Illinois 2025-2026 Regular Session

Illinois Senate Bill SB2022 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2022 Introduced 2/6/2025, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED: New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 new Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient. LRB104 09478 BAB 19539 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2022 Introduced 2/6/2025, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED: New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 new New Act 210 ILCS 85/10.10 225 ILCS 65/50-15.15 new Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient. LRB104 09478 BAB 19539 b LRB104 09478 BAB 19539 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2022 Introduced 2/6/2025, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED:
3	3	New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 new New Act 210 ILCS 85/10.10 225 ILCS 65/50-15.15 new
4	4	New Act
5	5	210 ILCS 85/10.10
6	6	225 ILCS 65/50-15.15 new
7	7	Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient.
8	8	LRB104 09478 BAB 19539 b LRB104 09478 BAB 19539 b
9	9	LRB104 09478 BAB 19539 b
10	10	A BILL FOR
11	11	SB2022LRB104 09478 BAB 19539 b SB2022 LRB104 09478 BAB 19539 b
12	12	SB2022 LRB104 09478 BAB 19539 b
13	13	1 AN ACT concerning health.
14	14	2 Be it enacted by the People of the State of Illinois,
15	15	3 represented in the General Assembly:
16	16	4 Section 1. Short title. This Act may be cited as the Safe
17	17	5 Patient Limits Act.
18	18	6 Section 5. Definitions. In this Act:
19	19	7 "Couplet" means one postpartum patient and one baby.
20	20	8 "Critical trauma patient" means a patient who has an
21	21	9 injury to an anatomic area that (i) requires life-saving
22	22	10 interventions or (ii) in conjunction with unstable vital
23	23	11 signs, poses an immediate threat to life or limb.
24	24	12 "Department" means the Department of Public Health.
25	25	13 "Direct care registered professional nurse" means a
26	26	14 registered professional nurse who has accepted a hands-on,
27	27	15 in-person patient care assignment and whose primary role is to
28	28	16 provide hands-on, in-person patient care.
29	29	17 "Facility" means a hospital licensed under the Hospital
30	30	18 Licensing Act or organized under the University of Illinois
31	31	19 Hospital Act, a private or State-owned and State-operated
32	32	20 general acute care hospital, an LTAC hospital as defined in
33	33	21 Section 10 of the Long Term Acute Care Hospital Quality
34	34	22 Improvement Transfer Program Act, an ambulatory surgical
35	35	23 treatment center as defined in Section 3 of the Ambulatory
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39	39	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2022 Introduced 2/6/2025, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED:
40	40	New Act210 ILCS 85/10.10225 ILCS 65/50-15.15 new New Act 210 ILCS 85/10.10 225 ILCS 65/50-15.15 new
41	41	New Act
42	42	210 ILCS 85/10.10
43	43	225 ILCS 65/50-15.15 new
44	44	Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient.
45	45	LRB104 09478 BAB 19539 b LRB104 09478 BAB 19539 b
46	46	LRB104 09478 BAB 19539 b
47	47	A BILL FOR
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53	53	New Act
54	54	210 ILCS 85/10.10
55	55	225 ILCS 65/50-15.15 new
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74	74	1 Surgical Treatment Center Act, a freestanding emergency center
75	75	2 licensed under the Emergency Medical Services (EMS) Systems
76	76	3 Act, a birth center licensed under the Birth Center Licensing
77	77	4 Act, an acute psychiatric hospital, an acute care specialty
78	78	5 hospital, or an acute care unit within a health care facility.
79	79	6 "Facility" does not include:
80	80	7 (1) the Alton Mental Health Center, at Alton;
81	81	8 (2) the Chicago-Read Mental Health Center, at Chicago;
82	82	9 (3) the Clyde L. Choate Mental Health and
83	83	10 Developmental Center, at Anna;
84	84	11 (4) the Elgin Mental Health Center, at Elgin;
85	85	12 (5) the John J. Madden Mental Health Center, at
86	86	13 Chicago;
87	87	14 (6) the Elizabeth Parsons Ware Packard Mental Health
88	88	15 Center, at Springfield; and
89	89	16 (7) the Chester Mental Health Center, at Chester.
90	90	17 "Health care emergency" means an emergency that is
91	91	18 declared by an authorized person within federal, State, or
92	92	19 local government and is related to circumstances that are
93	93	20 unpredictable and unavoidable, affect the delivery of medical
94	94	21 care, and require an immediate or exceptional level of
95	95	22 emergency or other medical services at the specific facility.
96	96	23 "Health care emergency" does not include a state of emergency
97	97	24 that results from a labor dispute in the health care industry
98	98	25 or consistent understaffing.
99	99	26 "Health care workforce" means personnel employed by or
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110	110	1 contracted to work at a facility that have an effect upon the
111	111	2 delivery of quality care to patients, including, but not
112	112	3 limited to, registered nurses, licensed practical nurses,
113	113	4 unlicensed assistive personnel, service, maintenance,
114	114	5 clerical, professional, and technical workers, and other
115	115	6 health care workers.
116	116	7 "Immediate postpartum patient" means a patient who has
117	117	8 given birth within the previous 2 hours.
118	118	9 "Nursing care" means care that falls within the scope of
119	119	10 practice described in Section 55-30 or 60-35 of the Nurse
120	120	11 Practice Act or is otherwise encompassed within recognized
121	121	12 standards of nursing practice.
122	122	13 "Rapid response team" means a team of health care
123	123	14 providers that provide care to patients with early signs of
124	124	15 deterioration to prevent respiratory or cardiac arrest.
125	125	16 "Registered nurse" or "registered professional nurse"
126	126	17 means a person who is licensed as a registered professional
127	127	18 nurse under the Nurse Practice Act and practices nursing as
128	128	19 described in Section 60-35 of the Nurse Practice Act.
129	129	20 "Specialty care unit" means a unit that is organized,
130	130	21 operated, and maintained to provide care for a specific
131	131	22 medical condition or a specific patient population.
132	132	23 Section 10. Maximum patient assignments for registered
133	133	24 nurses.
134	134	25 (a) The maximum number of patients assigned to a
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145	145	1 registered nurse in a facility shall not exceed the limits
146	146	2 provided in this Section. However, nothing shall preclude a
147	147	3 facility from assigning fewer patients to a registered nurse
148	148	4 than the limits provided in this Section. The requirements of
149	149	5 this Section apply at all times during each shift within each
150	150	6 clinical unit and each patient care area. For the purposes of
151	151	7 this Act, a patient is assigned to a registered nurse if the
152	152	8 registered nurse accepts responsibility for the patient's
153	153	9 nursing care.
154	154	10 (b) In all units with critical care or intensive care
155	155	11 patients, including, but not limited to, coronary care, acute
156	156	12 respiratory care, medical, burn, pediatric, or neonatal
157	157	13 intensive care patients, the maximum patient assignment of
158	158	14 critical care patients to a registered nurse is one.
159	159	15 (c) In all units with step-down or intermediate intensive
160	160	16 care patients, the maximum patient assignment of step-down or
161	161	17 intermediate intensive care patients to a registered nurse is
162	162	18 3.
163	163	19 (d) In all units with postanesthesia care patients,
164	164	20 regardless of the type of anesthesia administered, the maximum
165	165	21 patient assignment of postanesthesia care patients or patients
166	166	22 being monitored for the effects of any anesthetizing agent to
167	167	23 a registered nurse is one.
168	168	24 (e) In all units with operating room patients, the maximum
169	169	25 patient assignment of operating room patients to a registered
170	170	26 nurse is one, provided that a minimum of one additional person
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181	181	1 serves as a scrub assistant for each patient.
182	182	2 (f) In the emergency department:
183	183	3 (1) In a unit providing basic emergency services or
184	184	4 comprehensive emergency services, the maximum patient
185	185	5 assignment at any time to a registered nurse is 3.
186	186	6 (2) The maximum assignment of critical care emergency
187	187	7 patients to a registered nurse is one. A patient in the
188	188	8 emergency department shall be considered a critical care
189	189	9 patient when the patient meets the criteria for admission
190	190	10 to a critical care service area within the facility.
191	191	11 (3) The maximum assignment of critical trauma patients
192	192	12 in an emergency unit to a registered nurse is one.
193	193	13 (4) At least one direct care registered professional
194	194	14 nurse shall be assigned to triage patients. The direct
195	195	15 care registered professional nurse assigned to triage
196	196	16 patients shall be immediately available at all times to
197	197	17 triage patients when they arrive in the emergency
198	198	18 department. The direct care registered professional nurse
199	199	19 assigned to triage patients shall perform triage functions
200	200	20 only and may not be assigned the responsibility of the
201	201	21 base radio. Triage, radio, or flight registered nurses
202	202	22 shall not be counted in the calculation of direct care
203	203	23 registered nurse staffing levels.
204	204	24 (g) In all units with maternal child care patients the
205	205	25 maximum patient assignment:
206	206	26 (1) to a registered nurse of antepartum patients
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217	217	1 requiring continuous fetal monitoring is 2;
218	218	2 (2) of other antepartum patients who are not in active
219	219	3 labor to a registered nurse is 3;
220	220	4 (3) of active labor patients to a registered nurse is
221	221	5 one;
222	222	6 (4) of patients with medical or obstetrical
223	223	7 complications during the initiation of epidural anesthesia
224	224	8 or during circulation for a caesarean section delivery to
225	225	9 a registered nurse is one;
226	226	10 (5) during birth is one registered nurse responsible
227	227	11 for the patient in labor and, for each newborn, one
228	228	12 registered nurse whose sole responsibility is that newborn
229	229	13 patient;
230	230	14 (6) of postpartum patients when the parent has given
231	231	15 birth within the previous 2 hours is one registered nurse
232	232	16 for each couplet, and in the case of multiple births, one
233	233	17 registered nurse for each additional newborn;
234	234	18 (7) of couplets to a registered nurse is 2;
235	235	19 (8) of patients receiving postpartum or postoperative
236	236	20 gynecological care to a registered nurse is 4 when the
237	237	21 registered nurse has been assigned only to patients
238	238	22 receiving postpartum or postoperative gynecological care;
239	239	23 (9) of newborn patients when the patient is unstable,
240	240	24 as assessed by a direct care registered professional
241	241	25 nurse, to a registered nurse is one; and
242	242	26 (10) of newborn patients to a registered nurse is 2
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253	253	1 when the patients are receiving intermediate care or the
254	254	2 nurse has been assigned to a patient care unit that
255	255	3 receives newborn patients requiring intermediate care,
256	256	4 including, but not limited to, an intermediate care
257	257	5 nursery.
258	258	6 (h) In all units with pediatric patients, the maximum
259	259	7 patient assignment of pediatric patients to a registered nurse
260	260	8 is 3.
261	261	9 (i) In all units with psychiatric patients, the maximum
262	262	10 patient assignment of psychiatric patients to a registered
263	263	11 nurse is 4.
264	264	12 (j) In all units with medical and surgical patients, the
265	265	13 maximum patient assignment of medical or surgical patients to
266	266	14 a registered nurse is 4.
267	267	15 (k) In all units with telemetry patients, the maximum
268	268	16 patient assignment of telemetry patients to a registered nurse
269	269	17 is 3.
270	270	18 (l) In all units with observational patients, the maximum
271	271	19 patient assignment of observational patients to a registered
272	272	20 nurse is 3.
273	273	21 (m) In all units with acute rehabilitation patients, the
274	274	22 maximum patient assignment of acute rehabilitation patients to
275	275	23 a registered nurse is 4.
276	276	24 (n) In all units with conscious sedation patients, the
277	277	25 maximum patient assignment of conscious sedation patients to a
278	278	26 registered nurse is one.
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289	289	1 (o) In any unit not otherwise listed in this Section,
290	290	2 including all specialty care units not otherwise listed in
291	291	3 this Section, the maximum patient assignment to a registered
292	292	4 nurse is 4.
293	293	5 Section 15. Use of rapid response teams as first
294	294	6 responders prohibited. A rapid response team's registered
295	295	7 nurse shall not be given direct care patient assignments while
296	296	8 assigned as a registered nurse who is responsible for
297	297	9 responding to a rapid response team request.
298	298	10 Section 20. Implementation by a facility.
299	299	11 (a) A facility shall implement the patient limits
300	300	12 established under Section 10 without diminishing the staffing
301	301	13 levels of the facility's health care workforce. A facility may
302	302	14 not lay off licensed practical nurses, licensed psychiatric
303	303	15 technicians, certified nursing assistants, or other ancillary
304	304	16 support staff to meet the patient limits under Section 10.
305	305	17 (b) Each patient shall be assigned to a direct care
306	306	18 registered professional nurse who shall directly provide the
307	307	19 comprehensive patient assessment, development of a plan of
308	308	20 care, and supervision, implementation, and evaluation of the
309	309	21 nursing care provided to the patient at least every shift and
310	310	22 who has the responsibility for the provision of care to a
311	311	23 particular patient within the registered nurse's scope of
312	312	24 practice.
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323	323	1 (c) There shall be no averaging of the number of patients
324	324	2 and the total number of registered nurses in each clinical
325	325	3 unit or patient care area in order to meet the patient limits
326	326	4 under Section 10.
327	327	5 (d) Only registered nurses providing direct patient care
328	328	6 shall be considered when evaluating compliance with the
329	329	7 patient limits under Section 10. Ancillary staff and
330	330	8 unlicensed personnel shall not be considered when evaluating
331	331	9 compliance with the patient limits under Section 10.
332	332	10 (e) The hours in which a nurse administrator, nurse
333	333	11 supervisor, nurse manager, charge nurse, and other licensed
334	334	12 nurse provides patient care shall not be considered when
335	335	13 evaluating compliance with the patient limits under Section 10
336	336	14 and with the patient assignment requirement under subsection
337	337	15 (b) unless the registered nurse:
338	338	16 (1) has a current and active direct patient care
339	339	17 assignment;
340	340	18 (2) provides direct patient care in compliance with
341	341	19 this Act;
342	342	20 (3) has demonstrated the registered nurse's competence
343	343	21 in providing care in the registered nurse's assigned unit
344	344	22 to the facility; and
345	345	23 (4) has the principal responsibility of providing
346	346	24 direct patient care and has no additional job duties
347	347	25 during the time period during which the nurse has a
348	348	26 patient assignment.
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359	359	1 (f) The hours in which a nurse administrator, nurse
360	360	2 supervisor, nurse manager, charge nurse, or other licensed
361	361	3 nurse provides direct patient care may be considered when
362	362	4 evaluating compliance with the patient limits under Section 10
363	363	5 and with the patient assignment requirement under subsection
364	364	6 (b) only if he or she is providing relief for a direct care
365	365	7 registered professional nurse during breaks, meals, and other
366	366	8 routine and expected absences from that unit.
367	367	9 (g) At all times during each shift within a facility unit,
368	368	10 clinical unit, or patient care area of a facility, and with the
369	369	11 full complement of ancillary support staff, at least 2 direct
370	370	12 care registered nurses shall be physically present in each
371	371	13 facility unit, clinical unit, or patient care area where a
372	372	14 patient is present.
373	373	15 (h) Identifying a clinical unit or patient care area by a
374	374	16 name or term other than those listed in this Act does not
375	375	17 affect a facility's requirement to staff the unit consistent
376	376	18 with the patient limits identified for the level of intensity
377	377	19 or type of care described in this Act.
378	378	20 (i) A registered nurse providing direct care to a patient
379	379	21 has the authority to determine if a change in the patient's
380	380	22 status places the patient in a different category requiring a
381	381	23 different patient limit under Section 10.
382	382	24 (j) A facility shall assign direct care professional
383	383	25 registered nurses in a patient care unit in accordance with
384	384	26 Section 10 in order to meet the highest level of intensity and
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395	395	1 type of care provided in the patient care unit. If multiple
396	396	2 assignments described under Section 10 apply to a patient, the
397	397	3 facility shall assign a direct care professional registered
398	398	4 nurse in accordance with the lowest numerical patient
399	399	5 assignment under that Section.
400	400	6 (k) A facility shall provide staffing of direct care
401	401	7 registered professional nurses above the number of direct care
402	402	8 registered professional nurses required to comply with the
403	403	9 patient levels under Section 10, or additional staffing of
404	404	10 licensed practical nurses, certified nursing assistants, or
405	405	11 other licensed or unlicensed ancillary support staff, based on
406	406	12 the direct care registered professional nurse's assessment of
407	407	13 each assigned individual patient, the individual patient's
408	408	14 nursing care requirements, and the individual patient's
409	409	15 nursing care plan.
410	410	16 (l) A facility shall not employ video monitors, remote
411	411	17 patient monitoring, or any form of electronic visualization of
412	412	18 a patient as a substitute for the direct in-person observation
413	413	19 required for patient assessment by a registered nurse or for
414	414	20 patient protection. Video monitors or any form of electronic
415	415	21 visualization of a patient shall not constitute compliance
416	416	22 with the patient limits under Section 10.
417	417	23 (m) A facility must provide relief by a direct care
418	418	24 registered professional nurse with unit-specific education,
419	419	25 training, and competence during another direct care registered
420	420	26 professional nurse's meal periods, breaks, and routine
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431	431	1 absences as part of the facility's obligation to meet the
432	432	2 patient limits under Section 10 at all times.
433	433	3 Section 25. Changes in patient census.
434	434	4 (a) A facility shall plan for routine fluctuations in its
435	435	5 patient census, including, but not limited to, admissions,
436	436	6 discharges, and transfers.
437	437	7 (b) If a health care emergency causes a change in the
438	438	8 number of patients in a clinical care unit or patient care
439	439	9 area, the facility must be able to demonstrate that immediate
440	440	10 and diligent efforts were made to maintain required staffing
441	441	11 levels under this Act.
442	442	12 (c) A facility shall immediately notify the Department if
443	443	13 a health care emergency described under subsection (b) causes
444	444	14 a change in the number of patients in a clinical care unit or
445	445	15 patient care area and shall report to the Department efforts
446	446	16 made to maintain staffing levels required under this Act.
447	447	17 Section 30. Record of staff assignments.
448	448	18 (a) A facility shall keep a record of the actual direct
449	449	19 care registered professional nurse, licensed practical nurse,
450	450	20 certified nursing assistant, and other ancillary staff
451	451	21 assignments to individual patients documented on a day-to-day,
452	452	22 shift-by-shift basis, shall submit copies of its records to
453	453	23 the Department quarterly, and shall keep copies of its staff
454	454	24 assignments on file for a period of 7 years.
455	455
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465	465	1 (b) The documentation required under subsection (a) shall
466	466	2 be submitted to the Department as a mandatory condition of
467	467	3 licensure. The documentation shall be submitted with a
468	468	4 certification by the chief nursing officer of the facility
469	469	5 that the documentation completely and accurately reflects
470	470	6 registered nurse staffing levels by the facility for each
471	471	7 shift in each facility unit, clinical unit, and patient care
472	472	8 area in which patients receive care. The chief nursing officer
473	473	9 shall execute the certification under penalty of perjury and
474	474	10 the certification must contain an expressed acknowledgment
475	475	11 that any false statement constitutes fraud and is subject to
476	476	12 criminal and civil prosecution and penalties.
477	477	13 Section 35. Implementation by the Department. The
478	478	14 Department shall adopt rules governing the implementation and
479	479	15 administration of this Act, including methods for facility
480	480	16 staff, facility staff's collective bargaining representatives,
481	481	17 and the public to file complaints regarding violations of this
482	482	18 Act with the Department. The Department shall conduct periodic
483	483	19 audits to ensure compliance with this Act.
484	484	20 Section 40. Nursing staff education, training, and
485	485	21 orientation.
486	486	22 (a) A facility shall adopt written policies that include,
487	487	23 but are not limited to:
488	488	24 (1) procedures for the education, training, and
489	489
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499	499	1 orientation of nursing staff to each clinical area where
500	500	2 the nursing staff will work; and
501	501	3 (2) criteria for the facility to use in determining
502	502	4 whether a registered nurse has demonstrated current
503	503	5 competence in providing care in a clinical area.
504	504	6 (b) A registered nurse shall not be assigned to a facility
505	505	7 unit, clinical unit, or patient care area unless the
506	506	8 registered nurse has first received education, training, and
507	507	9 orientation in that clinical area that is sufficient to
508	508	10 provide safe, therapeutic, and competent care to patients in
509	509	11 that clinical area and has demonstrated competence in
510	510	12 providing care in that clinical area.
511	511	13 (c) A registered nurse shall not be assigned to relieve a
512	512	14 direct care professional registered nurse during breaks,
513	513	15 meals, and routine absences from a facility unit, clinical
514	514	16 unit, or patient care area unless that registered nurse has
515	515	17 first received education, training, and orientation in that
516	516	18 clinical area that is sufficient to provide safe, therapeutic,
517	517	19 and competent care to patients in that clinical area and has
518	518	20 demonstrated competence in providing care in that clinical
519	519	21 area.
520	520	22 (d) A health care facility may not assign any nursing
521	521	23 personnel from a temporary nursing agency to the facility's
522	522	24 unit, clinical unit, or patient care area unless the nursing
523	523	25 personnel have first received education, training, and
524	524	26 orientation in that clinical area that is sufficient to
525	525
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531	531
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535	535	1 provide safe, therapeutic, and competent care to patients in
536	536	2 that clinical area and have demonstrated competence in
537	537	3 providing care in that clinical area.
538	538	4 Section 45. Enforcement.
539	539	5 (a) In addition to any other penalty prescribed by law,
540	540	6 the Department may impose a civil penalty against a facility
541	541	7 that violates this Act of up to $25,000 for each violation,
542	542	8 except that the Department shall impose a civil penalty of at
543	543	9 least $25,000 for each violation if the Department determines
544	544	10 that the health care facility has a pattern of violation. A
545	545	11 separate and distinct violation shall be deemed to have been
546	546	12 committed on each day during which any violation continues
547	547	13 after receipt of written notice of the violation from the
548	548	14 Department by the facility.
549	549	15 (b) The Department shall post on its website the names of
550	550	16 facilities against which civil penalties have been imposed
551	551	17 under this Act, the violation for which the penalty was
552	552	18 imposed, and additional information as the Department deems
553	553	19 necessary.
554	554	20 (c) A facility's failure to adhere to the patient
555	555	21 assignment limits under Section 10, any other violation of
556	556	22 this Act, or any violation of Section 10.10 of the Hospital
557	557	23 Licensing Act shall be reported by the Department to the
558	558	24 Attorney General for enforcement, for which the Attorney
559	559	25 General may bring action in a court of competent jurisdiction
560	560
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570	570	1 seeking injunctive relief and civil penalties.
571	571	2 (d) It is a defense to an enforcement action under this Act
572	572	3 if the facility demonstrates that a health care emergency was
573	573	4 in force at the time of the alleged violation and that the
574	574	5 facility made immediate and diligent efforts to maintain
575	575	6 staffing levels required under this Act.
576	576	7 Section 50. Nurse rights and protections.
577	577	8 (a) A registered professional nurse may object to or
578	578	9 refuse to participate in any activity, practice, assignment,
579	579	10 or task if:
580	580	11 (1) in good faith, the registered nurse reasonably
581	581	12 believes it to be a violation of the direct care
582	582	13 registered professional nurse maximum patient assignments
583	583	14 or any other provision established under this Act or a
584	584	15 rule adopted by the Department under this Act;
585	585	16 (2) the registered nurse, based on the registered
586	586	17 nurse's nursing judgment, reasonably believes the
587	587	18 registered nurse is not prepared by education, training,
588	588	19 or experience to fulfill the assignment without
589	589	20 compromising the safety of any patient or jeopardizing the
590	590	21 license of the registered nurse; or
591	591	22 (3) in the registered nurse's nursing judgment, the
592	592	23 activity, policy, practice, assignment or task would be
593	593	24 outside the registered nurse's scope of practice or would
594	594	25 otherwise compromise the safety of any patient or the
595	595
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605	605	1 registered nurse.
606	606	2 (b) A facility shall not retaliate, discriminate, or
607	607	3 otherwise take adverse action in any manner with respect to
608	608	4 any aspect of a nurse's employment, including discharge,
609	609	5 promotion, compensation, or terms, conditions, or privileges
610	610	6 of employment, based on the nurse's refusal to complete an
611	611	7 assignment under subsection (a).
612	612	8 (c) A facility shall not file a complaint against a
613	613	9 registered professional nurse with the Board of Nursing based
614	614	10 on the nurse's refusal to complete an assignment under
615	615	11 subsection (a).
616	616	12 (d) A facility shall not retaliate, discriminate, or
617	617	13 otherwise take adverse action in any manner against any person
618	618	14 or with respect to any aspect of a nurse's employment,
619	619	15 including discharge, promotion, compensation, or terms,
620	620	16 conditions, or privileges of employment, based on that nurse's
621	621	17 or that person's opposition to any facility policy, practice,
622	622	18 or action that the nurse in good faith believes violates this
623	623	19 Act.
624	624	20 (e) A facility shall not retaliate, discriminate, or
625	625	21 otherwise take adverse action against any patient or employee
626	626	22 of the facility or any other individual on the basis that the
627	627	23 patient, employee, or individual, in good faith, individually
628	628	24 or in conjunction with another person or persons, has
629	629	25 presented a grievance or complaint, initiated or cooperated in
630	630	26 any investigation or proceeding of any governmental entity,
631	631
632	632
633	633
634	634
635	635
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641	641	1 regulatory agency, or private accreditation body, made a civil
642	642	2 claim or demand, or filed an action relating to the care,
643	643	3 services, or conditions of the facility or of any affiliated
644	644	4 or related facility.
645	645	5 (f) A facility shall not:
646	646	6 (1) interfere with, restrain, or deny the exercise of,
647	647	7 or attempt to deny the exercise of, a right conferred
648	648	8 under this Act; or
649	649	9 (2) coerce or intimidate any individual regarding the
650	650	10 exercise of, or an attempt to exercise, a right conferred
651	651	11 under this Act.
652	652	12 Section 97. Severability. The provisions of this Act are
653	653	13 severable under Section 1.31 of the Statute on Statutes.
654	654	14 Section 110. The Hospital Licensing Act is amended by
655	655	15 changing Section 10.10 as follows:
656	656	16 (210 ILCS 85/10.10)
657	657	17 Sec. 10.10. Nurse staffing by patient acuity.
658	658	18 (a) Findings. The Legislature finds and declares all of
659	659	19 the following:
660	660	20 (1) The State of Illinois has a substantial interest
661	661	21 in promoting quality care and improving the delivery of
662	662	22 health care services.
663	663	23 (2) Evidence-based studies have shown that the basic
664	664
665	665
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667	667
668	668
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673	673	SB2022 - 19 - LRB104 09478 BAB 19539 b
674	674	1 principles of staffing in the acute care setting should be
675	675	2 based on the complexity of patients' care needs aligned
676	676	3 with available nursing skills to promote quality patient
677	677	4 care consistent with professional nursing standards.
678	678	5 (3) Compliance with this Section promotes an
679	679	6 organizational climate that values registered nurses'
680	680	7 input in meeting the health care needs of hospital
681	681	8 patients.
682	682	9 (b) Definitions. As used in this Section:
683	683	10 "Acuity model" means an assessment tool selected and
684	684	11 implemented by a hospital, as recommended by a nursing care
685	685	12 committee, that assesses the complexity of patient care needs
686	686	13 requiring professional nursing care and skills and aligns
687	687	14 patient care needs and nursing skills consistent with
688	688	15 professional nursing standards.
689	689	16 "Department" means the Department of Public Health.
690	690	17 "Direct patient care" means care provided in person by a
691	691	18 registered professional nurse with direct responsibility to
692	692	19 oversee or carry out medical regimens or nursing care for one
693	693	20 or more patients.
694	694	21 "Nursing care committee" means a hospital-wide committee
695	695	22 or committees of nurses whose functions, in part or in whole,
696	696	23 contribute to the development, recommendation, and review of
697	697	24 the hospital's nurse staffing plan established pursuant to
698	698	25 subsection (d).
699	699	26 "Registered professional nurse" means a person licensed as
700	700
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710	710	1 a Registered Nurse under the Nurse Practice Act.
711	711	2 "Written staffing plan for nursing care services" means a
712	712	3 written plan for the assignment of patient care nursing staff
713	713	4 based on multiple nurse and patient considerations that
714	714	5 ensures the facility meets the maximum patient assignment
715	715	6 limits under Section 10 of the Safe Patient Limits Act and the
716	716	7 adopted method to adjust the staffing plan for each inpatient
717	717	8 care unit when additional staff are needed to fulfill the care
718	718	9 needs of each individual patient as determined by the
719	719	10 patient's assigned direct care registered professional nurse
720	720	11 yield minimum staffing levels for inpatient care units and the
721	721	12 adopted acuity model aligning patient care needs with nursing
722	722	13 skills required for quality patient care consistent with
723	723	14 professional nursing standards.
724	724	15 (c) Written staffing plan.
725	725	16 (1) Every hospital shall implement a written
726	726	17 hospital-wide staffing plan, prepared by a nursing care
727	727	18 committee or committees, that provides for minimum direct
728	728	19 care professional registered nurse-to-patient staffing
729	729	20 needs for each inpatient care unit and , including
730	730	21 inpatient emergency department departments. If the
731	731	22 staffing plan prepared by the nursing care committee is
732	732	23 not adopted by the hospital, or if substantial changes are
733	733	24 proposed to it, the chief nursing officer shall either:
734	734	25 (i) provide a written explanation to the committee of the
735	735	26 reasons the plan was not adopted; or (ii) provide a
736	736
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746	746	1 written explanation of any substantial changes made to the
747	747	2 proposed plan prior to it being adopted by the hospital.
748	748	3 The written hospital-wide staffing plan shall include, but
749	749	4 need not be limited to, the following considerations:
750	750	5 (A) The complexity of complete care, assessment on
751	751	6 patient admission, volume of patient admissions,
752	752	7 discharges and transfers, evaluation of the progress
753	753	8 of a patient's problems, ongoing physical assessments,
754	754	9 planning for a patient's discharge, assessment after a
755	755	10 change in patient condition, and assessment of the
756	756	11 need for patient referrals.
757	757	12 (B) The complexity of clinical professional
758	758	13 nursing judgment needed to design and implement a
759	759	14 patient's nursing care plan, the need for specialized
760	760	15 equipment and technology, the skill mix of other
761	761	16 personnel providing or supporting direct patient care,
762	762	17 and involvement in quality improvement activities,
763	763	18 professional preparation, and experience.
764	764	19 (C) Patient acuity and the number of patients for
765	765	20 whom care is being provided.
766	766	21 (D) The ongoing assessments of a unit's patient
767	767	22 acuity levels , as determined by the direct care
768	768	23 registered professional nurse responsible for each
769	769	24 patient's care, and nursing staff needed shall be
770	770	25 routinely made by the unit nurse manager or the unit
771	771	26 nurse manager's his or her designee.
772	772
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782	782	1 (E) The identification of additional registered
783	783	2 nurses available for direct patient care when
784	784	3 patients' unexpected needs exceed the planned workload
785	785	4 for direct care staff.
786	786	5 (F) Ensuring that patient limits under Section 10
787	787	6 of the Safe Patient Limits Act to a registered nurse
788	788	7 are not exceeded.
789	789	8 (2) In order to provide staffing flexibility to meet
790	790	9 patient needs, every hospital shall include in its
791	791	10 staffing plan a method to adjust the staffing plan for
792	792	11 each inpatient care unit when the maximum patient
793	793	12 assignment under Section 10 of the Safe Patient Limits Act
794	794	13 should be reduced or additional staff are needed to
795	795	14 fulfill the care needs of each individual patient as
796	796	15 determined by the patient's assigned direct care
797	797	16 registered professional nurse identify an acuity model for
798	798	17 adjusting the staffing plan for each inpatient care unit.
799	799	18 (2.5) Each hospital shall implement the staffing plan
800	800	19 and assign nursing personnel to each inpatient care unit
801	801	20 and emergency department , including inpatient emergency
802	802	21 departments, in accordance with the staffing plan.
803	803	22 (A) A registered nurse may report to the nursing
804	804	23 care committee any variations where the nurse
805	805	24 personnel assignment in an inpatient care unit is not
806	806	25 in accordance with the adopted staffing plan and may
807	807	26 make a written report to the nursing care committee
808	808
809	809
810	810
811	811
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814	814
815	815
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818	818	1 based on the variations.
819	819	2 (B) Shift-to-shift adjustments in staffing levels
820	820	3 required by the staffing plan may be made by the
821	821	4 appropriate hospital personnel overseeing inpatient
822	822	5 care operations. If a registered nurse in an inpatient
823	823	6 care unit objects to a shift-to-shift adjustment, the
824	824	7 registered nurse may submit a written report to the
825	825	8 nursing care committee.
826	826	9 (C) The nursing care committee shall develop a
827	827	10 process to examine and respond to written reports
828	828	11 submitted under subparagraphs (A) and (B) of this
829	829	12 paragraph (2.5), including the ability to determine if
830	830	13 a specific written report is resolved or should be
831	831	14 dismissed.
832	832	15 (3) The written staffing plan shall be posted, either
833	833	16 by physical or electronic means, in a conspicuous and
834	834	17 accessible location for both patients and direct care
835	835	18 staff, as required under the Hospital Report Card Act. A
836	836	19 copy of the written staffing plan shall be provided to any
837	837	20 member of the general public upon request.
838	838	21 (4) The written staffing plan shall be updated on an
839	839	22 annual basis and submitted to the Department.
840	840	23 (5) Any acuity model, or other method, software, or
841	841	24 tool used to create or evaluate a staffing plan adopted by
842	842	25 a facility, shall be transparent in all respects,
843	843	26 including disclosure of detailed documentation of the
844	844
845	845
846	846
847	847
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854	854	1 methodology used to determine nurse staffing and
855	855	2 identifying each factor, assumption, and value used in
856	856	3 applying the methodology. This documentation shall be
857	857	4 submitted to the Department and made available to facility
858	858	5 staff, facility staff's collective bargaining
859	859	6 representatives, and the public upon request. The patient
860	860	7 limits under Section 10 of the Safe Patient Limits Act
861	861	8 shall not be exceeded regardless of the use and
862	862	9 application of any acuity model.
863	863	10 (d) Nursing care committee.
864	864	11 (1) Every hospital shall have a nursing care committee
865	865	12 that meets at least 6 times per year. A hospital shall
866	866	13 appoint members of a committee whereby at least 55% of the
867	867	14 members are registered professional nurses providing
868	868	15 direct inpatient care, one of whom shall be selected
869	869	16 annually by the direct inpatient care nurses to serve as
870	870	17 co-chair of the committee.
871	871	18 (2) (Blank).
872	872	19 (2.5) A nursing care committee shall prepare and
873	873	20 recommend to hospital administration the hospital's
874	874	21 written hospital-wide staffing plan. If the staffing plan
875	875	22 is not adopted by the hospital, the chief nursing officer
876	876	23 shall provide a written statement to the committee prior
877	877	24 to a staffing plan being adopted by the hospital that: (A)
878	878	25 explains the reasons the committee's proposed staffing
879	879	26 plan was not adopted; and (B) describes the changes to the
880	880
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890	890	1 committee's proposed staffing or any alternative to the
891	891	2 committee's proposed staffing plan.
892	892	3 (3) A nursing care committee's or committees' written
893	893	4 staffing plan for the hospital shall be based on the
894	894	5 principles from the staffing components set forth in
895	895	6 subsection (c). In particular, a committee or committees
896	896	7 shall provide input and feedback on the following:
897	897	8 (A) Selection, implementation, and evaluation of
898	898	9 minimum staffing levels consistent with the maximum
899	899	10 patient limits under the Safe Patient Limits Act for
900	900	11 inpatient care units.
901	901	12 (B) Selection, implementation, and evaluation of a
902	902	13 method to increase staffing as needed to meet patient
903	903	14 care needs an acuity model to provide staffing
904	904	15 flexibility that aligns changing patient acuity with
905	905	16 nursing skills required.
906	906	17 (C) Selection, implementation, and evaluation of a
907	907	18 written staffing plan incorporating the items
908	908	19 described in subdivisions (c)(1) and (c)(2) of this
909	909	20 Section.
910	910	21 (D) Review the nurse staffing plans for all
911	911	22 inpatient areas and current acuity tools and measures
912	912	23 in use. The nursing care committee's review shall
913	913	24 consider:
914	914	25 (i) patient outcomes;
915	915	26 (ii) complaints regarding staffing, including
916	916
917	917
918	918
919	919
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922	922
923	923
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926	926	1 complaints about a delay in direct care nursing or
927	927	2 an absence of direct care nursing;
928	928	3 (iii) the number of hours of nursing care
929	929	4 provided through an inpatient hospital unit
930	930	5 compared with the number of inpatients served by
931	931	6 the hospital unit during a 24-hour period;
932	932	7 (iv) the aggregate hours of overtime worked by
933	933	8 the nursing staff;
934	934	9 (v) the extent to which actual nurse staffing
935	935	10 for each hospital inpatient unit differs from the
936	936	11 staffing specified by the staffing plan; and
937	937	12 (vi) any other matter or change to the
938	938	13 staffing plan determined by the committee to
939	939	14 ensure that the hospital is staffed to meet the
940	940	15 health care needs of patients.
941	941	16 (4) A nursing care committee must issue a written
942	942	17 report addressing the items described in subparagraphs (A)
943	943	18 through (D) of paragraph (3) semi-annually. A written copy
944	944	19 of this report shall be made available to direct inpatient
945	945	20 care nurses by making available a paper copy of the
946	946	21 report, distributing it electronically, or posting it on
947	947	22 the hospital's website.
948	948	23 (5) A nursing care committee must issue a written
949	949	24 report at least annually to the hospital governing board
950	950	25 that addresses items including, but not limited to: the
951	951	26 items described in paragraph (3); changes made based on
952	952
953	953
954	954
955	955
956	956
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958	958
959	959
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961	961	SB2022 - 27 - LRB104 09478 BAB 19539 b
962	962	1 committee recommendations and the impact of such changes;
963	963	2 and recommendations for future changes related to nurse
964	964	3 staffing.
965	965	4 (6) A nursing care committee must annually notify the
966	966	5 hospital nursing staff of the staff's rights under this
967	967	6 Section. The annual notice must provide a phone number and
968	968	7 an email address for staff to report noncompliance with
969	969	8 the nursing staff's rights as described in this Section.
970	970	9 The notice must be provided by email or by regular mail in
971	971	10 a manner that effectively facilitates receipt of the
972	972	11 notice. The Department shall monitor and enforce the
973	973	12 requirements of this paragraph (6).
974	974	13 (e) Nothing in this Section 10.10 shall be construed to
975	975	14 limit, alter, or modify any of the terms, conditions, or
976	976	15 provisions of a collective bargaining agreement entered into
977	977	16 by the hospital.
978	978	17 (f) No hospital may discipline, discharge, or take any
979	979	18 other adverse employment action against an employee solely
980	980	19 because the employee expresses a concern or complaint
981	981	20 regarding an alleged violation of this Section or concerns
982	982	21 related to nurse staffing.
983	983	22 (g) Any employee of a hospital may file a complaint with
984	984	23 the Department regarding an alleged violation of this Section.
985	985	24 The Department must forward notification of the alleged
986	986	25 violation to the hospital in question within 10 business days
987	987	26 after the complaint is filed. Upon receiving a complaint of a
988	988
989	989
990	990
991	991
992	992
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994	994
995	995
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998	998	1 violation of this Section, the Department may take any action
999	999	2 authorized under Section 7 or 9 of this Act.
1000	1000	3 (h) Delegation of nursing interventions by a registered
1001	1001	4 professional nurse must be in accordance with the Nurse
1002	1002	5 Practice Act.
1003	1003	6 (i) A hospital shall not mandate that a registered
1004	1004	7 professional nurse delegate any element of the nursing
1005	1005	8 process, including, but not limited to, nursing interventions,
1006	1006	9 medication administration, nursing judgment, comprehensive
1007	1007	10 patient assessment, development of the plan of care, or
1008	1008	11 evaluation of care. A delegation of a nursing intervention by
1009	1009	12 a registered professional nurse shall not be delegated again
1010	1010	13 to another person.
1011	1011	14 (j) The Department shall establish procedures to ensure
1012	1012	15 that the documentation submitted under this Section is
1013	1013	16 available for public inspection in its entirety.
1014	1014	17 (k) Nothing in this Section shall be construed to limit,
1015	1015	18 alter, or modify the requirements of the Safe Patient Limits
1016	1016	19 Act.
1017	1017	20 (Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
1018	1018	21 102-813, eff. 5-13-22; 103-211, eff. 1-1-24; 103-605, eff.
1019	1019	22 7-1-24.)
1020	1020	23 Section 115. The Nurse Practice Act is amended by adding
1021	1021	24 Section 50-15.15 as follows:
1022	1022
1023	1023
1024	1024
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1026	1026
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1032	1032	1 (225 ILCS 65/50-15.15 new)
1033	1033	2 Sec. 50-15.15. Nursing judgment.
1034	1034	3 (a) The General Assembly finds that:
1035	1035	4 (1) Performance of the scope of practice of a direct
1036	1036	5 care registered professional nurse requires the exercise
1037	1037	6 of nursing judgment in the exclusive interests of the
1038	1038	7 patient.
1039	1039	8 (2) The exercise of nursing judgment, unencumbered by
1040	1040	9 the commercial or revenue-generation priorities of a
1041	1041	10 hospital, long-term acute care hospital, ambulatory
1042	1042	11 surgical treatment center, or other employing entity of a
1043	1043	12 direct care registered professional nurse is necessary to
1044	1044	13 ensure safe, therapeutic, effective, and competent
1045	1045	14 treatment of patients and is essential to protect the
1046	1046	15 health and safety of the people of Illinois.
1047	1047	16 (b) The exercise of nursing judgment by a direct care
1048	1048	17 registered professional nurse in the performance of the scope
1049	1049	18 of practice of the registered professional nurse under Section
1050	1050	19 60-35 or the scope of practice of the advanced practice
1051	1051	20 registered nurse under Section 65-30 shall be provided in the
1052	1052	21 exclusive interests of the patient and shall not, for any
1053	1053	22 purpose, be considered, relied upon, or represented as a job
1054	1054	23 function, authority, responsibility, or activity undertaken in
1055	1055	24 any respect for the purpose of serving the business,
1056	1056	25 commercial, operational, or other institutional interests of
1057	1057	26 the employer.
1058	1058
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1062	1062
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