	21 (h) In all units with pediatric patients, the maximum
238	238	22 patient assignment of pediatric patients to a registered nurse
239	239	23 is 3.
240	240	24 (i) In all units with psychiatric patients, the maximum
241	241	25 patient assignment of psychiatric patients to a registered
242	242	26 nurse is 4.
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253	253	1 (j) In all units with medical and surgical patients, the
254	254	2 maximum patient assignment of medical or surgical patients to
255	255	3 a registered nurse is 4.
256	256	4 (k) In all units with telemetry patients, the maximum
257	257	5 patient assignment of telemetry patients to a registered nurse
258	258	6 is 3.
259	259	7 (l) In all units with observational patients, the maximum
260	260	8 patient assignment of observational patients to a registered
261	261	9 nurse is 3.
262	262	10 (m) In all units with acute rehabilitation patients, the
263	263	11 maximum patient assignment of acute rehabilitation patients to
264	264	12 a registered nurse is 4.
265	265	13 (n) In all units with conscious sedation patients, the
266	266	14 maximum patient assignment of conscious sedation patients to a
267	267	15 registered nurse is one.
268	268	16 (o) In any unit not otherwise listed in this Section,
269	269	17 including all specialty care units not otherwise listed in
270	270	18 this Section, the maximum patient assignment to a registered
271	271	19 nurse is 4.
272	272	20 Section 15. Use of rapid response teams as first
273	273	21 responders prohibited. A rapid response team's registered
274	274	22 nurse shall not be given direct care patient assignments while
275	275	23 assigned as a registered nurse who is responsible for
276	276	24 responding to a rapid response team request.
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287	287	1 Section 20. Implementation by a facility.
288	288	2 (a) A facility shall implement the patient limits
289	289	3 established under Section 10 without diminishing the staffing
290	290	4 levels of the facility's health care workforce. A facility may
291	291	5 not lay off licensed practical nurses, licensed psychiatric
292	292	6 technicians, certified nursing assistants, or other ancillary
293	293	7 support staff to meet the patient limits under Section 10.
294	294	8 (b) Each patient shall be assigned to a direct care
295	295	9 registered professional nurse who shall directly provide the
296	296	10 comprehensive patient assessment, development of a plan of
297	297	11 care, and supervision, implementation, and evaluation of the
298	298	12 nursing care provided to the patient at least every shift and
299	299	13 who has the responsibility for the provision of care to a
300	300	14 particular patient within the registered nurse's scope of
301	301	15 practice.
302	302	16 (c) There shall be no averaging of the number of patients
303	303	17 and the total number of registered nurses in each clinical
304	304	18 unit or patient care area in order to meet the patient limits
305	305	19 under Section 10.
306	306	20 (d) Only registered nurses providing direct patient care
307	307	21 shall be considered when evaluating compliance with the
308	308	22 patient limits under Section 10. Ancillary staff and
309	309	23 unlicensed personnel shall not be considered when evaluating
310	310	24 compliance with the patient limits under Section 10.
311	311	25 (e) The hours in which a nurse administrator, nurse
312	312	26 supervisor, nurse manager, charge nurse, and other licensed
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323	323	1 nurse provides patient care shall not be considered when
324	324	2 evaluating compliance with the patient limits under Section 10
325	325	3 and with the patient assignment requirement under subsection
326	326	4 (b) unless the registered nurse:
327	327	5 (1) has a current and active direct patient care
328	328	6 assignment;
329	329	7 (2) provides direct patient care in compliance with
330	330	8 this Act;
331	331	9 (3) has demonstrated the registered nurse's competence
332	332	10 in providing care in the registered nurse's assigned unit
333	333	11 to the facility; and
334	334	12 (4) has the principal responsibility of providing
335	335	13 direct patient care and has no additional job duties
336	336	14 during the time period during which the nurse has a
337	337	15 patient assignment.
338	338	16 (f) The hours in which a nurse administrator, nurse
339	339	17 supervisor, nurse manager, charge nurse, or other licensed
340	340	18 nurse provides direct patient care may be considered when
341	341	19 evaluating compliance with the patient limits under Section 10
342	342	20 and with the patient assignment requirement under subsection
343	343	21 (b) only if he or she is providing relief for a direct care
344	344	22 registered professional nurse during breaks, meals, and other
345	345	23 routine and expected absences from that unit.
346	346	24 (g) At all times during each shift within a facility unit,
347	347	25 clinical unit, or patient care area of a facility, and with the
348	348	26 full complement of ancillary support staff, at least 2 direct
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359	359	1 care registered nurses shall be physically present in each
360	360	2 facility unit, clinical unit, or patient care area where a
361	361	3 patient is present.
362	362	4 (h) Identifying a clinical unit or patient care area by a
363	363	5 name or term other than those listed in this Act does not
364	364	6 affect a facility's requirement to staff the unit consistent
365	365	7 with the patient limits identified for the level of intensity
366	366	8 or type of care described in this Act.
367	367	9 (i) A registered nurse providing direct care to a patient
368	368	10 has the authority to determine if a change in the patient's
369	369	11 status places the patient in a different category requiring a
370	370	12 different patient limit under Section 10.
371	371	13 (j) A facility shall assign direct care professional
372	372	14 registered nurses in a patient care unit in accordance with
373	373	15 Section 10 in order to meet the highest level of intensity and
374	374	16 type of care provided in the patient care unit. If multiple
375	375	17 assignments described under Section 10 apply to a patient, the
376	376	18 facility shall assign a direct care professional registered
377	377	19 nurse in accordance with the lowest numerical patient
378	378	20 assignment under that Section.
379	379	21 (k) A facility shall provide staffing of direct care
380	380	22 registered professional nurses above the number of direct care
381	381	23 registered professional nurses required to comply with the
382	382	24 patient levels under Section 10, or additional staffing of
383	383	25 licensed practical nurses, certified nursing assistants, or
384	384	26 other licensed or unlicensed ancillary support staff, based on
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395	395	1 the direct care registered professional nurse's assessment of
396	396	2 each assigned individual patient, the individual patient's
397	397	3 nursing care requirements, and the individual patient's
398	398	4 nursing care plan.
399	399	5 (l) A facility shall not employ video monitors, remote
400	400	6 patient monitoring, or any form of electronic visualization of
401	401	7 a patient as a substitute for the direct in-person observation
402	402	8 required for patient assessment by a registered nurse or for
403	403	9 patient protection. Video monitors or any form of electronic
404	404	10 visualization of a patient shall not constitute compliance
405	405	11 with the patient limits under Section 10.
406	406	12 (m) A facility must provide relief by a direct care
407	407	13 registered professional nurse with unit-specific education,
408	408	14 training, and competence during another direct care registered
409	409	15 professional nurse's meal periods, breaks, and routine
410	410	16 absences as part of the facility's obligation to meet the
411	411	17 patient limits under Section 10 at all times.
412	412	18 Section 25. Changes in patient census.
413	413	19 (a) A facility shall plan for routine fluctuations in its
414	414	20 patient census, including, but not limited to, admissions,
415	415	21 discharges, and transfers.
416	416	22 (b) If a health care emergency causes a change in the
417	417	23 number of patients in a clinical care unit or patient care
418	418	24 area, the facility must be able to demonstrate that immediate
419	419	25 and diligent efforts were made to maintain required staffing
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430	430	1 levels under this Act.
431	431	2 (c) A facility shall immediately notify the Department if
432	432	3 a health care emergency described under subsection (b) causes
433	433	4 a change in the number of patients in a clinical care unit or
434	434	5 patient care area and shall report to the Department efforts
435	435	6 made to maintain staffing levels required under this Act.
436	436	7 Section 30. Record of staff assignments.
437	437	8 (a) A facility shall keep a record of the actual direct
438	438	9 care registered professional nurse, licensed practical nurse,
439	439	10 certified nursing assistant, and other ancillary staff
440	440	11 assignments to individual patients documented on a day-to-day,
441	441	12 shift-by-shift basis, shall submit copies of its records to
442	442	13 the Department quarterly, and shall keep copies of its staff
443	443	14 assignments on file for a period of 7 years.
444	444	15 (b) The documentation required under subsection (a) shall
445	445	16 be submitted to the Department as a mandatory condition of
446	446	17 licensure. The documentation shall be submitted with a
447	447	18 certification by the chief nursing officer of the facility
448	448	19 that the documentation completely and accurately reflects
449	449	20 registered nurse staffing levels by the facility for each
450	450	21 shift in each facility unit, clinical unit, and patient care
451	451	22 area in which patients receive care. The chief nursing officer
452	452	23 shall execute the certification under penalty of perjury and
453	453	24 the certification must contain an expressed acknowledgment
454	454	25 that any false statement constitutes fraud and is subject to
455	455
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465	465	1 criminal and civil prosecution and penalties.
466	466	2 Section 35. Implementation by the Department. The
467	467	3 Department shall adopt rules governing the implementation and
468	468	4 administration of this Act, including methods for facility
469	469	5 staff, facility staff's collective bargaining representatives,
470	470	6 and the public to file complaints regarding violations of this
471	471	7 Act with the Department. The Department shall conduct periodic
472	472	8 audits to ensure compliance with this Act.
473	473	9 Section 40. Nursing staff education, training, and
474	474	10 orientation.
475	475	11 (a) A facility shall adopt written policies that include,
476	476	12 but are not limited to:
477	477	13 (1) procedures for the education, training, and
478	478	14 orientation of nursing staff to each clinical area where
479	479	15 the nursing staff will work; and
480	480	16 (2) criteria for the facility to use in determining
481	481	17 whether a registered nurse has demonstrated current
482	482	18 competence in providing care in a clinical area.
483	483	19 (b) A registered nurse shall not be assigned to a facility
484	484	20 unit, clinical unit, or patient care area unless the
485	485	21 registered nurse has first received education, training, and
486	486	22 orientation in that clinical area that is sufficient to
487	487	23 provide safe, therapeutic, and competent care to patients in
488	488	24 that clinical area and has demonstrated competence in
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499	499	1 providing care in that clinical area.
500	500	2 (c) A registered nurse shall not be assigned to relieve a
501	501	3 direct care professional registered nurse during breaks,
502	502	4 meals, and routine absences from a facility unit, clinical
503	503	5 unit, or patient care area unless that registered nurse has
504	504	6 first received education, training, and orientation in that
505	505	7 clinical area that is sufficient to provide safe, therapeutic,
506	506	8 and competent care to patients in that clinical area and has
507	507	9 demonstrated competence in providing care in that clinical
508	508	10 area.
509	509	11 (d) A health care facility may not assign any nursing
510	510	12 personnel from a temporary nursing agency to the facility's
511	511	13 unit, clinical unit, or patient care area unless the nursing
512	512	14 personnel have first received education, training, and
513	513	15 orientation in that clinical area that is sufficient to
514	514	16 provide safe, therapeutic, and competent care to patients in
515	515	17 that clinical area and have demonstrated competence in
516	516	18 providing care in that clinical area.
517	517	19 Section 45. Enforcement.
518	518	20 (a) In addition to any other penalty prescribed by law,
519	519	21 the Department may impose a civil penalty against a facility
520	520	22 that violates this Act of up to $25,000 for each violation,
521	521	23 except that the Department shall impose a civil penalty of at
522	522	24 least $25,000 for each violation if the Department determines
523	523	25 that the health care facility has a pattern of violation. A
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534	534	1 separate and distinct violation shall be deemed to have been
535	535	2 committed on each day during which any violation continues
536	536	3 after receipt of written notice of the violation from the
537	537	4 Department by the facility.
538	538	5 (b) The Department shall post on its website the names of
539	539	6 facilities against which civil penalties have been imposed
540	540	7 under this Act, the violation for which the penalty was
541	541	8 imposed, and additional information as the Department deems
542	542	9 necessary.
543	543	10 (c) A facility's failure to adhere to the patient
544	544	11 assignment limits under Section 10, any other violation of
545	545	12 this Act, or any violation of Section 10.10 of the Hospital
546	546	13 Licensing Act shall be reported by the Department to the
547	547	14 Attorney General for enforcement, for which the Attorney
548	548	15 General may bring action in a court of competent jurisdiction
549	549	16 seeking injunctive relief and civil penalties.
550	550	17 (d) It is a defense to an enforcement action under this Act
551	551	18 if the facility demonstrates that a health care emergency was
552	552	19 in force at the time of the alleged violation and that the
553	553	20 facility made immediate and diligent efforts to maintain
554	554	21 staffing levels required under this Act.
555	555	22 Section 50. Nurse rights and protections.
556	556	23 (a) A registered professional nurse may object to or
557	557	24 refuse to participate in any activity, practice, assignment,
558	558	25 or task if:
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569	569	1 (1) in good faith, the registered nurse reasonably
570	570	2 believes it to be a violation of the direct care
571	571	3 registered professional nurse maximum patient assignments
572	572	4 or any other provision established under this Act or a
573	573	5 rule adopted by the Department under this Act;
574	574	6 (2) the registered nurse, based on the registered
575	575	7 nurse's nursing judgment, reasonably believes the
576	576	8 registered nurse is not prepared by education, training,
577	577	9 or experience to fulfill the assignment without
578	578	10 compromising the safety of any patient or jeopardizing the
579	579	11 license of the registered nurse; or
580	580	12 (3) in the registered nurse's nursing judgment, the
581	581	13 activity, policy, practice, assignment or task would be
582	582	14 outside the registered nurse's scope of practice or would
583	583	15 otherwise compromise the safety of any patient or the
584	584	16 registered nurse.
585	585	17 (b) A facility shall not retaliate, discriminate, or
586	586	18 otherwise take adverse action in any manner with respect to
587	587	19 any aspect of a nurse's employment, including discharge,
588	588	20 promotion, compensation, or terms, conditions, or privileges
589	589	21 of employment, based on the nurse's refusal to complete an
590	590	22 assignment under subsection (a).
591	591	23 (c) A facility shall not file a complaint against a
592	592	24 registered professional nurse with the Board of Nursing based
593	593	25 on the nurse's refusal to complete an assignment under
594	594	26 subsection (a).
595	595
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597	597
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605	605	1 (d) A facility shall not retaliate, discriminate, or
606	606	2 otherwise take adverse action in any manner against any person
607	607	3 or with respect to any aspect of a nurse's employment,
608	608	4 including discharge, promotion, compensation, or terms,
609	609	5 conditions, or privileges of employment, based on that nurse's
610	610	6 or that person's opposition to any facility policy, practice,
611	611	7 or action that the nurse in good faith believes violates this
612	612	8 Act.
613	613	9 (e) A facility shall not retaliate, discriminate, or
614	614	10 otherwise take adverse action against any patient or employee
615	615	11 of the facility or any other individual on the basis that the
616	616	12 patient, employee, or individual, in good faith, individually
617	617	13 or in conjunction with another person or persons, has
618	618	14 presented a grievance or complaint, initiated or cooperated in
619	619	15 any investigation or proceeding of any governmental entity,
620	620	16 regulatory agency, or private accreditation body, made a civil
621	621	17 claim or demand, or filed an action relating to the care,
622	622	18 services, or conditions of the facility or of any affiliated
623	623	19 or related facility.
624	624	20 (f) A facility shall not:
625	625	21 (1) interfere with, restrain, or deny the exercise of,
626	626	22 or attempt to deny the exercise of, a right conferred
627	627	23 under this Act; or
628	628	24 (2) coerce or intimidate any individual regarding the
629	629	25 exercise of, or an attempt to exercise, a right conferred
630	630	26 under this Act.
631	631
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641	641	1 Section 97. Severability. The provisions of this Act are
642	642	2 severable under Section 1.31 of the Statute on Statutes.
643	643	3 Section 110. The Hospital Licensing Act is amended by
644	644	4 changing Section 10.10 as follows:
645	645	5 (210 ILCS 85/10.10)
646	646	6 Sec. 10.10. Nurse Staffing by Patient Acuity.
647	647	7 (a) Findings. The Legislature finds and declares all of
648	648	8 the following:
649	649	9 (1) The State of Illinois has a substantial interest
650	650	10 in promoting quality care and improving the delivery of
651	651	11 health care services.
652	652	12 (2) Evidence-based studies have shown that the basic
653	653	13 principles of staffing in the acute care setting should be
654	654	14 based on the complexity of patients' care needs aligned
655	655	15 with available nursing skills to promote quality patient
656	656	16 care consistent with professional nursing standards.
657	657	17 (3) Compliance with this Section promotes an
658	658	18 organizational climate that values registered nurses'
659	659	19 input in meeting the health care needs of hospital
660	660	20 patients.
661	661	21 (b) Definitions. As used in this Section:
662	662	22 "Acuity model" means an assessment tool selected and
663	663	23 implemented by a hospital, as recommended by a nursing care
664	664
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674	674	1 committee, that assesses the complexity of patient care needs
675	675	2 requiring professional nursing care and skills and aligns
676	676	3 patient care needs and nursing skills consistent with
677	677	4 professional nursing standards.
678	678	5 "Department" means the Department of Public Health.
679	679	6 "Direct patient care" means care provided in person by a
680	680	7 registered professional nurse with direct responsibility to
681	681	8 oversee or carry out medical regimens or nursing care for one
682	682	9 or more patients.
683	683	10 "Nursing care committee" means a hospital-wide committee
684	684	11 or committees of nurses whose functions, in part or in whole,
685	685	12 contribute to the development, recommendation, and review of
686	686	13 the hospital's nurse staffing plan established pursuant to
687	687	14 subsection (d).
688	688	15 "Registered professional nurse" means a person licensed as
689	689	16 a Registered Nurse under the Nurse Practice Act.
690	690	17 "Written staffing plan for nursing care services" means a
691	691	18 written plan for the assignment of patient care nursing staff
692	692	19 based on multiple nurse and patient considerations that
693	693	20 ensures the facility meets the maximum patient assignment
694	694	21 limits under Section 10 of the Safe Patient Limits Act and the
695	695	22 adopted method to adjust the staffing plan for each inpatient
696	696	23 care unit when additional staff are needed to fulfill the care
697	697	24 needs of each individual patient as determined by the
698	698	25 patient's assigned direct care registered professional nurse
699	699	26 yield minimum staffing levels for inpatient care units and the
700	700
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710	710	1 adopted acuity model aligning patient care needs with nursing
711	711	2 skills required for quality patient care consistent with
712	712	3 professional nursing standards.
713	713	4 (c) Written staffing plan.
714	714	5 (1) Every hospital shall implement a written
715	715	6 hospital-wide staffing plan, prepared by a nursing care
716	716	7 committee or committees, that provides for minimum direct
717	717	8 care professional registered nurse-to-patient staffing
718	718	9 needs for each inpatient care unit and , including
719	719	10 inpatient emergency department departments. If the
720	720	11 staffing plan prepared by the nursing care committee is
721	721	12 not adopted by the hospital, or if substantial changes are
722	722	13 proposed to it, the chief nursing officer shall either:
723	723	14 (i) provide a written explanation to the committee of the
724	724	15 reasons the plan was not adopted; or (ii) provide a
725	725	16 written explanation of any substantial changes made to the
726	726	17 proposed plan prior to it being adopted by the hospital.
727	727	18 The written hospital-wide staffing plan shall include, but
728	728	19 need not be limited to, the following considerations:
729	729	20 (A) The complexity of complete care, assessment on
730	730	21 patient admission, volume of patient admissions,
731	731	22 discharges and transfers, evaluation of the progress
732	732	23 of a patient's problems, ongoing physical assessments,
733	733	24 planning for a patient's discharge, assessment after a
734	734	25 change in patient condition, and assessment of the
735	735	26 need for patient referrals.
736	736
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746	746	1 (B) The complexity of clinical professional
747	747	2 nursing judgment needed to design and implement a
748	748	3 patient's nursing care plan, the need for specialized
749	749	4 equipment and technology, the skill mix of other
750	750	5 personnel providing or supporting direct patient care,
751	751	6 and involvement in quality improvement activities,
752	752	7 professional preparation, and experience.
753	753	8 (C) Patient acuity and the number of patients for
754	754	9 whom care is being provided.
755	755	10 (D) The ongoing assessments of a unit's patient
756	756	11 acuity levels, as determined by the direct care
757	757	12 registered professional nurse responsible for each
758	758	13 patient's care, and nursing staff needed shall be
759	759	14 routinely made by the unit nurse manager or the unit
760	760	15 nurse manager's his or her designee.
761	761	16 (E) The identification of additional registered
762	762	17 nurses available for direct patient care when
763	763	18 patients' unexpected needs exceed the planned workload
764	764	19 for direct care staff.
765	765	20 (F) Ensuring that patient limits under Section 10
766	766	21 of the Safe Patient Limits Act to a registered nurse
767	767	22 are not exceeded.
768	768	23 (2) In order to provide staffing flexibility to meet
769	769	24 patient needs, every hospital shall include in its
770	770	25 staffing plan a method to adjust the staffing plan for
771	771	26 each inpatient care unit when the maximum patient
772	772
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782	782	1 assignment under Section 10 of the Safe Patient Limits Act
783	783	2 should be reduced or additional staff are needed to
784	784	3 fulfill the care needs of each individual patient as
785	785	4 determined by the patient's assigned direct care
786	786	5 registered professional nurse identify an acuity model for
787	787	6 adjusting the staffing plan for each inpatient care unit.
788	788	7 (2.5) Each hospital shall implement the staffing plan
789	789	8 and assign nursing personnel to each inpatient care unit
790	790	9 and emergency department , including inpatient emergency
791	791	10 departments, in accordance with the staffing plan.
792	792	11 (A) A registered nurse may report to the nursing
793	793	12 care committee any variations where the nurse
794	794	13 personnel assignment in an inpatient care unit is not
795	795	14 in accordance with the adopted staffing plan and may
796	796	15 make a written report to the nursing care committee
797	797	16 based on the variations.
798	798	17 (B) Shift-to-shift adjustments in staffing levels
799	799	18 required by the staffing plan may be made by the
800	800	19 appropriate hospital personnel overseeing inpatient
801	801	20 care operations. If a registered nurse in an inpatient
802	802	21 care unit objects to a shift-to-shift adjustment, the
803	803	22 registered nurse may submit a written report to the
804	804	23 nursing care committee.
805	805	24 (C) The nursing care committee shall develop a
806	806	25 process to examine and respond to written reports
807	807	26 submitted under subparagraphs (A) and (B) of this
808	808
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810	810
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818	818	1 paragraph (2.5), including the ability to determine if
819	819	2 a specific written report is resolved or should be
820	820	3 dismissed.
821	821	4 (3) The written staffing plan shall be posted, either
822	822	5 by physical or electronic means, in a conspicuous and
823	823	6 accessible location for both patients and direct care
824	824	7 staff, as required under the Hospital Report Card Act. A
825	825	8 copy of the written staffing plan shall be provided to any
826	826	9 member of the general public upon request.
827	827	10 (4) The written staffing plan shall be updated on an
828	828	11 annual basis and submitted to the Department.
829	829	12 (5) Any acuity model, or other method, software, or
830	830	13 tool used to create or evaluate a staffing plan adopted by
831	831	14 a facility, shall be transparent in all respects,
832	832	15 including disclosure of detailed documentation of the
833	833	16 methodology used to determine nurse staffing and
834	834	17 identifying each factor, assumption, and value used in
835	835	18 applying the methodology. This documentation shall be
836	836	19 submitted to the Department and made available to facility
837	837	20 staff, facility staff's collective bargaining
838	838	21 representatives, and the public upon request. The patient
839	839	22 limits under Section 10 of the Safe Patient Limits Act
840	840	23 shall not be exceeded regardless of the use and
841	841	24 application of any acuity model.
842	842	25 (d) Nursing care committee.
843	843	26 (1) Every hospital shall have a nursing care committee
844	844
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854	854	1 that meets at least 6 times per year. A hospital shall
855	855	2 appoint members of a committee whereby at least 55% of the
856	856	3 members are registered professional nurses providing
857	857	4 direct inpatient care, one of whom shall be selected
858	858	5 annually by the direct inpatient care nurses to serve as
859	859	6 co-chair of the committee.
860	860	7 (2) (Blank).
861	861	8 (2.5) A nursing care committee shall prepare and
862	862	9 recommend to hospital administration the hospital's
863	863	10 written hospital-wide staffing plan. If the staffing plan
864	864	11 is not adopted by the hospital, the chief nursing officer
865	865	12 shall provide a written statement to the committee prior
866	866	13 to a staffing plan being adopted by the hospital that: (A)
867	867	14 explains the reasons the committee's proposed staffing
868	868	15 plan was not adopted; and (B) describes the changes to the
869	869	16 committee's proposed staffing or any alternative to the
870	870	17 committee's proposed staffing plan.
871	871	18 (3) A nursing care committee's or committees' written
872	872	19 staffing plan for the hospital shall be based on the
873	873	20 principles from the staffing components set forth in
874	874	21 subsection (c). In particular, a committee or committees
875	875	22 shall provide input and feedback on the following:
876	876	23 (A) Selection, implementation, and evaluation of
877	877	24 minimum staffing levels consistent with the maximum
878	878	25 patient limits under the Safe Patient Limits Act for
879	879	26 inpatient care units.
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890	890	1 (B) Selection, implementation, and evaluation of a
891	891	2 method to increase staffing as needed to meet patient
892	892	3 care needs an acuity model to provide staffing
893	893	4 flexibility that aligns changing patient acuity with
894	894	5 nursing skills required.
895	895	6 (C) Selection, implementation, and evaluation of a
896	896	7 written staffing plan incorporating the items
897	897	8 described in subdivisions (c)(1) and (c)(2) of this
898	898	9 Section.
899	899	10 (D) Review the nurse staffing plans for all
900	900	11 inpatient areas and current acuity tools and measures
901	901	12 in use. The nursing care committee's review shall
902	902	13 consider:
903	903	14 (i) patient outcomes;
904	904	15 (ii) complaints regarding staffing, including
905	905	16 complaints about a delay in direct care nursing or
906	906	17 an absence of direct care nursing;
907	907	18 (iii) the number of hours of nursing care
908	908	19 provided through an inpatient hospital unit
909	909	20 compared with the number of inpatients served by
910	910	21 the hospital unit during a 24-hour period;
911	911	22 (iv) the aggregate hours of overtime worked by
912	912	23 the nursing staff;
913	913	24 (v) the extent to which actual nurse staffing
914	914	25 for each hospital inpatient unit differs from the
915	915	26 staffing specified by the staffing plan; and
916	916
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926	926	1 (vi) any other matter or change to the
927	927	2 staffing plan determined by the committee to
928	928	3 ensure that the hospital is staffed to meet the
929	929	4 health care needs of patients.
930	930	5 (4) A nursing care committee must issue a written
931	931	6 report addressing the items described in subparagraphs (A)
932	932	7 through (D) of paragraph (3) semi-annually. A written copy
933	933	8 of this report shall be made available to direct inpatient
934	934	9 care nurses by making available a paper copy of the
935	935	10 report, distributing it electronically, or posting it on
936	936	11 the hospital's website.
937	937	12 (5) A nursing care committee must issue a written
938	938	13 report at least annually to the hospital governing board
939	939	14 that addresses items including, but not limited to: the
940	940	15 items described in paragraph (3); changes made based on
941	941	16 committee recommendations and the impact of such changes;
942	942	17 and recommendations for future changes related to nurse
943	943	18 staffing.
944	944	19 (e) Nothing in this Section 10.10 shall be construed to
945	945	20 limit, alter, or modify any of the terms, conditions, or
946	946	21 provisions of a collective bargaining agreement entered into
947	947	22 by the hospital.
948	948	23 (f) No hospital may discipline, discharge, or take any
949	949	24 other adverse employment action against an employee solely
950	950	25 because the employee expresses a concern or complaint
951	951	26 regarding an alleged violation of this Section or concerns
952	952
953	953
954	954
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962	962	1 related to nurse staffing.
963	963	2 (g) Any employee of a hospital may file a complaint with
964	964	3 the Department regarding an alleged violation of this Section.
965	965	4 The Department must forward notification of the alleged
966	966	5 violation to the hospital in question within 10 business days
967	967	6 after the complaint is filed. Upon receiving a complaint of a
968	968	7 violation of this Section, the Department may take any action
969	969	8 authorized under Sections 7 or 9 of this Act.
970	970	9 (h) Delegation of nursing interventions by a registered
971	971	10 professional nurse must be in accordance with the Nurse
972	972	11 Practice Act.
973	973	12 (i) A hospital shall not mandate that a registered
974	974	13 professional nurse delegate any element of the nursing
975	975	14 process, including, but not limited to, nursing interventions,
976	976	15 medication administration, nursing judgment, comprehensive
977	977	16 patient assessment, development of the plan of care, or
978	978	17 evaluation of care. A delegation of a nursing intervention by
979	979	18 a registered professional nurse shall not be delegated again
980	980	19 to another person.
981	981	20 (j) The Department shall establish procedures to ensure
982	982	21 that the documentation submitted under this Section is
983	983	22 available for public inspection in its entirety.
984	984	23 (k) Nothing in this Section shall be construed to limit,
985	985	24 alter, or modify the requirements of the Safe Patient Limits
986	986	25 Act.
987	987	26 (Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
988	988
989	989
990	990
991	991
992	992
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994	994
995	995
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998	998	1 102-813, eff. 5-13-22.)
999	999	2 Section 115. The Nurse Practice Act is amended by adding
1000	1000	3 Section 50-15.15 as follows:
1001	1001	4 (225 ILCS 65/50-15.15 new)
1002	1002	5 Sec. 50-15.15. Nursing judgment.
1003	1003	6 (a) The General Assembly finds that:
1004	1004	7 (1) Performance of the scope of practice of a direct
1005	1005	8 care registered professional nurse requires the exercise
1006	1006	9 of nursing judgment in the exclusive interests of the
1007	1007	10 patient.
1008	1008	11 (2) The exercise of nursing judgment, unencumbered by
1009	1009	12 the commercial or revenue-generation priorities of a
1010	1010	13 hospital, long-term acute care hospital, ambulatory
1011	1011	14 surgical treatment center, or other employing entity of a
1012	1012	15 direct care registered professional nurse is necessary to
1013	1013	16 ensure safe, therapeutic, effective, and competent
1014	1014	17 treatment of patients and is essential to protect the
1015	1015	18 health and safety of the people of Illinois.
1016	1016	19 (b) The exercise of nursing judgment by a direct care
1017	1017	20 registered professional nurse in the performance of the scope
1018	1018	21 of practice of the registered professional nurse under Section
1019	1019	22 60-35 or the scope of practice of the advanced practice
1020	1020	23 registered nurse under Section 65-30 shall be provided in the
1021	1021	24 exclusive interests of the patient and shall not, for any
1022	1022
1023	1023
1024	1024
1025	1025
1026	1026
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1032	1032	1 purpose, be considered, relied upon, or represented as a job
1033	1033	2 function, authority, responsibility, or activity undertaken in
1034	1034	3 any respect for the purpose of serving the business,
1035	1035	4 commercial, operational, or other institutional interests of
1036	1036	5 the employer.
1037	1037	6 (c) A hospital, long-term acute care hospital, ambulatory
1038	1038	7 surgical treatment center, or other health care facility shall
1039	1039	8 not adopt a policy that:
1040	1040	9 (1) limits a direct care registered professional nurse
1041	1041	10 in performing duties that are part of the nursing process,
1042	1042	11 including, but not limited to, full exercise of nursing
1043	1043	12 judgment in assessing, planning, implementing, and
1044	1044	13 evaluating care;
1045	1045	14 (2) substitutes recommendations, decisions, or outputs
1046	1046	15 of health information technology, algorithms used to
1047	1047	16 achieve a medical or nursing care objective at a facility,
1048	1048	17 systems based on artificial intelligence or machine
1049	1049	18 learning, or clinical practice guidelines for the
1050	1050	19 independent nursing judgment of a direct care registered
1051	1051	20 professional nurse or penalize a direct care registered
1052	1052	21 professional nurse for overriding the technology or
1053	1053	22 guidelines if, in that registered nurse's judgment, and in
1054	1054	23 accordance with that registered nurse's scope of practice,
1055	1055	24 it is in the best interest of the patient to do so; or
1056	1056	25 (3) limits a direct care registered professional nurse
1057	1057	26 in acting as a patient advocate in the exclusive interests
1058	1058
1059	1059
1060	1060
1061	1061
1062	1062
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1068	1068	1 of the patient.
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