103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2795 Introduced 1/17/2024, by Sen. Michael W. Halpin SYNOPSIS AS INTRODUCED: See Index 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. Ratifies and approves the Nurse Licensure Compact, which allows for the issuance of multistate licenses that allow nurses to practice in their home state and other compact states. Provides that the Compact does not supersede existing State labor laws. Provides that the State may not share with or disclose to the Interstate Commission of Nurse Licensure Compact Administrators or any other state any of the contents of a nationwide criminal history records check conducted for the purpose of multistate licensure under the Nurse Licensure Compact. LRB103 34815 SPS 64670 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2795 Introduced 1/17/2024, by Sen. Michael W. Halpin SYNOPSIS AS INTRODUCED: See Index See Index 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. Ratifies and approves the Nurse Licensure Compact, which allows for the issuance of multistate licenses that allow nurses to practice in their home state and other compact states. Provides that the Compact does not supersede existing State labor laws. Provides that the State may not share with or disclose to the Interstate Commission of Nurse Licensure Compact Administrators or any other state any of the contents of a nationwide criminal history records check conducted for the purpose of multistate licensure under the Nurse Licensure Compact. LRB103 34815 SPS 64670 b LRB103 34815 SPS 64670 b A BILL FOR
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2795 Introduced 1/17/2024, by Sen. Michael W. Halpin SYNOPSIS AS INTRODUCED:
See Index See Index
See Index
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. Ratifies and approves the Nurse Licensure Compact, which allows for the issuance of multistate licenses that allow nurses to practice in their home state and other compact states. Provides that the Compact does not supersede existing State labor laws. Provides that the State may not share with or disclose to the Interstate Commission of Nurse Licensure Compact Administrators or any other state any of the contents of a nationwide criminal history records check conducted for the purpose of multistate licensure under the Nurse Licensure Compact.
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A BILL FOR
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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 SB2795 Introduced 1/17/2024, by Sen. Michael W. Halpin SYNOPSIS AS INTRODUCED:
See Index See Index
See Index
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. Ratifies and approves the Nurse Licensure Compact, which allows for the issuance of multistate licenses that allow nurses to practice in their home state and other compact states. Provides that the Compact does not supersede existing State labor laws. Provides that the State may not share with or disclose to the Interstate Commission of Nurse Licensure Compact Administrators or any other state any of the contents of a nationwide criminal history records check conducted for the purpose of multistate licensure under the Nurse Licensure Compact.
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A BILL FOR
See Index
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1 Surgical Treatment Center Act, a freestanding emergency center
2 licensed under the Emergency Medical Services (EMS) Systems
3 Act, a birth center licensed under the Birth Center Licensing
4 Act, an acute psychiatric hospital, an acute care specialty
5 hospital, 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 (Text of Section before amendment by P.A. 103-211)
7 Sec. 10.10. Nurse staffing by patient acuity.
8 (a) Findings. The Legislature finds and declares all of
9 the following:
10 (1) The State of Illinois has a substantial interest
11 in promoting quality care and improving the delivery of
12 health care services.
13 (2) Evidence-based studies have shown that the basic
14 principles of staffing in the acute care setting should be
15 based on the complexity of patients' care needs aligned
16 with available nursing skills to promote quality patient
17 care consistent with professional nursing standards.
18 (3) Compliance with this Section promotes an
19 organizational climate that values registered nurses'
20 input in meeting the health care needs of hospital
21 patients.
22 (b) Definitions. As used in this Section:
23 "Acuity model" means an assessment tool selected and
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1 implemented by a hospital, as recommended by a nursing care
2 committee, that assesses the complexity of patient care needs
3 requiring professional nursing care and skills and aligns
4 patient care needs and nursing skills consistent with
5 professional nursing standards.
6 "Department" means the Department of Public Health.
7 "Direct patient care" means care provided by a registered
8 professional nurse with direct responsibility to oversee or
9 carry out medical regimens or nursing care for one or more
10 patients.
11 "Nursing care committee" means a hospital-wide committee
12 or committees of nurses whose functions, in part or in whole,
13 contribute to the development, recommendation, and review of
14 the hospital's nurse staffing plan established pursuant to
15 subsection (d).
16 "Registered professional nurse" means a person licensed as
17 a Registered Nurse under the Nurse Practice Act.
18 "Written staffing plan for nursing care services" means a
19 written plan for the assignment of patient care nursing staff
20 based on multiple nurse and patient considerations that yield
21 minimum staffing levels for inpatient care units and the
22 adopted acuity model aligning patient care needs with nursing
23 skills required for quality patient care consistent with
24 professional nursing standards.
25 (c) Written staffing plan.
26 (1) Every hospital shall implement a written
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1 hospital-wide staffing plan, prepared by a nursing care
2 committee or committees, that provides for minimum direct
3 care professional registered nurse-to-patient staffing
4 needs for each inpatient care unit, including inpatient
5 emergency departments. If the staffing plan prepared by
6 the nursing care committee is not adopted by the hospital,
7 or if substantial changes are proposed to it, the chief
8 nursing officer shall either: (i) provide a written
9 explanation to the committee of the reasons the plan was
10 not adopted; or (ii) provide a written explanation of any
11 substantial changes made to the proposed plan prior to it
12 being adopted by the hospital. The written hospital-wide
13 staffing plan shall include, but need not be limited to,
14 the following considerations:
15 (A) The complexity of complete care, assessment on
16 patient admission, volume of patient admissions,
17 discharges and transfers, evaluation of the progress
18 of a patient's problems, ongoing physical assessments,
19 planning for a patient's discharge, assessment after a
20 change in patient condition, and assessment of the
21 need for patient referrals.
22 (B) The complexity of clinical professional
23 nursing judgment needed to design and implement a
24 patient's nursing care plan, the need for specialized
25 equipment and technology, the skill mix of other
26 personnel providing or supporting direct patient care,
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1 and involvement in quality improvement activities,
2 professional preparation, and experience.
3 (C) Patient acuity and the number of patients for
4 whom care is being provided.
5 (D) The ongoing assessments of a unit's patient
6 acuity levels and nursing staff needed shall be
7 routinely made by the unit nurse manager or his or her
8 designee.
9 (E) The identification of additional registered
10 nurses available for direct patient care when
11 patients' unexpected needs exceed the planned workload
12 for direct care staff.
13 (2) In order to provide staffing flexibility to meet
14 patient needs, every hospital shall identify an acuity
15 model for adjusting the staffing plan for each inpatient
16 care unit.
17 (2.5) Each hospital shall implement the staffing plan
18 and assign nursing personnel to each inpatient care unit,
19 including inpatient emergency departments, in accordance
20 with the staffing plan.
21 (A) A registered nurse may report to the nursing
22 care committee any variations where the nurse
23 personnel assignment in an inpatient care unit is not
24 in accordance with the adopted staffing plan and may
25 make a written report to the nursing care committee
26 based on the variations.
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1 (B) Shift-to-shift adjustments in staffing levels
2 required by the staffing plan may be made by the
3 appropriate hospital personnel overseeing inpatient
4 care operations. If a registered nurse in an inpatient
5 care unit objects to a shift-to-shift adjustment, the
6 registered nurse may submit a written report to the
7 nursing care committee.
8 (C) The nursing care committee shall develop a
9 process to examine and respond to written reports
10 submitted under subparagraphs (A) and (B) of this
11 paragraph (2.5), including the ability to determine if
12 a specific written report is resolved or should be
13 dismissed.
14 (3) The written staffing plan shall be posted, either
15 by physical or electronic means, in a conspicuous and
16 accessible location for both patients and direct care
17 staff, as required under the Hospital Report Card Act. A
18 copy of the written staffing plan shall be provided to any
19 member of the general public upon request.
20 (d) Nursing care committee.
21 (1) Every hospital shall have a nursing care committee
22 that meets at least 6 times per year. A hospital shall
23 appoint members of a committee whereby at least 55% of the
24 members are registered professional nurses providing
25 direct inpatient care, one of whom shall be selected
26 annually by the direct inpatient care nurses to serve as
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1 co-chair of the committee.
2 (2) (Blank).
3 (2.5) A nursing care committee shall prepare and
4 recommend to hospital administration the hospital's
5 written hospital-wide staffing plan. If the staffing plan
6 is not adopted by the hospital, the chief nursing officer
7 shall provide a written statement to the committee prior
8 to a staffing plan being adopted by the hospital that: (A)
9 explains the reasons the committee's proposed staffing
10 plan was not adopted; and (B) describes the changes to the
11 committee's proposed staffing or any alternative to the
12 committee's proposed staffing plan.
13 (3) A nursing care committee's or committees' written
14 staffing plan for the hospital shall be based on the
15 principles from the staffing components set forth in
16 subsection (c). In particular, a committee or committees
17 shall provide input and feedback on the following:
18 (A) Selection, implementation, and evaluation of
19 minimum staffing levels for inpatient care units.
20 (B) Selection, implementation, and evaluation of
21 an acuity model to provide staffing flexibility that
22 aligns changing patient acuity with nursing skills
23 required.
24 (C) Selection, implementation, and evaluation of a
25 written staffing plan incorporating the items
26 described in subdivisions (c)(1) and (c)(2) of this
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1 Section.
2 (D) Review the nurse staffing plans for all
3 inpatient areas and current acuity tools and measures
4 in use. The nursing care committee's review shall
5 consider:
6 (i) patient outcomes;
7 (ii) complaints regarding staffing, including
8 complaints about a delay in direct care nursing or
9 an absence of direct care nursing;
10 (iii) the number of hours of nursing care
11 provided through an inpatient hospital unit
12 compared with the number of inpatients served by
13 the hospital unit during a 24-hour period;
14 (iv) the aggregate hours of overtime worked by
15 the nursing staff;
16 (v) the extent to which actual nurse staffing
17 for each hospital inpatient unit differs from the
18 staffing specified by the staffing plan; and
19 (vi) any other matter or change to the
20 staffing plan determined by the committee to
21 ensure that the hospital is staffed to meet the
22 health care needs of patients.
23 (4) A nursing care committee must issue a written
24 report addressing the items described in subparagraphs (A)
25 through (D) of paragraph (3) semi-annually. A written copy
26 of this report shall be made available to direct inpatient
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1 care nurses by making available a paper copy of the
2 report, distributing it electronically, or posting it on
3 the hospital's website.
4 (5) A nursing care committee must issue a written
5 report at least annually to the hospital governing board
6 that addresses items including, but not limited to: the
7 items described in paragraph (3); changes made based on
8 committee recommendations and the impact of such changes;
9 and recommendations for future changes related to nurse
10 staffing.
11 (e) Nothing in this Section 10.10 shall be construed to
12 limit, alter, or modify any of the terms, conditions, or
13 provisions of a collective bargaining agreement entered into
14 by the hospital.
15 (f) No hospital may discipline, discharge, or take any
16 other adverse employment action against an employee solely
17 because the employee expresses a concern or complaint
18 regarding an alleged violation of this Section or concerns
19 related to nurse staffing.
20 (g) Any employee of a hospital may file a complaint with
21 the Department regarding an alleged violation of this Section.
22 The Department must forward notification of the alleged
23 violation to the hospital in question within 10 business days
24 after the complaint is filed. Upon receiving a complaint of a
25 violation of this Section, the Department may take any action
26 authorized under Section Sections 7 or 9 of this Act.
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1 (Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
2 102-813, eff. 5-13-22; revised 9-26-23.)
3 (Text of Section after amendment by P.A. 103-211)
4 Sec. 10.10. Nurse staffing by patient acuity.
5 (a) Findings. The Legislature finds and declares all of
6 the following:
7 (1) The State of Illinois has a substantial interest
8 in promoting quality care and improving the delivery of
9 health care services.
10 (2) Evidence-based studies have shown that the basic
11 principles of staffing in the acute care setting should be
12 based on the complexity of patients' care needs aligned
13 with available nursing skills to promote quality patient
14 care consistent with professional nursing standards.
15 (3) Compliance with this Section promotes an
16 organizational climate that values registered nurses'
17 input in meeting the health care needs of hospital
18 patients.
19 (b) Definitions. As used in this Section:
20 "Acuity model" means an assessment tool selected and
21 implemented by a hospital, as recommended by a nursing care
22 committee, that assesses the complexity of patient care needs
23 requiring professional nursing care and skills and aligns
24 patient care needs and nursing skills consistent with
25 professional nursing standards.
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1 "Department" means the Department of Public Health.
2 "Direct patient care" means care provided in person by a
3 registered professional nurse with direct responsibility to
4 oversee or carry out medical regimens or nursing care for one
5 or more patients.
6 "Nursing care committee" means a hospital-wide committee
7 or committees of nurses whose functions, in part or in whole,
8 contribute to the development, recommendation, and review of
9 the hospital's nurse staffing plan established pursuant to
10 subsection (d).
11 "Registered professional nurse" means a person licensed as
12 a Registered Nurse under the Nurse Practice Act.
13 "Written staffing plan for nursing care services" means a
14 written plan for the assignment of patient care nursing staff
15 based on multiple nurse and patient considerations that
16 ensures the facility meets the maximum patient assignment
17 limits under Section 10 of the Safe Patient Limits Act and the
18 adopted method to adjust the staffing plan for each inpatient
19 care unit when additional staff are needed to fulfill the care
20 needs of each individual patient as determined by the
21 patient's assigned direct care registered professional nurse
22 yield minimum staffing levels for inpatient care units and the
23 adopted acuity model aligning patient care needs with nursing
24 skills required for quality patient care consistent with
25 professional nursing standards.
26 (c) Written staffing plan.
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1 (1) Every hospital shall implement a written
2 hospital-wide staffing plan, prepared by a nursing care
3 committee or committees, that provides for minimum direct
4 care professional registered nurse-to-patient staffing
5 needs for each inpatient care unit and , including
6 inpatient emergency department departments. If the
7 staffing plan prepared by the nursing care committee is
8 not adopted by the hospital, or if substantial changes are
9 proposed to it, the chief nursing officer shall either:
10 (i) provide a written explanation to the committee of the
11 reasons the plan was not adopted; or (ii) provide a
12 written explanation of any substantial changes made to the
13 proposed plan prior to it being adopted by the hospital.
14 The written hospital-wide staffing plan shall include, but
15 need not be limited to, the following considerations:
16 (A) The complexity of complete care, assessment on
17 patient admission, volume of patient admissions,
18 discharges and transfers, evaluation of the progress
19 of a patient's problems, ongoing physical assessments,
20 planning for a patient's discharge, assessment after a
21 change in patient condition, and assessment of the
22 need for patient referrals.
23 (B) The complexity of clinical professional
24 nursing judgment needed to design and implement a
25 patient's nursing care plan, the need for specialized
26 equipment and technology, the skill mix of other
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1 personnel providing or supporting direct patient care,
2 and involvement in quality improvement activities,
3 professional preparation, and experience.
4 (C) Patient acuity and the number of patients for
5 whom care is being provided.
6 (D) The ongoing assessments of a unit's patient
7 acuity levels, as determined by the direct care
8 registered professional nurse responsible for each
9 patient's care, and nursing staff needed shall be
10 routinely made by the unit nurse manager or the unit
11 nurse manager's his or her designee.
12 (E) The identification of additional registered
13 nurses available for direct patient care when
14 patients' unexpected needs exceed the planned workload
15 for direct care staff.
16 (F) Ensuring that patient limits under Section 10
17 of the Safe Patient Limits Act to a registered nurse
18 are not exceeded.
19 (2) In order to provide staffing flexibility to meet
20 patient needs, every hospital shall include in its
21 staffing plan a method to adjust the staffing plan for
22 each inpatient care unit when the maximum patient
23 assignment under Section 10 of the Safe Patient Limits Act
24 should be reduced or additional staff are needed to
25 fulfill the care needs of each individual patient as
26 determined by the patient's assigned direct care
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1 registered professional nurse identify an acuity model for
2 adjusting the staffing plan for each inpatient care unit.
3 (2.5) Each hospital shall implement the staffing plan
4 and assign nursing personnel to each inpatient care unit
5 and emergency department , including inpatient emergency
6 departments, in accordance with the staffing plan.
7 (A) A registered nurse may report to the nursing
8 care committee any variations where the nurse
9 personnel assignment in an inpatient care unit is not
10 in accordance with the adopted staffing plan and may
11 make a written report to the nursing care committee
12 based on the variations.
13 (B) Shift-to-shift adjustments in staffing levels
14 required by the staffing plan may be made by the
15 appropriate hospital personnel overseeing inpatient
16 care operations. If a registered nurse in an inpatient
17 care unit objects to a shift-to-shift adjustment, the
18 registered nurse may submit a written report to the
19 nursing care committee.
20 (C) The nursing care committee shall develop a
21 process to examine and respond to written reports
22 submitted under subparagraphs (A) and (B) of this
23 paragraph (2.5), including the ability to determine if
24 a specific written report is resolved or should be
25 dismissed.
26 (3) The written staffing plan shall be posted, either
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1 by physical or electronic means, in a conspicuous and
2 accessible location for both patients and direct care
3 staff, as required under the Hospital Report Card Act. A
4 copy of the written staffing plan shall be provided to any
5 member of the general public upon request.
6 (4) The written staffing plan shall be updated on an
7 annual basis and submitted to the Department.
8 (5) Any acuity model, or other method, software, or
9 tool used to create or evaluate a staffing plan adopted by
10 a facility, shall be transparent in all respects,
11 including disclosure of detailed documentation of the
12 methodology used to determine nurse staffing and
13 identifying each factor, assumption, and value used in
14 applying the methodology. This documentation shall be
15 submitted to the Department and made available to facility
16 staff, facility staff's collective bargaining
17 representatives, and the public upon request. The patient
18 limits under Section 10 of the Safe Patient Limits Act
19 shall not be exceeded regardless of the use and
20 application of any acuity model.
21 (d) Nursing care committee.
22 (1) Every hospital shall have a nursing care committee
23 that meets at least 6 times per year. A hospital shall
24 appoint members of a committee whereby at least 55% of the
25 members are registered professional nurses providing
26 direct inpatient care, one of whom shall be selected
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1 annually by the direct inpatient care nurses to serve as
2 co-chair of the committee.
3 (2) (Blank).
4 (2.5) A nursing care committee shall prepare and
5 recommend to hospital administration the hospital's
6 written hospital-wide staffing plan. If the staffing plan
7 is not adopted by the hospital, the chief nursing officer
8 shall provide a written statement to the committee prior
9 to a staffing plan being adopted by the hospital that: (A)
10 explains the reasons the committee's proposed staffing
11 plan was not adopted; and (B) describes the changes to the
12 committee's proposed staffing or any alternative to the
13 committee's proposed staffing plan.
14 (3) A nursing care committee's or committees' written
15 staffing plan for the hospital shall be based on the
16 principles from the staffing components set forth in
17 subsection (c). In particular, a committee or committees
18 shall provide input and feedback on the following:
19 (A) Selection, implementation, and evaluation of
20 minimum staffing levels consistent with the maximum
21 patient limits under the Safe Patient Limits Act for
22 inpatient care units.
23 (B) Selection, implementation, and evaluation of a
24 method to increase staffing as needed to meet patient
25 care needs an acuity model to provide staffing
26 flexibility that aligns changing patient acuity with
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1 nursing skills required.
2 (C) Selection, implementation, and evaluation of a
3 written staffing plan incorporating the items
4 described in subdivisions (c)(1) and (c)(2) of this
5 Section.
6 (D) Review the nurse staffing plans for all
7 inpatient areas and current acuity tools and measures
8 in use. The nursing care committee's review shall
9 consider:
10 (i) patient outcomes;
11 (ii) complaints regarding staffing, including
12 complaints about a delay in direct care nursing or
13 an absence of direct care nursing;
14 (iii) the number of hours of nursing care
15 provided through an inpatient hospital unit
16 compared with the number of inpatients served by
17 the hospital unit during a 24-hour period;
18 (iv) the aggregate hours of overtime worked by
19 the nursing staff;
20 (v) the extent to which actual nurse staffing
21 for each hospital inpatient unit differs from the
22 staffing specified by the staffing plan; and
23 (vi) any other matter or change to the
24 staffing plan determined by the committee to
25 ensure that the hospital is staffed to meet the
26 health care needs of patients.
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1 (4) A nursing care committee must issue a written
2 report addressing the items described in subparagraphs (A)
3 through (D) of paragraph (3) semi-annually. A written copy
4 of this report shall be made available to direct inpatient
5 care nurses by making available a paper copy of the
6 report, distributing it electronically, or posting it on
7 the hospital's website.
8 (5) A nursing care committee must issue a written
9 report at least annually to the hospital governing board
10 that addresses items including, but not limited to: the
11 items described in paragraph (3); changes made based on
12 committee recommendations and the impact of such changes;
13 and recommendations for future changes related to nurse
14 staffing.
15 (6) A nursing care committee must annually notify the
16 hospital nursing staff of the staff's rights under this
17 Section. The annual notice must provide a phone number and
18 an email address for staff to report noncompliance with
19 the nursing staff's rights as described in this Section.
20 The notice must be provided by email or by regular mail in
21 a manner that effectively facilitates receipt of the
22 notice. The Department shall monitor and enforce the
23 requirements of this paragraph (6).
24 (e) Nothing in this Section 10.10 shall be construed to
25 limit, alter, or modify any of the terms, conditions, or
26 provisions of a collective bargaining agreement entered into
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1 by the hospital.
2 (f) No hospital may discipline, discharge, or take any
3 other adverse employment action against an employee solely
4 because the employee expresses a concern or complaint
5 regarding an alleged violation of this Section or concerns
6 related to nurse staffing.
7 (g) Any employee of a hospital may file a complaint with
8 the Department regarding an alleged violation of this Section.
9 The Department must forward notification of the alleged
10 violation to the hospital in question within 10 business days
11 after the complaint is filed. Upon receiving a complaint of a
12 violation of this Section, the Department may take any action
13 authorized under Section Sections 7 or 9 of this Act.
14 (h) Delegation of nursing interventions by a registered
15 professional nurse must be in accordance with the Nurse
16 Practice Act.
17 (i) A hospital shall not mandate that a registered
18 professional nurse delegate any element of the nursing
19 process, including, but not limited to, nursing interventions,
20 medication administration, nursing judgment, comprehensive
21 patient assessment, development of the plan of care, or
22 evaluation of care. A delegation of a nursing intervention by
23 a registered professional nurse shall not be delegated again
24 to another person.
25 (j) The Department shall establish procedures to ensure
26 that the documentation submitted under this Section is
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1 available for public inspection in its entirety.
2 (k) Nothing in this Section shall be construed to limit,
3 alter, or modify the requirements of the Safe Patient Limits
4 Act.
5 (Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
6 102-813, eff. 5-13-22; 103-211, eff. 1-1-24; revised 9-26-23.)
7 Section 115. The Nurse Practice Act is amended by adding
8 Section 50-15.15 and Article 85 as follows:
9 (225 ILCS 65/50-15.15 new)
10 Sec. 50-15.15. Nursing judgment.
11 (a) The General Assembly finds that:
12 (1) Performance of the scope of practice of a direct
13 care registered professional nurse requires the exercise
14 of nursing judgment in the exclusive interests of the
15 patient.
16 (2) The exercise of nursing judgment, unencumbered by
17 the commercial or revenue-generation priorities of a
18 hospital, long-term acute care hospital, ambulatory
19 surgical treatment center, or other employing entity of a
20 direct care registered professional nurse is necessary to
21 ensure safe, therapeutic, effective, and competent
22 treatment of patients and is essential to protect the
23 health and safety of the people of Illinois.
24 (b) The exercise of nursing judgment by a direct care
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1 registered professional nurse in the performance of the scope
2 of practice of the registered professional nurse under Section
3 60-35 or the scope of practice of the advanced practice
4 registered nurse under Section 65-30 shall be provided in the
5 exclusive interests of the patient and shall not, for any
6 purpose, be considered, relied upon, or represented as a job
7 function, authority, responsibility, or activity undertaken in
8 any respect for the purpose of serving the business,
9 commercial, operational, or other institutional interests of
10 the employer.
11 (c) A hospital, long-term acute care hospital, ambulatory
12 surgical treatment center, or other health care facility shall
13 not adopt a policy that:
14 (1) limits a direct care registered professional nurse
15 in performing duties that are part of the nursing process,
16 including, but not limited to, full exercise of nursing
17 judgment in assessing, planning, implementing, and
18 evaluating care;
19 (2) substitutes recommendations, decisions, or outputs
20 of health information technology, algorithms used to
21 achieve a medical or nursing care objective at a facility,
22 systems based on artificial intelligence or machine
23 learning, or clinical practice guidelines for the
24 independent nursing judgment of a direct care registered
25 professional nurse or penalize a direct care registered
26 professional nurse for overriding the technology or
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1 guidelines if, in that registered nurse's judgment, and in
2 accordance with that registered nurse's scope of practice,
3 it is in the best interest of the patient to do so; or
4 (3) limits a direct care registered professional nurse
5 in acting as a patient advocate in the exclusive interests
6 of the patient.
7 (225 ILCS 65/Art. 85 heading new)
8 ARTICLE 85. NURSE LICENSURE COMPACT
9 (225 ILCS 65/85-5 new)
10 Sec. 85-5. Nurse Licensure Compact. The State of Illinois
11 ratifies and approves the following Compact:
12 ARTICLE I
13 Findings and Declaration of Purpose
14 a. The party states find that:
15 1. The health and safety of the public are affected by
16 the degree of compliance with and the effectiveness of
17 enforcement activities related to state nurse licensure
18 laws;
19 2. Violations of nurse licensure and other laws
20 regulating the practice of nursing may result in injury or
21 harm to the public;
22 3. The expanded mobility of nurses and the use of
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1 advanced communication technologies as part of our
2 nation's health care delivery system require greater
3 coordination and cooperation among states in the areas of
4 nurse licensure and regulation;
5 4. New practice modalities and technology make
6 compliance with individual state nurse licensure laws
7 difficult and complex;
8 5. The current system of duplicative licensure for
9 nurses practicing in multiple states is cumbersome and
10 redundant for both nurses and states; and
11 6. Uniformity of nurse licensure requirements
12 throughout the states promotes public safety and public
13 health benefits.
14 b. The general purposes of this Compact are to:
15 1. Facilitate the states' responsibility to protect
16 the public's health and safety;
17 2. Ensure and encourage the cooperation of party
18 states in the areas of nurse licensure and regulation;
19 3. Facilitate the exchange of information between
20 party states in the areas of nurse regulation,
21 investigation and adverse actions;
22 4. Promote compliance with the laws governing the
23 practice of nursing in each jurisdiction;
24 5. Invest all party states with the authority to hold
25 a nurse accountable for meeting all state practice laws in
26 the state in which the patient is located at the time care
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1 is rendered through the mutual recognition of party state
2 licenses;
3 6. Decrease redundancies in the consideration and
4 issuance of nurse licenses; and
5 7. Provide opportunities for interstate practice by
6 nurses who meet uniform licensure requirements.
7 ARTICLE II
8 Definitions
9 As used in this Compact:
10 a. "Adverse action" means any administrative, civil,
11 equitable or criminal action permitted by a state's laws
12 which is imposed by a licensing board or other authority
13 against a nurse, including actions against an individual's
14 license or multistate licensure privilege such as
15 revocation, suspension, probation, monitoring of the
16 licensee, limitation on the licensee's practice, or any
17 other encumbrance on licensure affecting a nurse's
18 authorization to practice, including issuance of a cease
19 and desist action.
20 b. "Alternative program" means a non-disciplinary
21 monitoring program approved by a licensing board.
22 c. "Coordinated licensure information system" means an
23 integrated process for collecting, storing and sharing
24 information on nurse licensure and enforcement activities
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1 related to nurse licensure laws that is administered by a
2 nonprofit organization composed of and controlled by
3 licensing boards.
4 d. "Current significant investigative information"
5 means:
6 1. Investigative information that a licensing
7 board, after a preliminary inquiry that includes
8 notification and an opportunity for the nurse to
9 respond, if required by state law, has reason to
10 believe is not groundless and, if proved true, would
11 indicate more than a minor infraction; or
12 2. Investigative information that indicates that
13 the nurse represents an immediate threat to public
14 health and safety regardless of whether the nurse has
15 been notified and had an opportunity to respond.
16 e. "Encumbrance" means a revocation or suspension of,
17 or any limitation on, the full and unrestricted practice
18 of nursing imposed by a licensing board.
19 f. "Home state" means the party state which is the
20 nurse's primary state of residence.
21 g. "Licensing board" means a party state's regulatory
22 body responsible for issuing nurse licenses.
23 h. "Multistate license" means a license to practice as
24 a registered or a licensed practical/vocational nurse
25 (LPN/VN) issued by a home state licensing board that
26 authorizes the licensed nurse to practice in all party
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1 states under a multistate licensure privilege.
2 i. "Multistate licensure privilege" means a legal
3 authorization associated with a multistate license
4 permitting the practice of nursing as either a registered
5 nurse (RN) or LPN/VN in a remote state.
6 j. "Nurse" means RN or LPN/VN, as those terms are
7 defined by each party state's practice laws.
8 k. "Party state" means any state that has adopted this
9 Compact.
10 l. "Remote state" means a party state, other than the
11 home state.
12 m. "Single-state license" means a nurse license issued
13 by a party state that authorizes practice only within the
14 issuing state and does not include a multistate licensure
15 privilege to practice in any other party state.
16 n. "State" means a state, territory or possession of
17 the United States and the District of Columbia.
18 o. "State practice laws" means a party state's laws,
19 rules and regulations that govern the practice of nursing,
20 define the scope of nursing practice, and create the
21 methods and grounds for imposing discipline. "State
22 practice laws" do not include requirements necessary to
23 obtain and retain a license, except for qualifications or
24 requirements of the home state.
25 ARTICLE III
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1 General Provisions and Jurisdiction
2 a. A multistate license to practice registered or licensed
3 practical/vocational nursing issued by a home state to a
4 resident in that state will be recognized by each party state
5 as authorizing a nurse to practice as a registered nurse (RN)
6 or as a licensed practical/vocational nurse (LPN/VN), under a
7 multistate licensure privilege, in each party state.
8 b. A state must implement procedures for considering the
9 criminal history records of applicants for initial multistate
10 license or licensure by endorsement. Such procedures shall
11 include the submission of fingerprints or other
12 biometric-based information by applicants for the purpose of
13 obtaining an applicant's criminal history record information
14 from the Federal Bureau of Investigation and the agency
15 responsible for retaining that state's criminal records.
16 c. Each party state shall require the following for an
17 applicant to obtain or retain a multistate license in the home
18 state:
19 1. Meets the home state's qualifications for licensure
20 or renewal of licensure, as well as, all other applicable
21 state laws;
22 2. i. Has graduated or is eligible to graduate from a
23 licensing board-approved RN or LPN/VN prelicensure
24 education program; or
25 ii. Has graduated from a foreign RN or LPN/VN
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1 prelicensure education program that (a) has been approved
2 by the authorized accrediting body in the applicable
3 country and (b) has been verified by an independent
4 credentials review agency to be comparable to a licensing
5 board-approved prelicensure education program;
6 3. Has, if a graduate of a foreign prelicensure
7 education program not taught in English or if English is
8 not the individual's native language, successfully passed
9 an English proficiency examination that includes the
10 components of reading, speaking, writing and listening;
11 4. Has successfully passed an NCLEX-RN or NCLEX-PN
12 Examination or recognized predecessor, as applicable;
13 5. Is eligible for or holds an active, unencumbered
14 license;
15 6. Has submitted, in connection with an application
16 for initial licensure or licensure by endorsement,
17 fingerprints or other biometric data for the purpose of
18 obtaining criminal history record information from the
19 Federal Bureau of Investigation and the agency responsible
20 for retaining that state's criminal records;
21 7. Has not been convicted or found guilty, or has
22 entered into an agreed disposition, of a felony offense
23 under applicable state or federal criminal law;
24 8. Has not been convicted or found guilty, or has
25 entered into an agreed disposition, of a misdemeanor
26 offense related to the practice of nursing as determined
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1 on a case-by-case basis;
2 9. Is not currently enrolled in an alternative
3 program;
4 10. Is subject to self-disclosure requirements
5 regarding current participation in an alternative program;
6 and
7 11. Has a valid United States Social Security number.
8 d. All party states shall be authorized, in accordance
9 with existing state due process law, to take adverse action
10 against a nurse's multistate licensure privilege such as
11 revocation, suspension, probation or any other action that
12 affects a nurse's authorization to practice under a multistate
13 licensure privilege, including cease and desist actions. If a
14 party state takes such action, it shall promptly notify the
15 administrator of the coordinated licensure information system.
16 The administrator of the coordinated licensure information
17 system shall promptly notify the home state of any such
18 actions by remote states.
19 e. A nurse practicing in a party state must comply with the
20 state practice laws of the state in which the client is located
21 at the time service is provided. The practice of nursing is not
22 limited to patient care, but shall include all nursing
23 practice as defined by the state practice laws of the party
24 state in which the client is located. The practice of nursing
25 in a party state under a multistate licensure privilege will
26 subject a nurse to the jurisdiction of the licensing board,
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1 the courts and the laws of the party state in which the client
2 is located at the time service is provided.
3 f. Individuals not residing in a party state shall
4 continue to be able to apply for a party state's single-state
5 license as provided under the laws of each party state.
6 However, the single-state license granted to these individuals
7 will not be recognized as granting the privilege to practice
8 nursing in any other party state. Nothing in this Compact
9 shall affect the requirements established by a party state for
10 the issuance of a single-state license.
11 g. Any nurse holding a home state multistate license, on
12 the effective date of this Compact, may retain and renew the
13 multistate license issued by the nurse's then-current home
14 state, provided that:
15 1. A nurse, who changes primary state of residence
16 after this Compact's effective date, must meet all
17 applicable Article III.c. requirements to obtain a
18 multistate license from a new home state.
19 2. A nurse who fails to satisfy the multistate
20 licensure requirements in Article III.c. due to a
21 disqualifying event occurring after this Compact's
22 effective date shall be ineligible to retain or renew a
23 multistate license, and the nurse's multistate license
24 shall be revoked or deactivated in accordance with
25 applicable rules adopted by the Interstate Commission of
26 Nurse Licensure Compact Administrators ("Commission").
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1 ARTICLE IV
2 Applications for Licensure in a Party State
3 a. Upon application for a multistate license, the
4 licensing board in the issuing party state shall ascertain,
5 through the coordinated licensure information system, whether
6 the applicant has ever held, or is the holder of, a license
7 issued by any other state, whether there are any encumbrances
8 on any license or multistate licensure privilege held by the
9 applicant, whether any adverse action has been taken against
10 any license or multistate licensure privilege held by the
11 applicant and whether the applicant is currently participating
12 in an alternative program.
13 b. A nurse may hold a multistate license, issued by the
14 home state, in only one party state at a time.
15 c. If a nurse changes primary state of residence by moving
16 between two party states, the nurse must apply for licensure
17 in the new home state, and the multistate license issued by the
18 prior home state will be deactivated in accordance with
19 applicable rules adopted by the Commission.
20 1. The nurse may apply for licensure in advance of a
21 change in primary state of residence.
22 2. A multistate license shall not be issued by the new
23 home state until the nurse provides satisfactory evidence
24 of a change in primary state of residence to the new home
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1 state and satisfies all applicable requirements to obtain
2 a multistate license from the new home state.
3 d. If a nurse changes primary state of residence by moving
4 from a party state to a non-party state, the multistate
5 license issued by the prior home state will convert to a
6 single-state license, valid only in the former home state.
7 ARTICLE V
8 Additional Authorities Invested in Party State Licensing
9 Boards
10 a. In addition to the other powers conferred by state law,
11 a licensing board shall have the authority to:
12 1. Take adverse action against a nurse's multistate
13 licensure privilege to practice within that party state.
14 i. Only the home state shall have the power to take
15 adverse action against a nurse's license issued by the
16 home state.
17 ii. For purposes of taking adverse action, the
18 home state licensing board shall give the same
19 priority and effect to reported conduct received from
20 a remote state as it would if such conduct had occurred
21 within the home state. In so doing, the home state
22 shall apply its own state laws to determine
23 appropriate action.
24 2. Issue cease and desist orders or impose an
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1 encumbrance on a nurse's authority to practice within that
2 party state.
3 3. Complete any pending investigations of a nurse who
4 changes primary state of residence during the course of
5 such investigations. The licensing board shall also have
6 the authority to take appropriate action(s) and shall
7 promptly report the conclusions of such investigations to
8 the administrator of the coordinated licensure information
9 system. The administrator of the coordinated licensure
10 information system shall promptly notify the new home
11 state of any such actions.
12 4. Issue subpoenas for both hearings and
13 investigations that require the attendance and testimony
14 of witnesses, as well as, the production of evidence.
15 Subpoenas issued by a licensing board in a party state for
16 the attendance and testimony of witnesses or the
17 production of evidence from another party state shall be
18 enforced in the latter state by any court of competent
19 jurisdiction, according to the practice and procedure of
20 that court applicable to subpoenas issued in proceedings
21 pending before it. The issuing authority shall pay any
22 witness fees, travel expenses, mileage and other fees
23 required by the service statutes of the state in which the
24 witnesses or evidence are located.
25 5. Obtain and submit, for each nurse licensure
26 applicant, fingerprint or other biometric-based
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1 information to the Federal Bureau of Investigation for
2 criminal background checks, receive the results of the
3 Federal Bureau of Investigation record search on criminal
4 background checks and use the results in making licensure
5 decisions.
6 6. If otherwise permitted by state law, recover from
7 the affected nurse the costs of investigations and
8 disposition of cases resulting from any adverse action
9 taken against that nurse.
10 7. Take adverse action based on the factual findings
11 of the remote state, provided that the licensing board
12 follows its own procedures for taking such adverse action.
13 b. If adverse action is taken by the home state against a
14 nurse's multistate license, the nurse's multistate licensure
15 privilege to practice in all other party states shall be
16 deactivated until all encumbrances have been removed from the
17 multistate license. All home state disciplinary orders that
18 impose adverse action against a nurse's multistate license
19 shall include a statement that the nurse's multistate
20 licensure privilege is deactivated in all party states during
21 the pendency of the order.
22 c. Nothing in this Compact shall override a party state's
23 decision that participation in an alternative program may be
24 used in lieu of adverse action. The home state licensing board
25 shall deactivate the multistate licensure privilege under the
26 multistate license of any nurse for the duration of the
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1 nurse's participation in an alternative program.
2 ARTICLE VI
3 Coordinated Licensure Information System and Exchange of
4 Information
5 a. All party states shall participate in a coordinated
6 licensure information system of all licensed registered nurses
7 (RNs) and licensed practical/vocational nurses (LPNs/VNs).
8 This system will include information on the licensure and
9 disciplinary history of each nurse, as submitted by party
10 states, to assist in the coordination of nurse licensure and
11 enforcement efforts.
12 b. The Commission, in consultation with the administrator
13 of the coordinated licensure information system, shall
14 formulate necessary and proper procedures for the
15 identification, collection and exchange of information under
16 this Compact.
17 c. All licensing boards shall promptly report to the
18 coordinated licensure information system any adverse action,
19 any current significant investigative information, denials of
20 applications (with the reasons for such denials) and nurse
21 participation in alternative programs known to the licensing
22 board regardless of whether such participation is deemed
23 nonpublic or confidential under state law.
24 d. Current significant investigative information and
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1 participation in nonpublic or confidential alternative
2 programs shall be transmitted through the coordinated
3 licensure information system only to party state licensing
4 boards.
5 e. Notwithstanding any other provision of law, all party
6 state licensing boards contributing information to the
7 coordinated licensure information system may designate
8 information that may not be shared with non-party states or
9 disclosed to other entities or individuals without the express
10 permission of the contributing state.
11 f. Any personally identifiable information obtained from
12 the coordinated licensure information system by a party state
13 licensing board shall not be shared with non-party states or
14 disclosed to other entities or individuals except to the
15 extent permitted by the laws of the party state contributing
16 the information.
17 g. Any information contributed to the coordinated
18 licensure information system that is subsequently required to
19 be expunged by the laws of the party state contributing that
20 information shall also be expunged from the coordinated
21 licensure information system.
22 h. The Compact administrator of each party state shall
23 furnish a uniform data set to the Compact administrator of
24 each other party state, which shall include, at a minimum:
25 1. Identifying information;
26 2. Licensure data;
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1 3. Information related to alternative program
2 participation; and
3 4. Other information that may facilitate the
4 administration of this Compact, as determined by
5 Commission rules.
6 i. The Compact administrator of a party state shall
7 provide all investigative documents and information requested
8 by another party state.
9 ARTICLE VII
10 Establishment of the Interstate Commission of Nurse Licensure
11 Compact Administrators
12 a. The party states hereby create and establish a joint
13 public entity known as the Interstate Commission of Nurse
14 Licensure Compact Administrators.
15 1. The Commission is an instrumentality of the party
16 states.
17 2. Venue is proper, and judicial proceedings by or
18 against the Commission shall be brought solely and
19 exclusively, in a court of competent jurisdiction where
20 the principal office of the Commission is located. The
21 Commission may waive venue and jurisdictional defenses to
22 the extent it adopts or consents to participate in
23 alternative dispute resolution proceedings.
24 3. Nothing in this Compact shall be construed to be a
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1 waiver of sovereign immunity.
2 b. Membership, Voting and Meetings
3 1. Each party state shall have and be limited to one
4 administrator. The head of the state licensing board or
5 designee shall be the administrator of this Compact for
6 each party state. Any administrator may be removed or
7 suspended from office as provided by the law of the state
8 from which the Administrator is appointed. Any vacancy
9 occurring in the Commission shall be filled in accordance
10 with the laws of the party state in which the vacancy
11 exists.
12 2. Each administrator shall be entitled to one (1)
13 vote with regard to the promulgation of rules and creation
14 of bylaws and shall otherwise have an opportunity to
15 participate in the business and affairs of the Commission.
16 An administrator shall vote in person or by such other
17 means as provided in the bylaws. The bylaws may provide
18 for an administrator's participation in meetings by
19 telephone or other means of communication.
20 3. The Commission shall meet at least once during each
21 calendar year. Additional meetings shall be held as set
22 forth in the bylaws or rules of the commission.
23 4. All meetings shall be open to the public, and
24 public notice of meetings shall be given in the same
25 manner as required under the rulemaking provisions in
26 Article VIII.
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1 5. The Commission may convene in a closed, nonpublic
2 meeting if the Commission must discuss:
3 i. Noncompliance of a party state with its
4 obligations under this Compact;
5 ii. The employment, compensation, discipline or
6 other personnel matters, practices or procedures
7 related to specific employees or other matters related
8 to the Commission's internal personnel practices and
9 procedures;
10 iii. Current, threatened or reasonably anticipated
11 litigation;
12 iv. Negotiation of contracts for the purchase or
13 sale of goods, services or real estate;
14 v. Accusing any person of a crime or formally
15 censuring any person;
16 vi. Disclosure of trade secrets or commercial or
17 financial information that is privileged or
18 confidential;
19 vii. Disclosure of information of a personal
20 nature where disclosure would constitute a clearly
21 unwarranted invasion of personal privacy;
22 viii. Disclosure of investigatory records compiled
23 for law enforcement purposes;
24 ix. Disclosure of information related to any
25 reports prepared by or on behalf of the Commission for
26 the purpose of investigation of compliance with this
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1 Compact; or
2 x. Matters specifically exempted from disclosure
3 by federal or state statute.
4 6. If a meeting, or portion of a meeting, is closed
5 pursuant to this provision, the Commission's legal counsel
6 or designee shall certify that the meeting may be closed
7 and shall reference each relevant exempting provision. The
8 Commission shall keep minutes that fully and clearly
9 describe all matters discussed in a meeting and shall
10 provide a full and accurate summary of actions taken, and
11 the reasons therefor, including a description of the views
12 expressed. All documents considered in connection with an
13 action shall be identified in such minutes. All minutes
14 and documents of a closed meeting shall remain under seal,
15 subject to release by a majority vote of the Commission or
16 order of a court of competent jurisdiction.
17 c. The Commission shall, by a majority vote of the
18 administrators, prescribe bylaws or rules to govern its
19 conduct as may be necessary or appropriate to carry out the
20 purposes and exercise the powers of this Compact, including
21 but not limited to:
22 1. Establishing the fiscal year of the Commission;
23 2. Providing reasonable standards and procedures:
24 i. For the establishment and meetings of other
25 committees; and
26 ii. Governing any general or specific delegation
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1 of any authority or function of the Commission;
2 3. Providing reasonable procedures for calling and
3 conducting meetings of the Commission, ensuring reasonable
4 advance notice of all meetings and providing an
5 opportunity for attendance of such meetings by interested
6 parties, with enumerated exceptions designed to protect
7 the public's interest, the privacy of individuals, and
8 proprietary information, including trade secrets. The
9 Commission may meet in closed session only after a
10 majority of the administrators vote to close a meeting in
11 whole or in part. As soon as practicable, the Commission
12 must make public a copy of the vote to close the meeting
13 revealing the vote of each administrator, with no proxy
14 votes allowed;
15 4. Establishing the titles, duties and authority and
16 reasonable procedures for the election of the officers of
17 the Commission;
18 5. Providing reasonable standards and procedures for
19 the establishment of the personnel policies and programs
20 of the Commission. Notwithstanding any civil service or
21 other similar laws of any party state, the bylaws shall
22 exclusively govern the personnel policies and programs of
23 the Commission; and
24 6. Providing a mechanism for winding up the operations
25 of the Commission and the equitable disposition of any
26 surplus funds that may exist after the termination of this
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1 Compact after the payment or reserving of all of its debts
2 and obligations;
3 d. The Commission shall publish its bylaws and rules, and
4 any amendments thereto, in a convenient form on the website of
5 the Commission.
6 e. The Commission shall maintain its financial records in
7 accordance with the bylaws.
8 f. The Commission shall meet and take such actions as are
9 consistent with the provisions of this Compact and the bylaws.
10 g. The Commission shall have the following powers:
11 1. To promulgate uniform rules to facilitate and
12 coordinate implementation and administration of this
13 Compact. The rules shall have the force and effect of law
14 and shall be binding in all party states;
15 2. To bring and prosecute legal proceedings or actions
16 in the name of the Commission, provided that the standing
17 of any licensing board to sue or be sued under applicable
18 law shall not be affected;
19 3. To purchase and maintain insurance and bonds;
20 4. To borrow, accept or contract for services of
21 personnel, including, but not limited to, employees of a
22 party state or nonprofit organizations;
23 5. To cooperate with other organizations that
24 administer state compacts related to the regulation of
25 nursing, including but not limited to sharing
26 administrative or staff expenses, office space or other
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1 resources;
2 6. To hire employees, elect or appoint officers, fix
3 compensation, define duties, grant such individuals
4 appropriate authority to carry out the purposes of this
5 Compact, and to establish the Commission's personnel
6 policies and programs relating to conflicts of interest,
7 qualifications of personnel and other related personnel
8 matters;
9 7. To accept any and all appropriate donations, grants
10 and gifts of money, equipment, supplies, materials and
11 services, and to receive, utilize and dispose of the same;
12 provided that at all times the Commission shall avoid any
13 appearance of impropriety or conflict of interest;
14 8. To lease, purchase, accept appropriate gifts or
15 donations of, or otherwise to own, hold, improve or use,
16 any property, whether real, personal or mixed; provided
17 that at all times the Commission shall avoid any
18 appearance of impropriety;
19 9. To sell, convey, mortgage, pledge, lease, exchange,
20 abandon or otherwise dispose of any property, whether
21 real, personal or mixed;
22 10. To establish a budget and make expenditures;
23 11. To borrow money;
24 12. To appoint committees, including advisory
25 committees comprised of administrators, state nursing
26 regulators, state legislators or their representatives,
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1 and consumer representatives, and other such interested
2 persons;
3 13. To provide and receive information from, and to
4 cooperate with, law enforcement agencies;
5 14. To adopt and use an official seal; and
6 15. To perform such other functions as may be
7 necessary or appropriate to achieve the purposes of this
8 Compact consistent with the state regulation of nurse
9 licensure and practice.
10 h. Financing of the Commission
11 1. The Commission shall pay, or provide for the
12 payment of, the reasonable expenses of its establishment,
13 organization and ongoing activities.
14 2. The Commission may also levy on and collect an
15 annual assessment from each party state to cover the cost
16 of its operations, activities and staff in its annual
17 budget as approved each year. The aggregate annual
18 assessment amount, if any, shall be allocated based upon a
19 formula to be determined by the Commission, which shall
20 promulgate a rule that is binding upon all party states.
21 3. The Commission shall not incur obligations of any
22 kind prior to securing the funds adequate to meet the
23 same; nor shall the Commission pledge the credit of any of
24 the party states, except by, and with the authority of,
25 such party state.
26 4. The Commission shall keep accurate accounts of all
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1 receipts and disbursements. The receipts and disbursements
2 of the Commission shall be subject to the audit and
3 accounting procedures established under its bylaws.
4 However, all receipts and disbursements of funds handled
5 by the Commission shall be audited yearly by a certified
6 or licensed public accountant, and the report of the audit
7 shall be included in and become part of the annual report
8 of the Commission.
9 i. Qualified Immunity, Defense and Indemnification
10 1. The administrators, officers, executive director,
11 employees and representatives of the Commission shall be
12 immune from suit and liability, either personally or in
13 their official capacity, for any claim for damage to or
14 loss of property or personal injury or other civil
15 liability caused by or arising out of any actual or
16 alleged act, error or omission that occurred, or that the
17 person against whom the claim is made had a reasonable
18 basis for believing occurred, within the scope of
19 Commission employment, duties or responsibilities;
20 provided that nothing in this paragraph shall be construed
21 to protect any such person from suit or liability for any
22 damage, loss, injury or liability caused by the
23 intentional, willful or wanton misconduct of that person.
24 2. The Commission shall defend any administrator,
25 officer, executive director, employee or representative of
26 the Commission in any civil action seeking to impose
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1 liability arising out of any actual or alleged act, error
2 or omission that occurred within the scope of Commission
3 employment, duties or responsibilities, or that the person
4 against whom the claim is made had a reasonable basis for
5 believing occurred within the scope of Commission
6 employment, duties or responsibilities; provided that
7 nothing herein shall be construed to prohibit that person
8 from retaining his or her own counsel; and provided
9 further that the actual or alleged act, error or omission
10 did not result from that person's intentional, willful or
11 wanton misconduct.
12 3. The Commission shall indemnify and hold harmless
13 any administrator, officer, executive director, employee
14 or representative of the Commission for the amount of any
15 settlement or judgment obtained against that person
16 arising out of any actual or alleged act, error or
17 omission that occurred within the scope of Commission
18 employment, duties or responsibilities, or that such
19 person had a reasonable basis for believing occurred
20 within the scope of Commission employment, duties or
21 responsibilities, provided that the actual or alleged act,
22 error or omission did not result from the intentional,
23 willful or wanton misconduct of that person.
24 ARTICLE VIII
25 Rulemaking
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1 a. The Commission shall exercise its rulemaking powers
2 pursuant to the criteria set forth in this Article and the
3 rules adopted thereunder. Rules and amendments shall become
4 binding as of the date specified in each rule or amendment and
5 shall have the same force and effect as provisions of this
6 Compact.
7 b. Rules or amendments to the rules shall be adopted at a
8 regular or special meeting of the Commission.
9 c. Prior to promulgation and adoption of a final rule or
10 rules by the Commission, and at least sixty (60) days in
11 advance of the meeting at which the rule will be considered and
12 voted upon, the Commission shall file a notice of proposed
13 rulemaking:
14 1. On the website of the Commission; and
15 2. On the website of each licensing board or the
16 publication in which each state would otherwise publish
17 proposed rules.
18 d. The notice of proposed rulemaking shall include:
19 1. The proposed time, date and location of the meeting
20 in which the rule will be considered and voted upon;
21 2. The text of the proposed rule or amendment, and the
22 reason for the proposed rule;
23 3. A request for comments on the proposed rule from
24 any interested person; and
25 4. The manner in which interested persons may submit
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1 notice to the Commission of their intention to attend the
2 public hearing and any written comments.
3 e. Prior to adoption of a proposed rule, the Commission
4 shall allow persons to submit written data, facts, opinions
5 and arguments, which shall be made available to the public.
6 f. The Commission shall grant an opportunity for a public
7 hearing before it adopts a rule or amendment.
8 g. The Commission shall publish the place, time and date
9 of the scheduled public hearing.
10 1. Hearings shall be conducted in a manner providing
11 each person who wishes to comment a fair and reasonable
12 opportunity to comment orally or in writing. All hearings
13 will be recorded, and a copy will be made available upon
14 request.
15 2. Nothing in this section shall be construed as
16 requiring a separate hearing on each rule. Rules may be
17 grouped for the convenience of the Commission at hearings
18 required by this section.
19 h. If no one appears at the public hearing, the Commission
20 may proceed with promulgation of the proposed rule.
21 i. Following the scheduled hearing date, or by the close
22 of business on the scheduled hearing date if the hearing was
23 not held, the Commission shall consider all written and oral
24 comments received.
25 j. The Commission shall, by majority vote of all
26 administrators, take final action on the proposed rule and
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1 shall determine the effective date of the rule, if any, based
2 on the rulemaking record and the full text of the rule.
3 k. Upon determination that an emergency exists, the
4 Commission may consider and adopt an emergency rule without
5 prior notice, opportunity for comment or hearing, provided
6 that the usual rulemaking procedures provided in this Compact
7 and in this section shall be retroactively applied to the rule
8 as soon as reasonably possible, in no event later than ninety
9 (90) days after the effective date of the rule. For the
10 purposes of this provision, an emergency rule is one that must
11 be adopted immediately in order to:
12 1. Meet an imminent threat to public health, safety or
13 welfare;
14 2. Prevent a loss of Commission or party state funds;
15 or
16 3. Meet a deadline for the promulgation of an
17 administrative rule that is required by federal law or
18 rule.
19 l. The Commission may direct revisions to a previously
20 adopted rule or amendment for purposes of correcting
21 typographical errors, errors in format, errors in consistency
22 or grammatical errors. Public notice of any revisions shall be
23 posted on the website of the Commission. The revision shall be
24 subject to challenge by any person for a period of thirty (30)
25 days after posting. The revision may be challenged only on
26 grounds that the revision results in a material change to a
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1 rule. A challenge shall be made in writing, and delivered to
2 the Commission, prior to the end of the notice period. If no
3 challenge is made, the revision will take effect without
4 further action. If the revision is challenged, the revision
5 may not take effect without the approval of the Commission.
6 ARTICLE IX
7 Oversight, Dispute Resolution and Enforcement
8 a. Oversight
9 1. Each party state shall enforce this Compact and
10 take all actions necessary and appropriate to effectuate
11 this Compact's purposes and intent.
12 2. The Commission shall be entitled to receive service
13 of process in any proceeding that may affect the powers,
14 responsibilities or actions of the Commission, and shall
15 have standing to intervene in such a proceeding for all
16 purposes. Failure to provide service of process in such
17 proceeding to the Commission shall render a judgment or
18 order void as to the Commission, this Compact or
19 promulgated rules.
20 b. Default, Technical Assistance and Termination
21 1. If the Commission determines that a party state has
22 defaulted in the performance of its obligations or
23 responsibilities under this Compact or the promulgated
24 rules, the Commission shall:
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1 i. Provide written notice to the defaulting state
2 and other party states of the nature of the default,
3 the proposed means of curing the default or any other
4 action to be taken by the Commission; and
5 ii. Provide remedial training and specific
6 technical assistance regarding the default.
7 2. If a state in default fails to cure the default, the
8 defaulting state's membership in this Compact may be
9 terminated upon an affirmative vote of a majority of the
10 administrators, and all rights, privileges and benefits
11 conferred by this Compact may be terminated on the
12 effective date of termination. A cure of the default does
13 not relieve the offending state of obligations or
14 liabilities incurred during the period of default.
15 3. Termination of membership in this Compact shall be
16 imposed only after all other means of securing compliance
17 have been exhausted. Notice of intent to suspend or
18 terminate shall be given by the Commission to the governor
19 of the defaulting state and to the executive officer of
20 the defaulting state's licensing board and each of the
21 party states.
22 4. A state whose membership in this Compact has been
23 terminated is responsible for all assessments, obligations
24 and liabilities incurred through the effective date of
25 termination, including obligations that extend beyond the
26 effective date of termination.
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1 5. The Commission shall not bear any costs related to
2 a state that is found to be in default or whose membership
3 in this Compact has been terminated unless agreed upon in
4 writing between the Commission and the defaulting state.
5 6. The defaulting state may appeal the action of the
6 Commission by petitioning the U.S. District Court for the
7 District of Columbia or the federal district in which the
8 Commission has its principal offices. The prevailing party
9 shall be awarded all costs of such litigation, including
10 reasonable attorneys' fees.
11 c. Dispute Resolution
12 1. Upon request by a party state, the Commission shall
13 attempt to resolve disputes related to the Compact that
14 arise among party states and between party and non-party
15 states.
16 2. The Commission shall promulgate a rule providing
17 for both mediation and binding dispute resolution for
18 disputes, as appropriate.
19 3. In the event the Commission cannot resolve disputes
20 among party states arising under this Compact:
21 i. The party states may submit the issues in
22 dispute to an arbitration panel, which will be
23 comprised of individuals appointed by the Compact
24 administrator in each of the affected party states and
25 an individual mutually agreed upon by the Compact
26 administrators of all the party states involved in the
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1 dispute.
2 ii. The decision of a majority of the arbitrators
3 shall be final and binding.
4 d. Enforcement
5 1. The Commission, in the reasonable exercise of its
6 discretion, shall enforce the provisions and rules of this
7 Compact.
8 2. By majority vote, the Commission may initiate legal
9 action in the U.S. District Court for the District of
10 Columbia or the federal district in which the Commission
11 has its principal offices against a party state that is in
12 default to enforce compliance with the provisions of this
13 Compact and its promulgated rules and bylaws. The relief
14 sought may include both injunctive relief and damages. In
15 the event judicial enforcement is necessary, the
16 prevailing party shall be awarded all costs of such
17 litigation, including reasonable attorneys' fees.
18 3. The remedies herein shall not be the exclusive
19 remedies of the Commission. The Commission may pursue any
20 other remedies available under federal or state law.
21 ARTICLE X
22 Effective Date, Withdrawal and Amendment
23 a. This Compact shall become effective and binding on the
24 earlier of the date of legislative enactment of this Compact
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1 into law by no less than twenty-six (26) states or December 31,
2 2018. All party states to this Compact, that also were parties
3 to the prior Nurse Licensure Compact, superseded by this
4 Compact, ("Prior Compact"), shall be deemed to have withdrawn
5 from said Prior Compact within six (6) months after the
6 effective date of this Compact.
7 b. Each party state to this Compact shall continue to
8 recognize a nurse's multistate licensure privilege to practice
9 in that party state issued under the Prior Compact until such
10 party state has withdrawn from the Prior Compact.
11 c. Any party state may withdraw from this Compact by
12 enacting a statute repealing the same. A party state's
13 withdrawal shall not take effect until six (6) months after
14 enactment of the repealing statute.
15 d. A party state's withdrawal or termination shall not
16 affect the continuing requirement of the withdrawing or
17 terminated state's licensing board to report adverse actions
18 and significant investigations occurring prior to the
19 effective date of such withdrawal or termination.
20 e. Nothing contained in this Compact shall be construed to
21 invalidate or prevent any nurse licensure agreement or other
22 cooperative arrangement between a party state and a non-party
23 state that is made in accordance with the other provisions of
24 this Compact.
25 f. This Compact may be amended by the party states. No
26 amendment to this Compact shall become effective and binding
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1 upon the party states unless and until it is enacted into the
2 laws of all party states.
3 g. Representatives of non-party states to this Compact
4 shall be invited to participate in the activities of the
5 Commission, on a nonvoting basis, prior to the adoption of
6 this Compact by all states.
7 ARTICLE XI
8 Construction and Severability
9 This Compact shall be liberally construed so as to effectuate
10 the purposes thereof. The provisions of this Compact shall be
11 severable, and if any phrase, clause, sentence or provision of
12 this Compact is declared to be contrary to the constitution of
13 any party state or of the United States, or if the
14 applicability thereof to any government, agency, person or
15 circumstance is held invalid, the validity of the remainder of
16 this Compact and the applicability thereof to any government,
17 agency, person or circumstance shall not be affected thereby.
18 If this Compact shall be held to be contrary to the
19 constitution of any party state, this Compact shall remain in
20 full force and effect as to the remaining party states and in
21 full force and effect as to the party state affected as to all
22 severable matters.
23 (225 ILCS 65/85-10 new)
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1 Sec. 85-10. State labor laws. The Nurse Licensure Compact
2 does not supersede existing State labor laws.
3 (225 ILCS 65/85-15 new)
4 Sec. 85-15. Criminal history record checks. The State may
5 not share with or disclose to the Interstate Commission of
6 Nurse Licensure Compact Administrators or any other state any
7 of the contents of a nationwide criminal history records check
8 conducted for the purpose of multistate licensure under the
9 Nurse Licensure Compact.
10 Section 995. No acceleration or delay. Where this Act
11 makes changes in a statute that is represented in this Act by
12 text that is not yet or no longer in effect (for example, a
13 Section represented by multiple versions), the use of that
14 text does not accelerate or delay the taking effect of (i) the
15 changes made by this Act or (ii) provisions derived from any
16 other Public Act.
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1 INDEX
2 Statutes amended in order of appearance
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1 INDEX
2 Statutes amended in order of appearance
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