SB0021 104TH GENERAL ASSEMBLY

LRB104 06121 BAB 16154 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB0021

Introduced 1/13/2025, by Sen. Christopher Belt

SYNOPSIS AS INTRODUCED:

210 ILCS 85/10.9
210 ILCS 85/10.15 new
210 ILCS 85/10.20 new

Amends the Hospital Licensing Act. Defines "hospital worker" as any person who receives an hourly wage, directly or indirectly via a subcontractor, from a hospital licensed under the Act. In provisions concerning limitations on mandated overtime and requiring rest periods for nurses, replaces "nurse" with "hospital worker". Requires additional hospital staffing information to be reported to the Department of Public Health, including any and all staffing matrices, staffing metrics, and underlying materials used to determine the metrics. Provides that the Department shall produce an annual report based on staffing disclosures and make recommendations for minimum staffing standards for hospital workers in each hospital unit. Requires hospitals to conduct a competency validation for each hospital worker hired, as a condition of employment, within the first month of employment and at no cost to the new hire. Provides that each hospital worker's competency validation must be submitted to the Department within 2 weeks after the hospital worker's start date. Establishes ongoing verification requirements for each hospital worker, and requires hospitals to submit a list of all competent employees currently employed at the end of each calendar year. Requires the Department to maintain, and make available to the public, a registry of all competent employees, including the hospital worker's name, address, contact information, and current employer. Provides that hospital employers that fail to comply with the competency validations requirements shall receive a fine equal to 0.1% of annual revenue reported during the most recently completed fiscal year each day until the hospital complies. Sets forth provisions concerning a hospital's requirements regarding assignment despite objection forms, a resolution process under the Department for assignment despite objection for certain hospital workers, and a fine for hospitals that fail to honor the assignment despite objection process. Makes other changes.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Hospital Licensing Act is amended by changing Section 10.9 and by adding Sections 10.15 and 10.20 as follows:

(210 ILCS 85/10.9)

Sec. 10.9. Hospital worker Nurse mandated overtime prohibited.

(a) Definitions. As used in this Section:

"Hospital worker" means any person who receives an hourly wage, directly or indirectly via a subcontractor, from a hospital licensed under this Act.

"Mandated overtime" means work that is required by the hospital in excess of an agreed-to, predetermined work shift. Time spent by nurses required to be available as a condition of employment in specialized units, such as surgical nursing services, shall not be counted or considered in calculating the amount of time worked for the purpose of applying the prohibition against mandated overtime under subsection (b).

"Nurse" means any advanced practice registered nurse, registered professional nurse, or licensed practical nurse, as defined in the Nurse Practice Act, who receives an hourly wage and has direct responsibility to oversee or carry out nursing care. For the purposes of this Section, "advanced practice registered nurse" does not include a certified registered nurse anesthetist who is primarily engaged in performing the duties of a nurse anesthetist.

"Related to the subcontractor" means that the subcontractor is, to a significant extent, associated or affiliated with, owns or is owned by, or has control of or is controlled by, the organization furnishing services to a hospital licensed under this Act.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes an organization that is related to the subcontractor that has a contract with the subcontractor.

"Unforeseen emergent circumstance" means (i) any declared national, State, or municipal disaster or other catastrophic event, or any implementation of a hospital's disaster plan, that will substantially affect or increase the need for health care services or (ii) any circumstance in which patient care needs require specialized nursing skills through the completion of a procedure. An "unforeseen emergent circumstance" does not include situations in which the hospital fails to have enough nursing staff to meet the usual and reasonably predictable patient care nursing needs of its patients.

(b) Mandated overtime prohibited. No hospital worker nurse may be required to work mandated overtime except in the case of an unforeseen emergent circumstance when such overtime is required only as a last resort. Such mandated overtime shall not exceed 4 hours beyond an agreed-to, predetermined work shift.

(c) Rest period required Off-duty period. When a hospital worker nurse is mandated to work up to 12 consecutive hours, the hospital worker nurse must be allowed at least 8 consecutive hours of time off off-duty time immediately following the completion of a shift.

(d) Retaliation prohibited. No hospital may discipline, discharge, or take any other adverse employment action against a hospital worker nurse solely because the hospital worker nurse refused to work mandated overtime as prohibited under subsection (b).

(e) Violations. Any employee of a hospital that is subject to this Act may file a complaint with the Department of Public Health regarding an alleged violation of this Section. The complaint must be filed within 45 days following the occurrence of the incident giving rise to the alleged violation. The Department must forward notification of the alleged violation to the hospital in question within 3 business days after the complaint is filed. Upon receiving a complaint of a violation of this Section, the Department may take any action authorized under Section 7 or 9 of this Act.

(f) Proof of violation. Any violation of this Section must be proved by clear and convincing evidence that a hospital worker nurse was required to work overtime against the hospital worker's his or her will. The hospital may defeat the claim of a violation by presenting clear and convincing evidence that an unforeseen emergent circumstance, which required overtime work, existed at the time the employee was required or compelled to work.

(Source: P.A. 100-513, eff. 1-1-18.)

(210 ILCS 85/10.15 new)

Sec. 10.15. Additional staffing transparency and reporting requirements.

(a) Definitions. As used in this Section:

"Hospital worker" means any person who receives an hourly wage, directly or indirectly via a subcontractor, from a hospital licensed under this Act.

"Related to the subcontractor" means that the subcontractor is, to a significant extent, associated or affiliated with, owns or is owned by, or has control of or is controlled by, the organization furnishing services to a hospital licensed under this Act.

"Staffing metric" means any tool used by hospital management to determine safe staffing levels in a patient care or support services unit.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes an organization that is related to the subcontractor that has a contract with the subcontractor.

"Unit" means a functional division of a hospital that provides patient care or support services.

(b) Hospitals licensed under this Act must employ and schedule enough hospital workers to provide quality patient care and ensure patient safety.

(c) In order to ensure compliance with safe staffing practices, hospitals licensed under this Act must make available upon request all the staffing matrices or other staffing metrics used to assess and maintain safe staffing levels for hospital workers in each unit.

(d) A hospital must also share with the Department at the beginning of each calendar year any and all staffing matrices, staffing metrics, and underlying materials used to determine the metrics.

(e) The Department shall produce an annual report based on staffing disclosures required under this Section, beginning the first year after implementation.

(f) The Department shall make recommendations for minimum staffing standards for hospital workers in each hospital unit based on the information collected under this Section.

(210 ILCS 85/10.20 new)

Sec. 10.20. Hospital worker competency validation and assignment despite objection.

(a) Findings. The General Assembly finds that:

(1) The State of Illinois has an obligation to ensure hospitals provide quality patient care.

(2) Numerous studies have linked patient outcomes, including in-hospital mortality rates, to hospital worker staffing.

(3) Despite the preponderance of evidence that adequate staffing improves patient outcomes, hospitals in Illinois and elsewhere too often systemically and intentionally understaff to maximize profit, even at the expense of quality patient care.

(4) The COVID-19 pandemic both exposed and exacerbated these unsafe staffing practices.

(5) The State asserts that, based on their demonstrated competencies and training, hospital workers are best positioned to identify unsafe conditions that jeopardize quality patient care, especially short staffing.

(6) Hospitals perform competency validations and ongoing verifications to ensure hospital workers know how to perform their jobs safely and to identify unsafe practices, including short staffing.

(7) The State should require hospitals to affirm that hospital workers have received the necessary training to safely perform their work via competency validations and ongoing verification and empower these hospital workers to identify and formally object to unsafe working conditions, including short staffing.

(8) To facilitate this, the State should create a dispute resolution process for hospital workers to formally object to unsafe working conditions.

(b) Definitions. As used in this Section:

"Assignment despite objection" means a formal process by which hospital workers notify management when they receive an assignment that, based on their training, is potentially unsafe.

"Competency validation" means a determination based on a hospital worker's satisfactory performance of each specific element of the hospital worker's job description and of specific requirements of the unit in which the hospital worker is employed in a safe and ethical manner.

"Competent employee" means a hospital worker whose employer has received a competency validation or ongoing verification during a given calendar year.

"Hospital worker" means any person who receives an hourly wage, directly or indirectly via a subcontractor, from a hospital licensed under this Act.

"Ongoing verification" means an annual redetermination based on a hospital worker's satisfactory performance of each specific element of the hospital worker's job description and the specific requirements of the unit in which the hospital worker is employed in a safe and ethical manner.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes an organization that, to a significant extent, is associated or affiliated with, owns or is owned by, or has control of or is controlled by, the entity furnishing services to a hospital licensed under this Act.

(c) Competency validation credential.

(1) Hospitals licensed under this Act shall conduct a competency validation for each hospital worker hired, as a condition of employment, within the first month of employment and at no cost to the new hire.

(2) The competency validation formally affirms the hospital has adequately trained a hospital worker to perform all aspects of the hospital worker's job safely and to identify unsafe conditions, including inadequate staffing.

(3) Hospitals must submit documentation of each hospital worker's competency validation to the Department within 2 weeks after the hospital worker's start date.

(4) Hospitals licensed under this Act shall also conduct an ongoing verification for each hospital worker employed during the calendar year to determine each hospital worker's continued competency to perform the hospital worker's job. The hospitals shall submit documentation of each hospital worker's ongoing verification to the Department within 2 weeks after completion.

(5) Hospitals licensed under this Act shall submit a list of all competent employees currently employed at the end of each calendar year.

(6) The Department shall maintain, and make available to the public, a registry of all competent employees, including the hospital worker's name, address, contact information, and current employer.

(7) Hospital employers that fail to comply with the requirements of this Section shall receive a fine equal to 0.1% of annual revenue reported during the most recently completed fiscal year each day until the hospital complies with the law.

(d) Assignment despite objection.

(1) A hospital licensed under this Act must create an assignment despite objection form that is applicable and accessible to all hospital workers that enables the hospital workers to formally object to unsafe working conditions (including unsafe staffing levels) and shifts liability for the unsafe working conditions to the hospital.

(2) The assignment despite objection form must include the following language: "This is to confirm that I notified you that, in my professional judgment derived from my competency validation, today's assignment is unsafe and places patients at risk. As a result, the facility is responsible for any adverse effects on patient care."

(3) A hospital must retain a copy of each assignment despite objection form and provide copies to the hospital worker's union (where relevant) and the Department. Hospitals must provide a report of all assignment despite objection forms filed annually at the end of each calendar year and maintain these records for a minimum of 5 years.

(4) A hospital must not retaliate against hospital workers for filing an assignment despite objection form or for reporting or objecting to unsafe conditions.

(e) Resolution process.

(1) A hospital must develop a transparent, fair, and expedient assignment despite objection resolution process for all hospital workers either via collective bargaining or in accordance with the Department process described in paragraph (3).

(2) Hospital workers currently covered by a collective bargaining agreement that includes an assignment despite objection resolution process shall abide by the process included in the collective bargaining agreement.

(3) Hospital workers not covered by a collective bargaining agreement that includes an assignment despite objection resolution process may use the Department's resolution process. The Department's resolution process for an assignment despite objection shall be as follows:

(A) Step 1: The objecting hospital worker shall make a good faith effort to inform the manager or supervisor at the time of the objection to assignment.

(B) Step 2: If the manager or supervisor fails to resolve the unsafe situation to the reporting hospital worker's satisfaction, the hospital worker shall then complete an assignment despite objection form and submit a copy to the manager or supervisor, submit a copy to the representative organization if covered by a collective bargaining agreement, and keep a copy for the hospital worker's records.

(C) Hospital management must respond in writing to the assignment despite objection within one week of its receipt and shall provide a copy of the response to the hospital worker's representative organization if the hospital worker is covered by a collective bargaining agreement.

(D) If the affected hospital worker is unsatisfied with the management's response, the hospital must convene a Safety Review Panel composed of 3 representatives selected by the hospital and 3 representatives selected by hospital workers via a transparent democratic process (the hospital workers' representatives need not be hospital employees). The panel shall attempt to resolve the dispute within 15 days of referral, unless extended by mutual consent.

(E) If the Safety Review Panel cannot resolve the dispute within 15 days of referral, the Department shall appoint a mutually agreed upon third-party neutral to assist in resolving the dispute. The third-party neutral shall make a binding decision to resolve the dispute.

(4) Hospital employers that refuse to honor the Department's assignment despite objection resolution process shall receive a fine equal to 0.1% of annual revenue reported each day during the most recently completed fiscal year until the hospital complies with the resolution process.

(5) The Department shall create a Hospital Safety Advocate position responsible for enforcing the new competency credentialing and assignment despite objection requirements and developing additional rules, as needed.