Section 690.25  Illustrative Examples

The following examples provide guidance on whether an entity is acting as a nurse agency and is subject to the provisions of the Act and this Part. The examples are intended to illustrate some possible facts that the Department would consider relevant to this analysis and do not encompass all possible relevant facts or factual scenarios.

a)         Example A:  A hospital contracts with Intermediary A for certain services. Per its contractual obligations, the hospital identifies its labor needs to Intermediary A. Intermediary A then engages several staffing agencies, including Staffing Agency, to source a pool of potential candidates for the hospital. Having received a pool of candidates from Staffing Agency, Intermediary A collects proof of the potential workers' credentials and background checks, consults with the hospital, and then provides the names of the selected workers to Staffing Agency for assignment to the hospital. Once workers are placed, Intermediary A tracks their hours worked. Then, Intermediary A bills the hospital according to their contractual agreement, and pays Staffing Agency according to their independent contractual agreement. Staffing Agency pays the workers for work performed at the hospital. Because Staffing Agency employs the nurses and participates in supplying them to Intermediary A's client (the hospital), the Staffing Agency and its contract with Intermediary A are subject to the Act and this Part. Intermediary A would not be subject to the Act.

b)         Example B:  Nurse Agency provides staffing services to several skilled care facilities. Nurse Agency identifies and recruits prospective nurses to provide to its skilled care facility clients, collects the prospective nurses' credentials, and conducts background checks. The skilled care facilities provide payment to Nurse Agency for nurses selected and placed at their facility. Nurse Agency separately contracts with Company B to provide Nurse Agency with payroll services. Company B tracks hours worked for the nurses placed by Nurse Agency and processes payments to the nurses on behalf of Nurse Agency.  Because Nurse Agency identifies and places temporary nursing labor to the skilled care facilities, Nurse Agency is covered by the Act and its contracts with the skilled care facilities are subject to the Act and this Part. Because Company B provides only payroll services and is not involved in the identification, assignment, or referral of nurses, Company B is not considered a nurse agency and its contract with Nurse Agency is not subject to the Act or this Part.

c)         Example C:  Nurse Agency B coordinates staffing for large long-term care facilities and is the exclusive provider to those facilities. Nurse Agency B recruits and identifies qualified certified nurse aides and employs them directly at these facilities. Nurse Agency B also contracts with Nurse Agencies C and D to identify nurse aides employed by Nurse Agencies C and D to provide supplemental nurse staffing to the facilities when necessary. The long-term care facilities provide payment to Nurse Agency B for all nurse aides referred through their agency. Nurse Agency B separately compensates Nurse Agencies C and D for those nurse aides that these agencies have identified and referred to Nurse Agency B for placement at the long-term care facilities. Because Nurse Agencies B, C, and D employ, assign, or refer temporary nursing labor at these long-term care facilities, they are subject to the Act.  However, Nurse Agency B is only a nurse agency subject to the Act with regard to its employment, assignment, and referral of its own employees.  It is not a Nurse Agency with regard to the certified nurse aides employed by Nurse Agencies C and D. As such, the contracts between the facilities and Nurse Agency B are subject to the reporting requirements of the Act and this Part, as are the contracts for the provision of supplemental staffing services between Nurse Agencies B and C, and between Nurse Agencies B and D.

d)         Example D:  Hospital E has a human resources department that recruits, interviews, and hires eligible health care workers, including nurses and certified nurse aides, to work as employees of Hospital E. Hospital E also contracts with a consultant who identifies and recruits nurses and certified nurse aides to become direct hire employees of Hospital E. These nurses and certified nurse aides are managed by fellow employees of Hospital E and are paid by Hospital E. Although Hospital E employs nurses and certified nurse aides, and its HR department verifies their credentials, and assigns them to certain departments within Hospital E, it is not acting as a nurse agency because it is not assigning them to work at a third-party health care facility for a fee. The contracted consultant, although it is earning a fee for recruitment, is not employing, assigning, or referring the nurses and certified nurse aides.

(Source:  Added at 49 Ill. Reg. 6180, effective April 25, 2025)