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
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
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
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A BILL FOR
SB2314LRB103 30711 CPF 57186 b SB2314 LRB103 30711 CPF 57186 b
SB2314 LRB103 30711 CPF 57186 b
1 AN ACT concerning health.
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 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
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
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A BILL FOR
New Act
210 ILCS 85/10.10
225 ILCS 65/50-15.15 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, affect the delivery of medical
10 care, and require an immediate or exceptional level of
11 emergency or other medical services at the specific facility.
12 "Health care emergency" does not include a state of emergency
13 that results from a labor dispute in the health care industry
14 or consistent 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 patient" means a patient who has
23 given birth within the previous 2 hours.
24 "Nursing care" means care that falls within the scope of
25 practice 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 that is organized,
10 operated, and maintained to provide care for a specific
11 medical condition or a specific patient population.
12 Section 10. Maximum patient assignments for registered
13 nurses.
14 (a) The maximum number of patients assigned to a
15 registered nurse in a facility shall not exceed the limits
16 provided in this Section. However, nothing shall preclude a
17 facility from assigning fewer patients to a registered nurse
18 than the limits provided in this Section. The requirements of
19 this Section apply at all times during each shift within each
20 clinical unit and each patient care area. For the purposes of
21 this Act, a patient is assigned to a registered nurse if the
22 registered nurse accepts responsibility for the patient's
23 nursing care.
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 one.
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 postanesthesia care patients,
9 regardless of the type of anesthesia administered, the maximum
10 patient assignment of postanesthesia care patients or patients
11 being monitored for the effects of any anesthetizing agent to
12 a registered nurse is one.
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 one. 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 the
14 maximum patient assignment:
15 (1) to a registered nurse of antepartum patients
16 requiring continuous fetal monitoring is 2;
17 (2) of other antepartum patients who are not in active
18 labor to a registered nurse is 3;
19 (3) of active labor patients to a registered nurse is
20 one;
21 (4) of patients with medical or obstetrical
22 complications during the initiation of epidural anesthesia
23 or during circulation for a caesarean section delivery to
24 a registered nurse is one;
25 (5) during birth is one registered nurse responsible
26 for the patient in labor and, for each newborn, one
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1 registered nurse whose sole responsibility is that newborn
2 patient;
3 (6) of postpartum patients when the parent has given
4 birth within the previous 2 hours is one registered nurse
5 for each couplet, and in the case of multiple births, one
6 registered nurse for each additional newborn;
7 (7) of couplets to a registered nurse is 2;
8 (8) of patients receiving postpartum or postoperative
9 gynecological care to a registered nurse is 4 when the
10 registered nurse has been assigned only to patients
11 receiving postpartum or postoperative gynecological care;
12 (9) of newborn patients when the patient is unstable,
13 as assessed by a direct care registered professional
14 nurse, to a registered nurse is one; and
15 (10) of newborn patients to a registered nurse is 2
16 when the patients are receiving intermediate care or the
17 nurse has been assigned to a patient care unit that
18 receives newborn patients requiring intermediate care,
19 including, but not limited to, an intermediate care
20 nursery.
21 (h) In all units with pediatric patients, the maximum
22 patient assignment of pediatric patients to a registered nurse
23 is 3.
24 (i) In all units with psychiatric patients, the maximum
25 patient assignment of psychiatric patients to a registered
26 nurse is 4.
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1 (j) In all units with medical and surgical patients, the
2 maximum patient assignment of medical or surgical patients to
3 a registered nurse is 4.
4 (k) In all units with telemetry patients, the maximum
5 patient assignment of telemetry patients to a registered nurse
6 is 3.
7 (l) In all units with observational patients, the maximum
8 patient assignment of observational patients to a registered
9 nurse is 3.
10 (m) In all units with acute rehabilitation patients, the
11 maximum patient assignment of acute rehabilitation patients to
12 a registered nurse is 4.
13 (n) In all units with conscious sedation patients, the
14 maximum patient assignment of conscious sedation patients to a
15 registered nurse is one.
16 (o) In any unit not otherwise listed in this Section,
17 including all specialty care units not otherwise listed in
18 this Section, the maximum patient assignment to a registered
19 nurse is 4.
20 Section 15. Use of rapid response teams as first
21 responders prohibited. A rapid response team's registered
22 nurse shall not be given direct care patient assignments while
23 assigned as a registered nurse who is responsible for
24 responding to a rapid response team request.
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1 Section 20. Implementation by a facility.
2 (a) A facility shall implement the patient limits
3 established under Section 10 without diminishing the staffing
4 levels of the facility's health care workforce. A facility may
5 not lay off licensed practical nurses, licensed psychiatric
6 technicians, certified nursing assistants, or other ancillary
7 support staff to meet the patient limits under Section 10.
8 (b) Each patient shall be assigned to a direct care
9 registered professional nurse who shall directly provide the
10 comprehensive patient assessment, development of a plan of
11 care, and supervision, implementation, and evaluation of the
12 nursing care provided to the patient at least every shift and
13 who has the responsibility for the provision of care to a
14 particular patient within the registered nurse's scope of
15 practice.
16 (c) There shall be no averaging of the number of patients
17 and the total number of registered nurses in each clinical
18 unit or patient care area in order to meet the patient limits
19 under Section 10.
20 (d) Only registered nurses providing direct patient care
21 shall be considered when evaluating compliance with the
22 patient limits under Section 10. Ancillary staff and
23 unlicensed personnel shall not be considered when evaluating
24 compliance with the patient limits under Section 10.
25 (e) The hours in which a nurse administrator, nurse
26 supervisor, nurse manager, charge nurse, and other licensed
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1 nurse provides patient care shall not be considered when
2 evaluating compliance with the patient limits under Section 10
3 and with the patient assignment requirement under subsection
4 (b) unless the registered nurse:
5 (1) has a current and active direct patient care
6 assignment;
7 (2) provides direct patient care in compliance with
8 this Act;
9 (3) has demonstrated the registered nurse's competence
10 in providing care in the registered nurse's assigned unit
11 to the facility; and
12 (4) has the principal responsibility of providing
13 direct patient care and has no additional job duties
14 during the time period during which the nurse has a
15 patient assignment.
16 (f) The hours in which a nurse administrator, nurse
17 supervisor, nurse manager, charge nurse, or other licensed
18 nurse provides direct patient care may be considered when
19 evaluating compliance with the patient limits under Section 10
20 and with the patient assignment requirement under subsection
21 (b) only if he or she is providing relief for a direct care
22 registered professional nurse during breaks, meals, and other
23 routine and expected absences from that unit.
24 (g) At all times during each shift within a facility unit,
25 clinical unit, or patient care area of a facility, and with the
26 full complement of ancillary support staff, at least 2 direct
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1 care registered nurses shall be physically present in each
2 facility unit, clinical unit, or patient care area where a
3 patient is present.
4 (h) Identifying a clinical unit or patient care area by a
5 name or term other than those listed in this Act does not
6 affect a facility's requirement to staff the unit consistent
7 with the patient limits identified for the level of intensity
8 or type of care described in this Act.
9 (i) A registered nurse providing direct care to a patient
10 has the authority to determine if a change in the patient's
11 status places the patient in a different category requiring a
12 different patient limit under Section 10.
13 (j) A facility shall assign direct care professional
14 registered nurses in a patient care unit in accordance with
15 Section 10 in order to meet the highest level of intensity and
16 type of care provided in the patient care unit. If multiple
17 assignments described under Section 10 apply to a patient, the
18 facility shall assign a direct care professional registered
19 nurse in accordance with the lowest numerical patient
20 assignment under that Section.
21 (k) A facility shall provide staffing of direct care
22 registered professional nurses above the number of direct care
23 registered professional nurses required to comply with the
24 patient levels under Section 10, or additional staffing of
25 licensed practical nurses, certified nursing assistants, or
26 other licensed or unlicensed ancillary support staff, based on
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1 the direct care registered professional nurse's assessment of
2 each assigned individual patient, the individual patient's
3 nursing care requirements, and the individual patient's
4 nursing care plan.
5 (l) A facility shall not employ video monitors, remote
6 patient monitoring, or any form of electronic visualization of
7 a patient as a substitute for the direct in-person observation
8 required for patient assessment by a registered nurse or for
9 patient protection. Video monitors or any form of electronic
10 visualization of a patient shall not constitute compliance
11 with the patient limits under Section 10.
12 (m) A facility must provide relief by a direct care
13 registered professional nurse with unit-specific education,
14 training, and competence during another direct care registered
15 professional nurse's meal periods, breaks, and routine
16 absences as part of the facility's obligation to meet the
17 patient limits under Section 10 at all times.
18 Section 25. Changes in patient census.
19 (a) A facility shall plan for routine fluctuations in its
20 patient census, including, but not limited to, admissions,
21 discharges, and transfers.
22 (b) If a health care emergency causes a change in the
23 number of patients in a clinical care unit or patient care
24 area, the facility must be able to demonstrate that immediate
25 and diligent efforts were made to maintain required staffing
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1 levels under this Act.
2 (c) A facility shall immediately notify the Department if
3 a health care emergency described under subsection (b) causes
4 a change in the number of patients in a clinical care unit or
5 patient care area and shall report to the Department efforts
6 made to maintain staffing levels required under this Act.
7 Section 30. Record of staff assignments.
8 (a) A facility shall keep a record of the actual direct
9 care registered professional nurse, licensed practical nurse,
10 certified nursing assistant, and other ancillary staff
11 assignments to individual patients documented on a day-to-day,
12 shift-by-shift basis, shall submit copies of its records to
13 the Department quarterly, and shall keep copies of its staff
14 assignments on file for a period of 7 years.
15 (b) The documentation required under subsection (a) shall
16 be submitted to the Department as a mandatory condition of
17 licensure. The documentation shall be submitted with a
18 certification by the chief nursing officer of the facility
19 that the documentation completely and accurately reflects
20 registered nurse staffing levels by the facility for each
21 shift in each facility unit, clinical unit, and patient care
22 area in which patients receive care. The chief nursing officer
23 shall execute the certification under penalty of perjury and
24 the certification must contain an expressed acknowledgment
25 that any false statement constitutes fraud and is subject to
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1 criminal and civil prosecution and penalties.
2 Section 35. Implementation by the Department. The
3 Department shall adopt rules governing the implementation and
4 administration of this Act, including methods for facility
5 staff, facility staff's collective bargaining representatives,
6 and the public to file complaints regarding violations of this
7 Act with the Department. The Department shall conduct periodic
8 audits to ensure compliance with this Act.
9 Section 40. Nursing staff education, training, and
10 orientation.
11 (a) A facility shall adopt written policies that include,
12 but are not limited to:
13 (1) procedures for the education, training, and
14 orientation of nursing staff to each clinical area where
15 the nursing staff will work; and
16 (2) criteria for the facility to use in determining
17 whether a registered nurse has demonstrated current
18 competence in providing care in a clinical area.
19 (b) A registered nurse shall not be assigned to a facility
20 unit, clinical unit, or patient care area unless the
21 registered nurse has first received education, training, and
22 orientation in that clinical area that is sufficient to
23 provide safe, therapeutic, and competent care to patients in
24 that clinical area and has demonstrated competence in
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1 providing care in that clinical area.
2 (c) A registered nurse shall not be assigned to relieve a
3 direct care professional registered nurse during breaks,
4 meals, and routine absences from a facility unit, clinical
5 unit, or patient care area unless that registered nurse has
6 first received education, training, and orientation in that
7 clinical area that is sufficient to provide safe, therapeutic,
8 and competent care to patients in that clinical area and has
9 demonstrated competence in providing care in that clinical
10 area.
11 (d) A health care facility may not assign any nursing
12 personnel from a temporary nursing agency to the facility's
13 unit, clinical unit, or patient care area unless the nursing
14 personnel have first received education, training, and
15 orientation in that clinical area that is sufficient to
16 provide safe, therapeutic, and competent care to patients in
17 that clinical area and have demonstrated competence in
18 providing care in that clinical area.
19 Section 45. Enforcement.
20 (a) In addition to any other penalty prescribed by law,
21 the Department may impose a civil penalty against a facility
22 that violates this Act of up to $25,000 for each violation,
23 except that the Department shall impose a civil penalty of at
24 least $25,000 for each violation if the Department determines
25 that the health care facility has a pattern of violation. A
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1 separate and distinct violation shall be deemed to have been
2 committed on each day during which any violation continues
3 after receipt of written notice of the violation from the
4 Department by the facility.
5 (b) The Department shall post on its website the names of
6 facilities against which civil penalties have been imposed
7 under this Act, the violation for which the penalty was
8 imposed, and additional information as the Department deems
9 necessary.
10 (c) A facility's failure to adhere to the patient
11 assignment limits under Section 10, any other violation of
12 this Act, or any violation of Section 10.10 of the Hospital
13 Licensing Act shall be reported by the Department to the
14 Attorney General for enforcement, for which the Attorney
15 General may bring action in a court of competent jurisdiction
16 seeking injunctive relief and civil penalties.
17 (d) It is a defense to an enforcement action under this Act
18 if the facility demonstrates that a health care emergency was
19 in force at the time of the alleged violation and that the
20 facility made immediate and diligent efforts to maintain
21 staffing levels required under this Act.
22 Section 50. Nurse rights and protections.
23 (a) A registered professional nurse may object to or
24 refuse to participate in any activity, practice, assignment,
25 or task if:
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1 (1) in good faith, the registered nurse reasonably
2 believes it to be a violation of the direct care
3 registered professional nurse maximum patient assignments
4 or any other provision established under this Act or a
5 rule adopted by the Department under this Act;
6 (2) the registered nurse, based on the registered
7 nurse's nursing judgment, reasonably believes the
8 registered nurse is not prepared by education, training,
9 or experience to fulfill the assignment without
10 compromising the safety of any patient or jeopardizing the
11 license of the registered nurse; or
12 (3) in the registered nurse's nursing judgment, the
13 activity, policy, practice, assignment or task would be
14 outside the registered nurse's scope of practice or would
15 otherwise compromise the safety of any patient or the
16 registered nurse.
17 (b) A facility shall not retaliate, discriminate, or
18 otherwise take adverse action in any manner with respect to
19 any aspect of a nurse's employment, including discharge,
20 promotion, compensation, or terms, conditions, or privileges
21 of employment, based on the nurse's refusal to complete an
22 assignment under subsection (a).
23 (c) A facility shall not file a complaint against a
24 registered professional nurse with the Board of Nursing based
25 on the nurse's refusal to complete an assignment under
26 subsection (a).
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1 (d) A facility shall not retaliate, discriminate, or
2 otherwise take adverse action in any manner against any person
3 or with respect to any aspect of a nurse's employment,
4 including discharge, promotion, compensation, or terms,
5 conditions, or privileges of employment, based on that nurse's
6 or that person's opposition to any facility policy, practice,
7 or action that the nurse in good faith believes violates this
8 Act.
9 (e) A facility shall not retaliate, discriminate, or
10 otherwise take adverse action against any patient or employee
11 of the facility or any other individual on the basis that the
12 patient, employee, or individual, in good faith, individually
13 or in conjunction with another person or persons, has
14 presented a grievance or complaint, initiated or cooperated in
15 any investigation or proceeding of any governmental entity,
16 regulatory agency, or private accreditation body, made a civil
17 claim or demand, or filed an action relating to the care,
18 services, or conditions of the facility or of any affiliated
19 or related facility.
20 (f) A facility shall not:
21 (1) interfere with, restrain, or deny the exercise of,
22 or attempt to deny the exercise of, a right conferred
23 under this Act; or
24 (2) coerce or intimidate any individual regarding the
25 exercise of, or an attempt to exercise, a right conferred
26 under this Act.
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1 Section 97. Severability. The provisions of this Act are
2 severable under Section 1.31 of the Statute on Statutes.
3 Section 110. The Hospital Licensing Act is amended by
4 changing Section 10.10 as follows:
5 (210 ILCS 85/10.10)
6 Sec. 10.10. Nurse Staffing by Patient Acuity.
7 (a) Findings. The Legislature finds and declares all of
8 the following:
9 (1) The State of Illinois has a substantial interest
10 in promoting quality care and improving the delivery of
11 health care services.
12 (2) Evidence-based studies have shown that the basic
13 principles of staffing in the acute care setting should be
14 based on the complexity of patients' care needs aligned
15 with available nursing skills to promote quality patient
16 care consistent with professional nursing standards.
17 (3) Compliance with this Section promotes an
18 organizational climate that values registered nurses'
19 input in meeting the health care needs of hospital
20 patients.
21 (b) Definitions. As used in this Section:
22 "Acuity model" means an assessment tool selected and
23 implemented by a hospital, as recommended by a nursing care
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1 committee, that assesses the complexity of patient care needs
2 requiring professional nursing care and skills and aligns
3 patient care needs and nursing skills consistent with
4 professional nursing standards.
5 "Department" means the Department of Public Health.
6 "Direct patient care" means care provided in person by a
7 registered professional nurse with direct responsibility to
8 oversee or carry out medical regimens or nursing care for one
9 or more patients.
10 "Nursing care committee" means a hospital-wide committee
11 or committees of nurses whose functions, in part or in whole,
12 contribute to the development, recommendation, and review of
13 the hospital's nurse staffing plan established pursuant to
14 subsection (d).
15 "Registered professional nurse" means a person licensed as
16 a Registered Nurse under the Nurse Practice Act.
17 "Written staffing plan for nursing care services" means a
18 written plan for the assignment of patient care nursing staff
19 based on multiple nurse and patient considerations that
20 ensures the facility meets the maximum patient assignment
21 limits under Section 10 of the Safe Patient Limits Act and the
22 adopted method to adjust the staffing plan for each inpatient
23 care unit when additional staff are needed to fulfill the care
24 needs of each individual patient as determined by the
25 patient's assigned direct care registered professional nurse
26 yield minimum staffing levels for inpatient care units and the
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1 adopted acuity model aligning patient care needs with nursing
2 skills required for quality patient care consistent with
3 professional nursing standards.
4 (c) Written staffing plan.
5 (1) Every hospital shall implement a written
6 hospital-wide staffing plan, prepared by a nursing care
7 committee or committees, that provides for minimum direct
8 care professional registered nurse-to-patient staffing
9 needs for each inpatient care unit and , including
10 inpatient emergency department departments. If the
11 staffing plan prepared by the nursing care committee is
12 not adopted by the hospital, or if substantial changes are
13 proposed to it, the chief nursing officer shall either:
14 (i) provide a written explanation to the committee of the
15 reasons the plan was not adopted; or (ii) provide a
16 written explanation of any substantial changes made to the
17 proposed plan prior to it being adopted by the hospital.
18 The written hospital-wide staffing plan shall include, but
19 need not be limited to, the following considerations:
20 (A) The complexity of complete care, assessment on
21 patient admission, volume of patient admissions,
22 discharges and transfers, evaluation of the progress
23 of a patient's problems, ongoing physical assessments,
24 planning for a patient's discharge, assessment after a
25 change in patient condition, and assessment of the
26 need for patient referrals.
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1 (B) The complexity of clinical professional
2 nursing judgment needed to design and implement a
3 patient's nursing care plan, the need for specialized
4 equipment and technology, the skill mix of other
5 personnel providing or supporting direct patient care,
6 and involvement in quality improvement activities,
7 professional preparation, and experience.
8 (C) Patient acuity and the number of patients for
9 whom care is being provided.
10 (D) The ongoing assessments of a unit's patient
11 acuity levels, as determined by the direct care
12 registered professional nurse responsible for each
13 patient's care, and nursing staff needed shall be
14 routinely made by the unit nurse manager or the unit
15 nurse manager's his or her designee.
16 (E) The identification of additional registered
17 nurses available for direct patient care when
18 patients' unexpected needs exceed the planned workload
19 for direct care staff.
20 (F) Ensuring that patient limits under Section 10
21 of the Safe Patient Limits Act to a registered nurse
22 are not exceeded.
23 (2) In order to provide staffing flexibility to meet
24 patient needs, every hospital shall include in its
25 staffing plan a method to adjust the staffing plan for
26 each inpatient care unit when the maximum patient
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1 assignment under Section 10 of the Safe Patient Limits Act
2 should be reduced or additional staff are needed to
3 fulfill the care needs of each individual patient as
4 determined by the patient's assigned direct care
5 registered professional nurse identify an acuity model for
6 adjusting the staffing plan for each inpatient care unit.
7 (2.5) Each hospital shall implement the staffing plan
8 and assign nursing personnel to each inpatient care unit
9 and emergency department , including inpatient emergency
10 departments, in accordance with the staffing plan.
11 (A) A registered nurse may report to the nursing
12 care committee any variations where the nurse
13 personnel assignment in an inpatient care unit is not
14 in accordance with the adopted staffing plan and may
15 make a written report to the nursing care committee
16 based on the variations.
17 (B) Shift-to-shift adjustments in staffing levels
18 required by the staffing plan may be made by the
19 appropriate hospital personnel overseeing inpatient
20 care operations. If a registered nurse in an inpatient
21 care unit objects to a shift-to-shift adjustment, the
22 registered nurse may submit a written report to the
23 nursing care committee.
24 (C) The nursing care committee shall develop a
25 process to examine and respond to written reports
26 submitted under subparagraphs (A) and (B) of this
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1 paragraph (2.5), including the ability to determine if
2 a specific written report is resolved or should be
3 dismissed.
4 (3) The written staffing plan shall be posted, either
5 by physical or electronic means, in a conspicuous and
6 accessible location for both patients and direct care
7 staff, as required under the Hospital Report Card Act. A
8 copy of the written staffing plan shall be provided to any
9 member of the general public upon request.
10 (4) The written staffing plan shall be updated on an
11 annual basis and submitted to the Department.
12 (5) Any acuity model, or other method, software, or
13 tool used to create or evaluate a staffing plan adopted by
14 a facility, shall be transparent in all respects,
15 including disclosure of detailed documentation of the
16 methodology used to determine nurse staffing and
17 identifying each factor, assumption, and value used in
18 applying the methodology. This documentation shall be
19 submitted to the Department and made available to facility
20 staff, facility staff's collective bargaining
21 representatives, and the public upon request. The patient
22 limits under Section 10 of the Safe Patient Limits Act
23 shall not be exceeded regardless of the use and
24 application of any acuity model.
25 (d) Nursing care committee.
26 (1) Every hospital shall have a nursing care committee
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1 that meets at least 6 times per year. A hospital shall
2 appoint members of a committee whereby at least 55% of the
3 members are registered professional nurses providing
4 direct inpatient care, one of whom shall be selected
5 annually by the direct inpatient care nurses to serve as
6 co-chair of the committee.
7 (2) (Blank).
8 (2.5) A nursing care committee shall prepare and
9 recommend to hospital administration the hospital's
10 written hospital-wide staffing plan. If the staffing plan
11 is not adopted by the hospital, the chief nursing officer
12 shall provide a written statement to the committee prior
13 to a staffing plan being adopted by the hospital that: (A)
14 explains the reasons the committee's proposed staffing
15 plan was not adopted; and (B) describes the changes to the
16 committee's proposed staffing or any alternative to the
17 committee's proposed staffing plan.
18 (3) A nursing care committee's or committees' written
19 staffing plan for the hospital shall be based on the
20 principles from the staffing components set forth in
21 subsection (c). In particular, a committee or committees
22 shall provide input and feedback on the following:
23 (A) Selection, implementation, and evaluation of
24 minimum staffing levels consistent with the maximum
25 patient limits under the Safe Patient Limits Act for
26 inpatient care units.
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1 (B) Selection, implementation, and evaluation of a
2 method to increase staffing as needed to meet patient
3 care needs an acuity model to provide staffing
4 flexibility that aligns changing patient acuity with
5 nursing skills required.
6 (C) Selection, implementation, and evaluation of a
7 written staffing plan incorporating the items
8 described in subdivisions (c)(1) and (c)(2) of this
9 Section.
10 (D) Review the nurse staffing plans for all
11 inpatient areas and current acuity tools and measures
12 in use. The nursing care committee's review shall
13 consider:
14 (i) patient outcomes;
15 (ii) complaints regarding staffing, including
16 complaints about a delay in direct care nursing or
17 an absence of direct care nursing;
18 (iii) the number of hours of nursing care
19 provided through an inpatient hospital unit
20 compared with the number of inpatients served by
21 the hospital unit during a 24-hour period;
22 (iv) the aggregate hours of overtime worked by
23 the nursing staff;
24 (v) the extent to which actual nurse staffing
25 for each hospital inpatient unit differs from the
26 staffing specified by the staffing plan; and
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1 (vi) any other matter or change to the
2 staffing plan determined by the committee to
3 ensure that the hospital is staffed to meet the
4 health care needs of patients.
5 (4) A nursing care committee must issue a written
6 report addressing the items described in subparagraphs (A)
7 through (D) of paragraph (3) semi-annually. A written copy
8 of this report shall be made available to direct inpatient
9 care nurses by making available a paper copy of the
10 report, distributing it electronically, or posting it on
11 the hospital's website.
12 (5) A nursing care committee must issue a written
13 report at least annually to the hospital governing board
14 that addresses items including, but not limited to: the
15 items described in paragraph (3); changes made based on
16 committee recommendations and the impact of such changes;
17 and recommendations for future changes related to nurse
18 staffing.
19 (e) Nothing in this Section 10.10 shall be construed to
20 limit, alter, or modify any of the terms, conditions, or
21 provisions of a collective bargaining agreement entered into
22 by the hospital.
23 (f) No hospital may discipline, discharge, or take any
24 other adverse employment action against an employee solely
25 because the employee expresses a concern or complaint
26 regarding an alleged violation of this Section or concerns
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1 related to nurse staffing.
2 (g) Any employee of a hospital may file a complaint with
3 the Department regarding an alleged violation of this Section.
4 The Department must forward notification of the alleged
5 violation to the hospital in question within 10 business days
6 after the complaint is filed. Upon receiving a complaint of a
7 violation of this Section, the Department may take any action
8 authorized under Sections 7 or 9 of this Act.
9 (h) Delegation of nursing interventions by a registered
10 professional nurse must be in accordance with the Nurse
11 Practice Act.
12 (i) A hospital shall not mandate that a registered
13 professional nurse delegate any element of the nursing
14 process, including, but not limited to, nursing interventions,
15 medication administration, nursing judgment, comprehensive
16 patient assessment, development of the plan of care, or
17 evaluation of care. A delegation of a nursing intervention by
18 a registered professional nurse shall not be delegated again
19 to another person.
20 (j) The Department shall establish procedures to ensure
21 that the documentation submitted under this Section is
22 available for public inspection in its entirety.
23 (k) Nothing in this Section shall be construed to limit,
24 alter, or modify the requirements of the Safe Patient Limits
25 Act.
26 (Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
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1 102-813, eff. 5-13-22.)
2 Section 115. The Nurse Practice Act is amended by adding
3 Section 50-15.15 as follows:
4 (225 ILCS 65/50-15.15 new)
5 Sec. 50-15.15. Nursing judgment.
6 (a) The General Assembly finds that:
7 (1) Performance of the scope of practice of a direct
8 care registered professional nurse requires the exercise
9 of nursing judgment in the exclusive interests of the
10 patient.
11 (2) The exercise of nursing judgment, unencumbered by
12 the commercial or revenue-generation priorities of a
13 hospital, long-term acute care hospital, ambulatory
14 surgical treatment center, or other employing entity of a
15 direct care registered professional nurse is necessary to
16 ensure safe, therapeutic, effective, and competent
17 treatment of patients and is essential to protect the
18 health and safety of the people of Illinois.
19 (b) The exercise of nursing judgment by a direct care
20 registered professional nurse in the performance of the scope
21 of practice of the registered professional nurse under Section
22 60-35 or the scope of practice of the advanced practice
23 registered nurse under Section 65-30 shall be provided in the
24 exclusive interests of the patient and shall not, for any
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1 purpose, be considered, relied upon, or represented as a job
2 function, authority, responsibility, or activity undertaken in
3 any respect for the purpose of serving the business,
4 commercial, operational, or other institutional interests of
5 the employer.
6 (c) A hospital, long-term acute care hospital, ambulatory
7 surgical treatment center, or other health care facility shall
8 not adopt a policy that:
9 (1) limits a direct care registered professional nurse
10 in performing duties that are part of the nursing process,
11 including, but not limited to, full exercise of nursing
12 judgment in assessing, planning, implementing, and
13 evaluating care;
14 (2) substitutes recommendations, decisions, or outputs
15 of health information technology, algorithms used to
16 achieve a medical or nursing care objective at a facility,
17 systems based on artificial intelligence or machine
18 learning, or clinical practice guidelines for the
19 independent nursing judgment of a direct care registered
20 professional nurse or penalize a direct care registered
21 professional nurse for overriding the technology or
22 guidelines if, in that registered nurse's judgment, and in
23 accordance with that registered nurse's scope of practice,
24 it is in the best interest of the patient to do so; or
25 (3) limits a direct care registered professional nurse
26 in acting as a patient advocate in the exclusive interests
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1 of the patient.
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