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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | ARTICLE 1. SHORT TITLE | |||||||||||||||||||||||
5 | Section 1-1. Short title. This Act may be cited as the | |||||||||||||||||||||||
6 | Hospital Patient Protection Act. | |||||||||||||||||||||||
7 | ARTICLE 5. DEFINITIONS | |||||||||||||||||||||||
8 | Section 5-1. Definitions. In this Act: | |||||||||||||||||||||||
9 | "Ambulatory surgical treatment center" has the meaning | |||||||||||||||||||||||
10 | ascribed to it in Section 3 of the Ambulatory Surgical | |||||||||||||||||||||||
11 | Treatment Center Act. | |||||||||||||||||||||||
12 | "Competence" has the has the meaning ascribed to it in | |||||||||||||||||||||||
13 | Section 50-10 of the Nurse Practice Act. | |||||||||||||||||||||||
14 | "Comprehensive nursing assessment" has the meaning | |||||||||||||||||||||||
15 | ascribed to it in Section 50-10 of the Nurse Practice Act. | |||||||||||||||||||||||
16 | "Department" means the
Department of Public Health. | |||||||||||||||||||||||
17 | "Direct care registered professional nurse" means a | |||||||||||||||||||||||
18 | competent registered professional nurse who has accepted a | |||||||||||||||||||||||
19 | direct, hands-on patient care assignment to implement the | |||||||||||||||||||||||
20 | nursing care plan for such patient and the nursing process | |||||||||||||||||||||||
21 | while, at all times, exercising independent professional |
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1 | judgment in the exclusive interest of the patient. | ||||||
2 | "Hospital" has the meaning ascribed to it in subsection (A) | ||||||
3 | of Section 3 of the Hospital Licensing Act. | ||||||
4 | "LTAC hospital" or "long term acute care hospital" has the | ||||||
5 | meaning ascribed to it in Section 10 of the Long Term Acute | ||||||
6 | Care Hospital Quality Improvement Transfer Program Act. | ||||||
7 | "Professional judgment" means the exercise of a direct care | ||||||
8 | registered professional nurse's independent clinical judgment, | ||||||
9 | through the utilization of a scientific process founded on a | ||||||
10 | professional body of knowledge and experience and based on a | ||||||
11 | comprehensive nursing assessment, to provide appropriate | ||||||
12 | nursing care to a particular patient at a particular time and | ||||||
13 | in making independent decisions about patient care and about | ||||||
14 | the nursing plan for a patient's care, including the need for | ||||||
15 | additional nursing or other staff. | ||||||
16 | ARTICLE 10. MINIMUM SAFE STAFFING RATIOS | ||||||
17 | Section 10-1. Direct care registered professional nurse | ||||||
18 | staffing generally. | ||||||
19 | (a) Each hospital shall provide staffing by direct care | ||||||
20 | registered professional nurses in accordance with direct care | ||||||
21 | registered professional nurse-to-patient staffing requirements | ||||||
22 | and ratios specified in this Act. Staffing for care not | ||||||
23 | requiring a direct care registered professional nurse is not | ||||||
24 | included within the registered professional nurse-to-patient |
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1 | ratios and shall be determined under Section 10-30. | ||||||
2 | (b) No hospital shall assign a direct care registered | ||||||
3 | professional nurse to a clinical unit or patient care area | ||||||
4 | unless that hospital and such direct care registered | ||||||
5 | professional nurse determine that the direct care registered | ||||||
6 | professional nurse has demonstrated and validated current | ||||||
7 | competence in providing care in that unit or area and has also | ||||||
8 | received orientation to that hospital's clinical area | ||||||
9 | sufficient to provide competent safe, therapeutic, and | ||||||
10 | effective nursing care to patients in that area. The policies | ||||||
11 | and procedures of the hospital shall contain the hospital's | ||||||
12 | criteria for making this determination. | ||||||
13 | Section 10-5. Direct care registered professional | ||||||
14 | nurse-to-patient ratios generally. | ||||||
15 | (a) Each hospital, LTAC hospital, and ambulatory surgical | ||||||
16 | treatment centers is subject to the staffing requirements and | ||||||
17 | the direct care registered professional nurse-to-patient ratio | ||||||
18 | requirements under this Act. | ||||||
19 | (b) Each hospital, LTAC hospital, and ambulatory surgical | ||||||
20 | center shall provide that, at all times during each shift | ||||||
21 | within each clinical unit and each patient care area, a direct | ||||||
22 | care registered professional nurses shall not be assigned at | ||||||
23 | any time more than the maximum number of patients described in | ||||||
24 | the direct care registered professional nurse-to-patient | ||||||
25 | ratios in this Article. |
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1 | (1) Each patient shall be assigned to a direct care | ||||||
2 | registered professional nurse at all times and may not be | ||||||
3 | assigned to more than one direct care registered | ||||||
4 | professional nurse at any time unless each direct care | ||||||
5 | registered professional nurse has no other patient | ||||||
6 | assignments. | ||||||
7 | (2) For purposes of this subsection, "assigned" means | ||||||
8 | that the direct care registered professional nurse has | ||||||
9 | responsibility for the provision of care to a particular | ||||||
10 | patient within her or his validated competency and directly | ||||||
11 | provides the assessment, planning, supervision, | ||||||
12 | implementation, and evaluation of such patient's nursing | ||||||
13 | care. | ||||||
14 | (c) There shall be no averaging of the number of patients | ||||||
15 | and the total number of direct care registered professional | ||||||
16 | nurses on each clinical unit or patient care area during any | ||||||
17 | one shift or over any period of time. | ||||||
18 | (d) Only direct care registered professional nurses | ||||||
19 | providing direct patient care shall be included in the | ||||||
20 | calculation of the direct care registered professional | ||||||
21 | nurse-to-patient ratios. Nurse administrators, nurse | ||||||
22 | supervisors, nurse managers, charge nurses, case managers, or | ||||||
23 | any other hospital administrator or supervisor shall not be | ||||||
24 | included in the calculation of the direct care registered | ||||||
25 | professional nurse-to-patient ratio unless that nurse has a | ||||||
26 | current and active direct patient care assignment and provides |
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1 | direct patient care in compliance with the requirements of this | ||||||
2 | section, including competency requirements. The exemption in | ||||||
3 | this subsection shall apply only during the hours in which the | ||||||
4 | individual registered professional nurse has the principal | ||||||
5 | responsibility of providing direct patient care and has no | ||||||
6 | additional job duties as would other direct care registered | ||||||
7 | professional nurses. | ||||||
8 | (e) Only a direct care registered professional nurse who | ||||||
9 | had demonstrated current competence in providing care on a | ||||||
10 | particular clinical unit or patient care area and who has | ||||||
11 | received orientation to such unit or area shall relieve another | ||||||
12 | direct care registered professional nurses during breaks, | ||||||
13 | meals, and other routine, expected absences from the clinical | ||||||
14 | unit or patient care area. | ||||||
15 | Section 10-10. Direct care registered professional nurse | ||||||
16 | staffing; emergency department. | ||||||
17 | (a) There shall be no fewer than 2 direct care registered | ||||||
18 | professional nurses physically present in the emergency | ||||||
19 | department at all times. | ||||||
20 | (1) At least one direct care registered professional | ||||||
21 | nurse shall be assigned to triage patients. | ||||||
22 | (2) The direct care registered professional nurse | ||||||
23 | assigned to triage patients shall be immediately available | ||||||
24 | at all times to triage patients when they arrive in the | ||||||
25 | emergency department. The direct care registered |
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1 | professional nurse assigned to triage patients shall | ||||||
2 | perform triage functions only. | ||||||
3 | (3) Triage, base radio responder, and specialty or | ||||||
4 | flight registered professional nurses do not count in the | ||||||
5 | calculation of the direct care registered professional | ||||||
6 | nurse-to-patient ratio. | ||||||
7 | (b) A direct care registered professional nurse who has | ||||||
8 | been assigned a critical care patient in the emergency | ||||||
9 | department shall have validated critical care competency and | ||||||
10 | shall not be assigned more than 2 patients. A patient in the | ||||||
11 | emergency department shall be considered a critical care | ||||||
12 | patient when the patient meets the criteria for admission to a | ||||||
13 | critical care service area within the hospital. | ||||||
14 | (c) A direct care registered professional nurse who has | ||||||
15 | been assigned a critical trauma patient in the emergency | ||||||
16 | department shall not be assigned more than one patient. A | ||||||
17 | critical trauma patient is a patient who has injuries to an | ||||||
18 | anatomic area that (i) require lifesaving interventions or (ii) | ||||||
19 | in conjunction with unstable vital signs, pose an immediate | ||||||
20 | threat to life or limb. | ||||||
21 | Section 10-15. Direct care registered professional | ||||||
22 | nurse-to-patient ratios; hospital, LTAC hospital, and | ||||||
23 | ambulatory surgical treatment center clinical units or patient | ||||||
24 | care areas. | ||||||
25 | (a) The direct care registered professional nurse shall not |
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1 | be assigned more that one patient when such registered | ||||||
2 | professional nurse has been assigned to the duties of the | ||||||
3 | circulating registered professional nurse in the operating | ||||||
4 | room or during a cesarean delivery; assigned to an active labor | ||||||
5 | patient or patient with medical or obstetrical complications; | ||||||
6 | when initiating epidural anesthesia in the labor and delivery | ||||||
7 | suite; when assigned to an unstable or in resuscitation period | ||||||
8 | newborn; when assigned to a critical trauma patient in the | ||||||
9 | emergency department; or when assigned to a patient receiving | ||||||
10 | conscious sedation. | ||||||
11 | (b) The direct care registered professional nurse shall not | ||||||
12 | be assigned more that 2 patients when such registered | ||||||
13 | professional nurse has been assigned to a critical care, | ||||||
14 | intensive care, neonatal intensive care, labor and delivery, | ||||||
15 | coronary care, acute respiratory care, post-anesthesia | ||||||
16 | recovery (regardless of the type of anesthesia the patient | ||||||
17 | received), or burn units or patient care areas; critical care | ||||||
18 | patients in the emergency department; or immediate post-partum | ||||||
19 | patients. | ||||||
20 | (c) The direct care registered professional nurse shall not | ||||||
21 | be assigned more that 3 patients when such registered | ||||||
22 | professional nurse has been assigned to an emergency | ||||||
23 | department; a step-down or intermediate intensive care, | ||||||
24 | pediatric, telemetry, observation, or clinical decision unit | ||||||
25 | or patient care area; a combined labor/delivery/post-partum | ||||||
26 | unit or patient care area; or an ante-partum patient who is not |
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1 | in active labor. | ||||||
2 | (d) The direct care registered professional nurse shall not | ||||||
3 | be assigned more that 4 patients when such registered | ||||||
4 | professional nurse has been assigned to a medical/surgical or | ||||||
5 | pre-surgical/admission unit or patient care area; a | ||||||
6 | psychiatric or other specialty care unit or patient care area; | ||||||
7 | post-partum patients, post-surgical gynecological patients, or | ||||||
8 | mothers only; recently born infants; or combined post-cesarean | ||||||
9 | delivery mothers and newborns. | ||||||
10 | (e) The direct care registered professional nurse shall not | ||||||
11 | be assigned more that 5 patients when such registered | ||||||
12 | professional nurse has been assigned to a well-baby nursery or | ||||||
13 | a rehabilitation unit or patient care area; or for a skilled | ||||||
14 | nursing facility. | ||||||
15 | (f) The direct care registered professional nurse shall not | ||||||
16 | be assigned more that 6 patients or three couplets when such | ||||||
17 | registered professional nurse has been assigned to a postpartum | ||||||
18 | units or patient care areas. In the event of multiple births, | ||||||
19 | the total number of mothers plus infants assigned to a single | ||||||
20 | direct care registered professional nurse shall never exceed 6. | ||||||
21 | Section 10-20. Staffing requirements in relation to | ||||||
22 | hospital, LTAC hospital, or ambulatory surgical treatment | ||||||
23 | center clinical units or patient care areas. | ||||||
24 | (a) Identifying a clinical unit or patient care area by a | ||||||
25 | name or term other than those listed in this Article, does not |
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1 | affect a hospital, LTAC hospital, or ambulatory surgical | ||||||
2 | treatment centers' requirement to staff the unit at the direct | ||||||
3 | care registered professional nurse-to-patient ratios | ||||||
4 | identified for the level of intensity or type of care described | ||||||
5 | in this Article. | ||||||
6 | (b) Patients shall be cared for only on clinical units or | ||||||
7 | patient care areas where the level of intensity, type of care, | ||||||
8 | and direct care registered professional nurse-to-patient | ||||||
9 | ratios meet the individual requirements and needs of each | ||||||
10 | patient. The use of acuity-adjustable clinical units or patient | ||||||
11 | care areas is strictly prohibited. | ||||||
12 | Section 10-25. Staffing committees and staffing plans. | ||||||
13 | (a) Any method, software, or tool used to create or | ||||||
14 | evaluate a staffing plan adopted by a hospital, LTAC hospital, | ||||||
15 | or ambulatory surgical treatment center shall be established in | ||||||
16 | coordination with direct care registered professional nurses | ||||||
17 | and shall be transparent in all respects, including disclosure | ||||||
18 | of detailed documentation of the methodology used to determine | ||||||
19 | nursing staffing and identifying each factor, assumption, and | ||||||
20 | value used in applying such methodology. | ||||||
21 | (b) The Department shall establish procedures to provide | ||||||
22 | that the documentation submitted under subsection (a) is | ||||||
23 | available for public inspection in its entirety. | ||||||
24 | Section 10-30. Adjustments to ratios and nursing staff. |
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1 | (a) The assigned direct care registered professional nurse | ||||||
2 | shall determine whether (1) the number of patients assigned to | ||||||
3 | a registered professional nurse should be reduced, relative to | ||||||
4 | the applicable numerical ratio and/or (2) additional nursing | ||||||
5 | staff, such as licensed practical nurses, certified nursing | ||||||
6 | assistants, and other ancillary staff, excluding medical | ||||||
7 | assistants, shall be assigned. | ||||||
8 | (b) Any assignment of additional staff under subsection (a) | ||||||
9 | shall be based on the assigned direct care registered | ||||||
10 | professional nurse's comprehensive nursing assessment of the | ||||||
11 | severity and complexity of the individual patient's nursing | ||||||
12 | care needs; the intensity of nursing interventions required; | ||||||
13 | and the need for specialized equipment. | ||||||
14 | Section 10-35. Record of staff assignments. Every hospital | ||||||
15 | shall keep a record of the actual direct care registered | ||||||
16 | professional nurse, licensed practical nurse, certified | ||||||
17 | nursing assistant, and other ancillary staff assignments to | ||||||
18 | individual patients documented on a day-to-day, shift-by-shift | ||||||
19 | basis and must keep copies of its staff assignments on file for | ||||||
20 | a period of 3 years. | ||||||
21 | Section 10-40. Changes in patient census. | ||||||
22 | (a) Every hospital shall plan for routine fluctuations, | ||||||
23 | such as admissions, discharges, and transfers, in its patient | ||||||
24 | census. |
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1 | (b) If a health care emergency causes a change in the | ||||||
2 | number of patients on a clinical care unit or patient care | ||||||
3 | area, the hospital must demonstrate that immediate and diligent | ||||||
4 | efforts were made to maintain required staffing levels. For | ||||||
5 | purposes of this subsection, "health care emergency" means an | ||||||
6 | emergency declared by the federal government or the head of a | ||||||
7 | State or local governmental entity. | ||||||
8 | Section 10-45. Prohibited activities. | ||||||
9 | (a) A hospital, LTAC hospital, or ambulatory surgical | ||||||
10 | treatment centers may not directly assign any unlicensed | ||||||
11 | personnel to perform registered professional nurse functions | ||||||
12 | in lieu of care delivered by a registered professional nurse | ||||||
13 | and may not assign unlicensed personnel to perform registered | ||||||
14 | professional nurse functions under the supervision of a direct | ||||||
15 | care registered professional nurse. | ||||||
16 | (b) Unlicensed personnel may not perform tasks that require | ||||||
17 | the clinical assessment, professional judgment, and skill of a | ||||||
18 | licensed registered professional nurse, including, without | ||||||
19 | limitation: activities that require a nursing assessment or | ||||||
20 | nursing judgment during implementation; physical, | ||||||
21 | psychological, and social assessments that require nursing | ||||||
22 | judgment, intervention, referral, or follow-up; formulation of | ||||||
23 | a plan of nursing care and evaluation of the patient's response | ||||||
24 | to the care provided; and administration of medications. | ||||||
25 | (c) A hospital, LTAC hospital, or ambulatory surgical |
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1 | treatment centers may not impose mandatory overtime | ||||||
2 | requirements to meet the staffing ratios required in this | ||||||
3 | Article. | ||||||
4 | (d) A hospital, LTAC hospital, or ambulatory surgical | ||||||
5 | treatment centers may not impose lay-offs of licensed or | ||||||
6 | practical nurses, certified nursing assistants, or other | ||||||
7 | ancillary staff to meet the direct care registered professional | ||||||
8 | nurse-to-patient ratio requirements of this Article. | ||||||
9 | (e) A hospital or LTAC hospital shall not assign medical | ||||||
10 | assistants to clinical care units or patient care areas | ||||||
11 | including the emergency department, GI Labs, or cardiac | ||||||
12 | diagnostic and/or intervention labs. | ||||||
13 | (f) An ambulatory surgical center shall not assign medical | ||||||
14 | assistants to clinical care units or patient care areas. | ||||||
15 | (g) A hospital, LTAC hospital, or ambulatory surgical | ||||||
16 | treatment center shall not employ video monitors or any form of | ||||||
17 | electronic visualization of a patient as a substitute for the | ||||||
18 | direct observation required for patient assessment by the | ||||||
19 | direct care registered professional nurse or required for | ||||||
20 | patient protection. Video monitors or any form of electronic | ||||||
21 | visualization of a patient shall not be included in the | ||||||
22 | calculation of the direct care registered professional | ||||||
23 | nurse-to-patient ratio required in this Article and shall not | ||||||
24 | replace the requirement of paragraph (1) of subsection (b) of | ||||||
25 | Section 10-5 that each patient shall be assigned to a direct | ||||||
26 | care registered professional nurse who shall provide the |
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1 | assessment, planning, implementation, and evaluation of the | ||||||
2 | nursing care provided to the patient and have the | ||||||
3 | responsibility for the provision of care to a particular | ||||||
4 | patient within such direct care registered professional | ||||||
5 | nurse's scope of practice. | ||||||
6 | Section 10-50. Consumer protection. Every hospital shall | ||||||
7 | post on a day-to-day, shift-by-shift basis, in a conspicuous | ||||||
8 | place visible and accessible to patients, hospital staff, and | ||||||
9 | the public (i) the required minimum ratios of direct care | ||||||
10 | registered professional nursing staff to patients on each | ||||||
11 | clinical unit or patient care area, (ii) additional staffing | ||||||
12 | requirements as determined by the assigned direct care | ||||||
13 | registered professional nurse under Section 10-30, and (iii) | ||||||
14 | the actual direct care registered professional | ||||||
15 | nurse-to-patient ratio, number of staff, and staff mix | ||||||
16 | provided. Every hospital shall give to each patient admitted to | ||||||
17 | the hospital for inpatient care a toll-free telephone number | ||||||
18 | for the Department of Public Health to report inadequate | ||||||
19 | staffing or care. | ||||||
20 | Section 10-55. Use of rapid response teams as first | ||||||
21 | responders prohibited. In no case may a hospital, LTAC | ||||||
22 | hospital, or ambulatory surgical treatment center use rapid | ||||||
23 | response teams as first responders. |
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1 | ARTICLE 15. DIRECT CARE REGISTERED PROFESSIONAL NURSE | ||||||
2 | FUNCTIONS RELATING TO PATIENT CARE | ||||||
3 | Section 15-1. Functions generally. | ||||||
4 | (a) A direct care registered professional nurse, holding a | ||||||
5 | valid license to practice as a registered professional nurse, | ||||||
6 | employing scientific knowledge and experience in the physical, | ||||||
7 | social, and biological sciences and exercising independent | ||||||
8 | professional judgment in applying the nursing process in the | ||||||
9 | exclusive interests of the patient, shall directly perform the | ||||||
10 | following essential functions: | ||||||
11 | (1) Continuous and ongoing comprehensive nursing | ||||||
12 | assessments of a patient's condition based upon the | ||||||
13 | independent professional judgment of the direct care | ||||||
14 | registered professional nurse. | ||||||
15 | (2) Planning, implementation, and evaluation of the | ||||||
16 | nursing care provided to each patient. The implementation | ||||||
17 | of nursing care may be assigned by the direct care | ||||||
18 | registered professional nurse responsible for the patient | ||||||
19 | to other licensed nursing staff or to unlicensed staff, | ||||||
20 | subject to any limitations of the licensure, | ||||||
21 | certification, level of validated competency, or | ||||||
22 | applicable law concerning such staff. In any case, however: | ||||||
23 | (A) The direct care registered professional nurse | ||||||
24 | assigned to a patient must determine in her or his | ||||||
25 | professional judgment that nursing personnel to be |
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1 | assigned patient care tasks possess the necessary | ||||||
2 | preparation and capability to competently perform the | ||||||
3 | assigned tasks. | ||||||
4 | (B) The direct care registered professional nurse | ||||||
5 | may assign the implementation of nursing care only when | ||||||
6 | the registered professional nurse is physically | ||||||
7 | present and available. | ||||||
8 | (3) Assessment, planning, implementation, and | ||||||
9 | evaluation of patient education, including ongoing | ||||||
10 | discharge education of each patient. | ||||||
11 | (b) The planning and delivery of patient care (i) shall | ||||||
12 | reflect all elements of the nursing process, including | ||||||
13 | comprehensive nursing assessment, nursing diagnosis, planning, | ||||||
14 | intervention, evaluation, and, as circumstances require, | ||||||
15 | patient advocacy, and (ii) shall be initiated by a direct care | ||||||
16 | registered professional nurse at the time of a patient's | ||||||
17 | admission to the hospital. | ||||||
18 | (c) The nursing plan for a patient's care shall be | ||||||
19 | discussed with and developed as a result of coordination with | ||||||
20 | the patient, the patient's family, or other representatives of | ||||||
21 | the patient, when appropriate, and staff of other disciplines | ||||||
22 | involved in the care of the patient. | ||||||
23 | (d) The direct care registered professional nurse shall | ||||||
24 | evaluate the effectiveness of the care plan (i) through | ||||||
25 | comprehensive nursing assessments based on direct observation | ||||||
26 | of the patient's physical condition and behavior, signs and |
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1 | symptoms of illness, and reactions to treatment and (ii) | ||||||
2 | through communication with the patient and other care givers as | ||||||
3 | applicable. The direct care registered professional nurse | ||||||
4 | shall modify the plan as needed. | ||||||
5 | (e) Information related to the patient's initial | ||||||
6 | comprehensive nursing assessment and reassessments, nursing | ||||||
7 | diagnosis, plan, intervention, evaluation, and patient | ||||||
8 | advocacy shall be permanently recorded, as narrative | ||||||
9 | registered professional nurse progress notes, in the patient's | ||||||
10 | medical record. The practice of "charting by exception" is | ||||||
11 | expressly prohibited. | ||||||
12 | Section 15-5. Patient assessment. | ||||||
13 | (a) Patient assessment requires (i) direct observation of | ||||||
14 | the patient's signs and symptoms of illness, reaction to | ||||||
15 | treatment, behavior and physical condition, and (ii) | ||||||
16 | interpretation of information obtained from the patient and | ||||||
17 | others, including other care givers as applicable. | ||||||
18 | (b) Only a direct care registered professional nurse who is | ||||||
19 | physically present with the patient is authorized to perform | ||||||
20 | patient assessments. A licensed practical nurse may assist a | ||||||
21 | direct care registered professional nurse in data collection. | ||||||
22 | Section 15-10. Determining nursing care needs of patients. | ||||||
23 | (a) The nursing care needs of each individual patient shall | ||||||
24 | be determined by a direct care registered professional nurse |
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1 | through the process of ongoing comprehensive nursing | ||||||
2 | assessments, nursing diagnosis, and formulation and adjustment | ||||||
3 | of nursing care plans. | ||||||
4 | (b) The prediction of individual patient nursing care needs | ||||||
5 | for prospective assignment of direct care registered | ||||||
6 | professional nurses shall be based on individual comprehensive | ||||||
7 | nursing assessments by the direct care registered professional | ||||||
8 | nurse assigned to each patient and in accordance with Article | ||||||
9 | 10. | ||||||
10 | Section 15-15. Independent professional judgment. | ||||||
11 | (a) Competent performance of the essential functions of a | ||||||
12 | direct care registered professional nurse requires the | ||||||
13 | exercise of independent professional judgment in the exclusive | ||||||
14 | interests of the patient. The exercise of such independent | ||||||
15 | professional judgment, unencumbered by the commercial or | ||||||
16 | revenue-generation priorities of a hospital, LTAC hospital, or | ||||||
17 | ambulatory surgical treatment center or other employing entity | ||||||
18 | of a direct care registered professional nurse, is necessary to | ||||||
19 | assure safe, therapeutic, effective and competent treatment of | ||||||
20 | hospital patients and is essential to protect the health and | ||||||
21 | safety of the people of Illinois. | ||||||
22 | (b) The exercise of independent professional judgment by a | ||||||
23 | direct care registered professional nurse in the performance of | ||||||
24 | the essential functions, as described in paragraphs (1) through | ||||||
25 | (3) of subsection (a) of Section 15-1 and in the Nurse Practice |
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1 | Act, shall be provided in the exclusive interests of the | ||||||
2 | patient and shall not, for any purpose, be considered, relied | ||||||
3 | upon, or represented as a job function, authority, | ||||||
4 | responsibility, or activity undertaken in any respect for the | ||||||
5 | purpose of serving the business, commercial, operational, or | ||||||
6 | other institutional interests of the hospital. | ||||||
7 | (c) No hospital, LTAC hospital, ambulatory surgical | ||||||
8 | treatment center, or other health care institution shall | ||||||
9 | utilize technology that (1) limits a direct care registered | ||||||
10 | professional nurse in performing functions that are part of the | ||||||
11 | nursing process, including full exercise of independent | ||||||
12 | professional judgment in assessment, planning, implementation | ||||||
13 | and evaluation of care or (2) limits a direct care registered | ||||||
14 | professional nurse in acting as a patient advocate in the | ||||||
15 | exclusive interests of the patient. Technology shall not be | ||||||
16 | skill-degrading, interfere with a direct care registered | ||||||
17 | professional nurse's provision of individualized patient care, | ||||||
18 | or override a direct care registered professional nurse's | ||||||
19 | independent professional judgment. | ||||||
20 | ARTICLE 20. PATIENT ADVOCACY | ||||||
21 | Section 20-1. Professional obligation. A registered | ||||||
22 | professional nurse has the obligation and right to act as a | ||||||
23 | patient's advocate, as circumstances require, including, | ||||||
24 | without limitation: |
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1 | (1) ensuring that patients have an opportunity to make | ||||||
2 | informed decisions regarding their health care before the care | ||||||
3 | is provided; | ||||||
4 | (2) initiating action to improve the patient's health care | ||||||
5 | or to change decisions or activities which, in the professional | ||||||
6 | judgment of the registered professional nurse, are against the | ||||||
7 | interests or wishes of the patient; | ||||||
8 | (3) initiating action to improve health care practices in | ||||||
9 | the hospital, including providing professional input on the | ||||||
10 | methods of patient care documentation and the number of | ||||||
11 | ancillary and support staff who should be available and present | ||||||
12 | to supplement the work of registered professional nurses, such | ||||||
13 | as physical therapists, respiratory therapists, social | ||||||
14 | workers, and patient lifting, transportation, housekeeping, | ||||||
15 | and security personnel; | ||||||
16 | (4) advocating and monitoring activities to ensure | ||||||
17 | hospital compliance with this Act to ensure that safe | ||||||
18 | registered professional nurse staffing levels at the clinical | ||||||
19 | unit or patient care level are implemented; and | ||||||
20 | (5) determining whether a health information technology | ||||||
21 | program or tool displaces registered professional nurses from | ||||||
22 | patient care, interferes with the nursing process, or otherwise | ||||||
23 | compromises a registered professional nurse's professional | ||||||
24 | judgment. | ||||||
25 | Section 20-5. Acceptance of patient care assignments. A |
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1 | direct care registered professional nurse is always | ||||||
2 | responsible for providing safe, therapeutic, and competent | ||||||
3 | nursing care to assigned patients. Before accepting a patient | ||||||
4 | assignment, a direct care registered professional nurse must | ||||||
5 | have the necessary knowledge, judgment, skills, and ability to | ||||||
6 | provide the required care. If a direct care is not, in the | ||||||
7 | direct care registered professional nurse's professional | ||||||
8 | judgment, clinically competent to perform the care required for | ||||||
9 | a patient to be assigned for nursing care, she or he should not | ||||||
10 | accept the patient care assignment. Such a refusal to accept a | ||||||
11 | patient care assignment is an exercise of the direct care | ||||||
12 | registered professional nurse's duty and right of patient | ||||||
13 | advocacy. | ||||||
14 | ARTICLE 25. CIVIL PENALTIES | ||||||
15 | Section 25-1. Violations. | ||||||
16 | (a) A hospital, LTAC hospital, or ambulatory surgical | ||||||
17 | treatment center found to have knowingly or willfully violated, | ||||||
18 | or aided and abetted a violation of, any provision of this Act | ||||||
19 | is subject to: | ||||||
20 | (1) enforcement action by the Department, including | ||||||
21 | the use of injunctive relief available to force compliance | ||||||
22 | with the Act or closure of the hospital; and | ||||||
23 | (2) a civil money penalty assessed by the Department of | ||||||
24 | not more than $25,000 for each violation and an additional |
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1 | $10,000 per shift for each clinical care unit or patient | ||||||
2 | care area until the violation is corrected. | ||||||
3 | (b) The Attorney General shall enforce penalties imposed | ||||||
4 | under this Section in the county in which the violation | ||||||
5 | occurred. | ||||||
6 | (c) The penalties authorized under this Section are in | ||||||
7 | addition to any other penalties that may be prescribed by law. | ||||||
8 | Penalties collected under this Section shall be deposited into | ||||||
9 | the General Revenue Fund. | ||||||
10 | ARTICLE 30. WHISTLEBLOWER PROTECTIONS | ||||||
11 | Section 30-1. Objection or refusal of assignment. A | ||||||
12 | registered professional nurse may object to, or refuse to | ||||||
13 | participate in, any activity, policy, practice, assignment, or | ||||||
14 | task if: | ||||||
15 | (1) in good faith the nurse reasonably believes it to be a | ||||||
16 | violation of the direct care registered professional | ||||||
17 | nurse-to-patient rations under this Act; or | ||||||
18 | (2) the nurse is not prepared by education, training, or | ||||||
19 | experience to fulfill the assignment without compromising the | ||||||
20 | safety or any patient or jeopardizing the license of the nurse. | ||||||
21 | Section 30-5. Protections for whistleblowers. | ||||||
22 | (a) A hospital, LTAC hospital, or ambulatory surgical | ||||||
23 | treatment center shall not retaliate, discriminate, or |
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1 | otherwise take adverse action in any manner with respect to any | ||||||
2 | aspect of a nurse's employment, including discharge, | ||||||
3 | promotion, compensation, or terms, conditions, or privileges | ||||||
4 | of employment, based on the nurse's refusal to complete an | ||||||
5 | assignment as described in Section 30-1. | ||||||
6 | (b) A hospital, LTAC hospital, or ambulatory surgical | ||||||
7 | treatment center shall not file a complaint against a | ||||||
8 | registered professional nurse with the board of nursing based | ||||||
9 | on the nurse's refusal to complete an assignment as described | ||||||
10 | in Section 30-1. | ||||||
11 | (c) A hospital, LTAC hospital, or ambulatory surgical | ||||||
12 | treatment center shall not retaliate, discriminate, or | ||||||
13 | otherwise take adverse action in any manner against any person | ||||||
14 | or with respect to any aspect of a nurse's employment, | ||||||
15 | including discharge, promotion, compensation, or terms, | ||||||
16 | conditions, or privileges of employment, based on such nurse's | ||||||
17 | or person's opposition to any hospital policy, practice, or | ||||||
18 | action that such nurse in good faith believes violates this | ||||||
19 | Act. | ||||||
20 | (d) A hospital, LTAC hospital, or ambulatory surgical | ||||||
21 | treatment centers shall not retaliate, discriminate, or | ||||||
22 | otherwise take adverse action against any patient, employee, or | ||||||
23 | contract employee of the hospital, or any other individual, on | ||||||
24 | the basis that such individual, in good faith, individually or | ||||||
25 | in conjunction with another person or persons, has presented a | ||||||
26 | grievance or complaint, or has initiated or cooperated in any |
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1 | investigation or proceeding of any governmental entity, | ||||||
2 | regulatory agency, or private accreditation body, made a civil | ||||||
3 | claim or demand, or filed an action relating to the care, | ||||||
4 | services, or conditions of the hospital or of any affiliated or | ||||||
5 | related facilities. | ||||||
6 | (e) A hospital, LTAC hospital, or ambulatory surgical | ||||||
7 | treatment centers, or an individual representing a hospital, | ||||||
8 | LTAC hospital, and ambulatory surgical treatment center, shall | ||||||
9 | not do either of the following: | ||||||
10 | (1) Interfere with, restrain, or deny the exercise of, | ||||||
11 | or attempt to deny the exercise of, a right conferred this | ||||||
12 | Act; | ||||||
13 | (2) Coerce or intimidate any individual regarding the | ||||||
14 | exercise of, or an attempt to exercise, a right conferred | ||||||
15 | by this Act. | ||||||
16 | ARTICLE 90. AMENDATORY PROVISIONS | ||||||
17 | Section 90-1. The Hospital Licensing Act is amended by | ||||||
18 | adding Section 2.5 as follows: | ||||||
19 | (210 ILCS 85/2.5 new) | ||||||
20 | Sec. 2.5. Relationship to Hospital Patient Protection Act. | ||||||
21 | In the case of a conflict between a provision of the Hospital | ||||||
22 | Licensing Act and a provision of the Hospital Patient | ||||||
23 | Protection Act, the Hospital Patient Protection Act shall |
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1 | control. | ||||||
2 | Section 90-5. The Nurse Practice Act is amended by adding | ||||||
3 | Section 50-17 as follows: | ||||||
4 | (225 ILCS 65/50-17 new) | ||||||
5 | Sec. 50-17. Relationship to Hospital Patient Protection | ||||||
6 | Act. In the case of a conflict between a provision of the Nurse | ||||||
7 | Practice Act and a provision of the Hospital Patient Protection | ||||||
8 | Act, the Hospital Patient Protection Act shall control.
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9 | ARTICLE 99. EFFECTIVE DATE | ||||||
10 | Section 99. Effective date. This Act takes effect January | ||||||
11 | 1, 2020.
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