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1 | AN ACT concerning healthcare.
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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 | Section 1. Short title. This Act may be cited as the | ||||||||||||||||||||||||
5 | Nursing Care and Quality Improvement Act. | ||||||||||||||||||||||||
6 | Section 5. Findings. The Legislature finds and declares all | ||||||||||||||||||||||||
7 | of the following: | ||||||||||||||||||||||||
8 | (1) The State of Illinois has a substantial interest in | ||||||||||||||||||||||||
9 | promoting quality care and improving the delivery of health | ||||||||||||||||||||||||
10 | care services to patients in health care facilities in the | ||||||||||||||||||||||||
11 | State. | ||||||||||||||||||||||||
12 | (2) Recent changes in the health care delivery systems | ||||||||||||||||||||||||
13 | that have resulted in higher acuity levels among patients | ||||||||||||||||||||||||
14 | in health care facilities increase the need for improved | ||||||||||||||||||||||||
15 | quality measures in order to protect patient care and | ||||||||||||||||||||||||
16 | reduce the incidence of medical errors. | ||||||||||||||||||||||||
17 | (3) Inadequate and poorly monitored registered nurse | ||||||||||||||||||||||||
18 | staffing practices that result in too few registered nurses | ||||||||||||||||||||||||
19 | providing direct care jeopardize the delivery of quality | ||||||||||||||||||||||||
20 | health care. | ||||||||||||||||||||||||
21 | (4) Numerous studies have shown that patient outcomes | ||||||||||||||||||||||||
22 | are directly correlated to direct care registered nurse | ||||||||||||||||||||||||
23 | staffing levels. |
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1 | (5) Requirements for direct care registered nurse | ||||||
2 | staffing ratios will help address the registered nurse | ||||||
3 | shortage in Illinois by aiding in recruitment of new | ||||||
4 | registered nurses and improving retention of registered | ||||||
5 | nurses who are considering leaving direct patient care | ||||||
6 | because of the demands created by inadequate staffing. | ||||||
7 | (6) Establishing adequate minimum direct care | ||||||
8 | registered nurse-to-patient ratios that take into account | ||||||
9 | patient acuity measures will improve the delivery of | ||||||
10 | quality health care services and patient safety. | ||||||
11 | (7) Establishing safe staffing standards for direct | ||||||
12 | care registered nurses is a critical component of assuring | ||||||
13 | that there is adequate hospital staffing at all levels to | ||||||
14 | improve the delivery of quality care and protect patient | ||||||
15 | safety. | ||||||
16 | Section 10. Definitions. In this Act: | ||||||
17 |
"Acuity system" means an established measurement tool that | ||||||
18 | does all of the following: | ||||||
19 | (1) predicts nursing care requirements for individual | ||||||
20 | patients based on the severity of patient illness, the need | ||||||
21 | for specialized equipment and technology, the intensity of | ||||||
22 | nursing interventions required, and the complexity of | ||||||
23 | clinical nursing judgment that is needed to design, | ||||||
24 | implement, and evaluate the patient's nursing care plan; | ||||||
25 | (2) details the amount of nursing care needed, both in |
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1 | the number of nurses and in the skill mix of nursing | ||||||
2 | personnel required, on a daily basis for each patient in a | ||||||
3 | nursing department or unit; | ||||||
4 | (3) takes into consideration the patient care services | ||||||
5 | provided not only by registered nurses but also by direct | ||||||
6 | care licensed practical nurses and other health care | ||||||
7 | personnel; and | ||||||
8 | (4) is stated in terms that can be readily used and | ||||||
9 | understood by nurses. | ||||||
10 | "Nurse" and "registered nurse" mean any person licensed as | ||||||
11 | a registered nurse or a registered professional nurse under the | ||||||
12 | Nurse Practice Act. | ||||||
13 | "Direct care registered nurse" means an individual who has | ||||||
14 | been granted a license to practice as a registered nurse and | ||||||
15 | who provides bedside care for one or more patients. | ||||||
16 | "Director" means the Director of Public Health.
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17 | "Department" means the Department of Public Health.
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18 | "Employment" includes the provision of services under a | ||||||
19 | contract or other arrangement. | ||||||
20 | "Hospital" means an entity licensed under the Hospital | ||||||
21 | Licensing Act. | ||||||
22 | "Staffing plan" means a staffing plan required under | ||||||
23 | Section 15 of this Act.
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24 | Section 15. Staffing plan required. | ||||||
25 | (a) Each hospital shall implement a staffing plan that (i) |
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1 | provides adequate, appropriate, and quality delivery of health | ||||||
2 | care services, (ii) protects patient safety, and (iii) is | ||||||
3 | consistent with the requirements of this Act. | ||||||
4 | (b) Subject to Section 20 of this Act, the requirements of | ||||||
5 | subsection (a) shall take effect not later than one year after | ||||||
6 | the effective date of this Act.
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7 | Section 20. Minimum direct care registered | ||||||
8 | nurse-to-patient ratios.
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9 | (a) For the purposes of this Section: | ||||||
10 | "Assigned" means the registered nurse has responsibility | ||||||
11 | for the provision of care to a particular patient within his or | ||||||
12 | her scope of practice. | ||||||
13 | "Assist" means that licensed nurses may provide patient | ||||||
14 | care beyond their patient assignments if the tasks performed | ||||||
15 | are specific and time-limited. | ||||||
16 | "Declared state-of-emergency" means a state-of-emergency | ||||||
17 | that has been declared by the federal government or the head of | ||||||
18 | the appropriate State or local governmental agency having | ||||||
19 | authority to declare that the State, county, municipality, or | ||||||
20 | locality is in a state-of-emergency, but does not include | ||||||
21 | consistent understaffing. | ||||||
22 | (b) A hospital's staffing plan shall provide that, during | ||||||
23 | each shift within a unit of the hospital, a direct care | ||||||
24 | registered nurse may be assigned to not more than the following | ||||||
25 | number of patients in that unit: |
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1 | (1) One patient in operating room units and trauma | ||||||
2 | emergency units. | ||||||
3 | (2) 2 patients in critical care units, including | ||||||
4 | emergency critical care and intensive care units, labor and | ||||||
5 | delivery units, and post anesthesia units. | ||||||
6 | (3) 3 patients in ante partum units, emergency room | ||||||
7 | units, pediatrics units, step-down units, and telemetry | ||||||
8 | units. | ||||||
9 | (4) 4 patients in intermediate care nursery units, | ||||||
10 | specialty care units, medical or surgical units, and acute | ||||||
11 | care psychiatric units. | ||||||
12 | (5) 5 patients in rehabilitation units.
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13 | (6) 6 patients in postpartum (3 couplets) units and | ||||||
14 | well-baby nursery units. | ||||||
15 | Registered nurse-to-patient ratios represent the maximum | ||||||
16 | number of patients who may be assigned to one registered nurse | ||||||
17 | at any one time. There shall be no averaging of the number of | ||||||
18 | patients and the total number of registered nurses on the unit | ||||||
19 | during any one shift nor over any period of time. The | ||||||
20 | registered nurse-to-patient ratio must be maintained at all | ||||||
21 | times throughout each shift. Only nurses providing direct | ||||||
22 | patient care shall be included in the ratios.
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23 | Staffing for care not requiring a registered nurse is not | ||||||
24 | included within these ratios. Additional staff in excess of | ||||||
25 | these prescribed ratios, including non-licensed staff, shall | ||||||
26 | be assigned in accordance with the hospital's documented |
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1 | patient acuity system for determining nursing care | ||||||
2 | requirements, considering factors that include the severity of | ||||||
3 | the illness, the need for specialized equipment and technology, | ||||||
4 | the complexity of clinical judgment needed to design, | ||||||
5 | implement, and evaluate the patient care plan, the ability for | ||||||
6 | self-care, and the licensure of the personnel required for | ||||||
7 | care. | ||||||
8 | Nurse administrators, nurse supervisors, nurse managers, | ||||||
9 | charge nurses, and other licensed nurses shall be included in | ||||||
10 | the calculation of the licensed nurse-to-patient ratio only | ||||||
11 | when those licensed nurses are engaged in providing direct | ||||||
12 | patient care. When a nurse administrator, nurse supervisor, | ||||||
13 | nurse manager, charge nurse, or other licensed nurse is engaged | ||||||
14 | in activities other than direct patient care, that nurse shall | ||||||
15 | not be included in the ratio. Nurse administrators, nurse | ||||||
16 | supervisors, nurse managers, and charge nurses who have | ||||||
17 | demonstrated current competence to the hospital in providing | ||||||
18 | care on a particular unit may relieve nurses during breaks, | ||||||
19 | meals, and other routine, expected absences from the unit. | ||||||
20 | (c) Nothing in this Section shall prohibit a nurse from | ||||||
21 | assisting with specific tasks within the scope of his or her | ||||||
22 | practice for a patient assigned to another nurse. | ||||||
23 | (d) Within one year after the effective date of this Act, | ||||||
24 | the Department shall adopt rules providing specific guidance on | ||||||
25 | the implementation of the minimum direct care registered | ||||||
26 | nurse-to-patient ratios. The Department shall adopt these |
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1 | rules in accordance with the Department's licensing and | ||||||
2 | certification rules and other professional and vocational | ||||||
3 | rules under Illinois law. | ||||||
4 | (e) The Director may apply the minimum direct care | ||||||
5 | registered nurse-to-patient ratios established in subsection | ||||||
6 | (b) of this Section to a type of hospital unit not referred to | ||||||
7 | in that subsection (b) if that other unit performs a function | ||||||
8 | similar to the function performed by a unit referred to in | ||||||
9 | subsection (b). | ||||||
10 | (f) If necessary to protect patient safety, the Director | ||||||
11 | may prescribe regulations that (i) increase minimum direct care | ||||||
12 | registered nurse-to-patient ratios under this Section to | ||||||
13 | further limit the number of patients that may be assigned to | ||||||
14 | each direct care nurse or (ii) add minimum direct care | ||||||
15 | registered nurse-to-patient ratios for units not referred to in | ||||||
16 | subsections (b) and (d). These regulations shall be prescribed | ||||||
17 | after consultation with affected hospitals and registered | ||||||
18 | nurses. | ||||||
19 | (g) The requirements established under this Section shall | ||||||
20 | not apply during a declared state-of-emergency, if a hospital | ||||||
21 | is requested or expected to provide an exceptional level of | ||||||
22 | emergency or other medical services.
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23 | (h) Nursing personnel from temporary nursing agencies | ||||||
24 | shall not be responsible for a patient care unit without having | ||||||
25 | demonstrated clinical and supervisory competence. | ||||||
26 | (i) The requirements this Section shall take effect as soon |
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1 | as practicable, as determined by the Director, but not later | ||||||
2 | than 2 years after the effective date of this Act.
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3 | Section 25. Development and reevaluation of staffing plan.
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4 | (a) In developing a staffing plan, a hospital shall provide | ||||||
5 | for direct care registered nurse-to-patient ratios above the | ||||||
6 | minimum direct care registered nurse-to-patient ratios | ||||||
7 | required under Section 20 of this Act, if appropriate, based | ||||||
8 | upon consideration of all of the following factors: | ||||||
9 | (1) the number of patients and acuity level of patients | ||||||
10 | as determined by the application of an acuity system, on a | ||||||
11 | shift-by-shift basis; | ||||||
12 | (2) the anticipated admissions, discharges, and | ||||||
13 | transfers of patients during each shift that impacts direct | ||||||
14 | patient care; | ||||||
15 | (3) specialized experience required of direct care | ||||||
16 | registered nurses on a particular unit; | ||||||
17 | (4) staffing levels and services provided by other | ||||||
18 | health care personnel in meeting direct patient care needs | ||||||
19 | not required by a direct care registered nurse; | ||||||
20 | (5) the level of technology available that affects the | ||||||
21 | delivery of direct patient care; | ||||||
22 | (6) the level of familiarity with hospital practices, | ||||||
23 | policies, and procedures by temporary agency direct care | ||||||
24 | registered nurses used during a shift; and | ||||||
25 | (7) obstacles to efficiency in the delivery of patient |
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1 | care presented by physical layout. | ||||||
2 | (b) A hospital shall specify the system used to document | ||||||
3 | actual staffing in each unit for each shift. | ||||||
4 | (c) A hospital shall annually evaluate (i) its staffing | ||||||
5 | plan in each unit in relation to actual patient care | ||||||
6 | requirements and (ii) the accuracy of its acuity system and | ||||||
7 | update its staffing plan and acuity system to the extent | ||||||
8 | appropriate based on the evaluation. | ||||||
9 | (d) A staffing plan of a hospital shall be developed and | ||||||
10 | subsequent reevaluations shall be conducted under this Section | ||||||
11 | on the basis of input from direct care registered nurses at the | ||||||
12 | hospital or, if the nurses are represented through collective | ||||||
13 | bargaining, from the applicable recognized or certified | ||||||
14 | collective bargaining representative of the nurses. | ||||||
15 | (e) A hospital shall submit to the Director its staffing | ||||||
16 | plan and any annual updates under subsection (c). | ||||||
17 | (f) Nothing in this Act shall be construed to permit | ||||||
18 | conduct prohibited under the National Labor Relations Act or | ||||||
19 | under the Federal Labor Relations Act of 1978. | ||||||
20 | Section 30. Protection of nurses and other individuals.
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21 | (a) A nurse may refuse to accept an assignment as a nurse | ||||||
22 | in a hospital if either of the following conditions apply: | ||||||
23 | (1) the assignment would violate the provisions of | ||||||
24 | Sections 15, 20, or 25; or | ||||||
25 | (2) the nurse is not prepared by education, training, |
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1 | or experience to fulfill the assignment without | ||||||
2 | compromising the safety of any patient or jeopardizing his | ||||||
3 | or her license. | ||||||
4 | The requirements of this subsection (a) shall apply to | ||||||
5 | refusals occurring on or after the effective date of this Act, | ||||||
6 | except that the requirements of paragraph (2) of this | ||||||
7 | subsection (a) shall not apply to refusals in any hospital | ||||||
8 | before the requirements of Section 15 of this Act apply to that | ||||||
9 | hospital. | ||||||
10 | (b) No hospital shall discharge, discriminate against, or | ||||||
11 | retaliate against a nurse in any manner with respect to any | ||||||
12 | aspect of employment, including discharge, promotion, | ||||||
13 | compensation, or terms, conditions, or privileges of | ||||||
14 | employment, based on the nurse's refusal of a work assignment | ||||||
15 | under subsection (a). The requirements of this subsection (b) | ||||||
16 | shall apply to refusals occurring on or after the effective | ||||||
17 | date of this Act. | ||||||
18 | (c) No hospital shall file a complaint or a report against | ||||||
19 | a nurse with the appropriate State professional disciplinary | ||||||
20 | agency because of the nurse's refusal of a work assignment | ||||||
21 | under subsection (a). The requirements of this subsection (c) | ||||||
22 | shall apply to refusals occurring on or after the effective | ||||||
23 | date of this Act. | ||||||
24 | (d) Any nurse who has been discharged, discriminated | ||||||
25 | against, or retaliated against or against whom a complaint has | ||||||
26 | been filed in violation of this Section may bring a cause of |
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1 | action in a State court. A nurse who prevails in the cause of | ||||||
2 | action shall be entitled to one or more of the following: | ||||||
3 | (1) Reinstatement. | ||||||
4 | (2) Reimbursement of lost wages, compensation, and | ||||||
5 | benefits. | ||||||
6 | (3) Attorneys' fees. | ||||||
7 | (4) Court costs. | ||||||
8 | (5) Other damages. | ||||||
9 | The requirements of this subsection (d) shall apply to | ||||||
10 | refusals occurring on or after the effective date of this Act. | ||||||
11 | (e) A nurse or other individual may file a complaint with | ||||||
12 | the Director against a hospital that violates any provision of | ||||||
13 | this Act. For any complaint filed, the Director shall do all of | ||||||
14 | the following: | ||||||
15 | (1) receive and investigate the complaint; | ||||||
16 | (2) determine whether a violation of this Act as | ||||||
17 | alleged in the complaint has occurred; and | ||||||
18 | (3) if such a violation has occurred, issue an order | ||||||
19 | that the complaining nurse or individual shall not suffer | ||||||
20 | any retaliation under subsections (b), (c) or (f). | ||||||
21 | (f) A hospital shall not discriminate or retaliate in any | ||||||
22 | manner with respect to any aspect of employment, including | ||||||
23 | hiring, discharge, promotion, compensation, or terms, | ||||||
24 | conditions, or privileges of employment, against any | ||||||
25 | individual who in good faith, individually or in conjunction | ||||||
26 | with another person or persons, does any of the following: |
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1 | (1) reports a violation or a suspected violation of | ||||||
2 | this Act to the Director, a public regulatory agency, a | ||||||
3 | private accreditation body, or the management personnel of | ||||||
4 | the hospital; | ||||||
5 | (2) initiates, cooperates, or otherwise participates | ||||||
6 | in an investigation or proceeding brought by the Director, | ||||||
7 | a public regulatory agency, or a private accreditation body | ||||||
8 | concerning matters covered by this Act; or | ||||||
9 | (3) informs or discusses with other individuals or with | ||||||
10 | representatives of hospital employees a violation or | ||||||
11 | suspected violation of this Act. | ||||||
12 | For the purposes of this subsection (f), an individual | ||||||
13 | shall be deemed to be acting in good faith if the individual | ||||||
14 | reasonably believes that the information reported or disclosed | ||||||
15 | is true and that a violation of this Act has occurred or may | ||||||
16 | occur. | ||||||
17 | The requirements of this subsection (f) shall apply to | ||||||
18 | those actions set forth in paragraphs (1) and (3) of this | ||||||
19 | subsection (f) and occurring on or after the effective date | ||||||
20 | this Act. The requirements of this subsection (f) shall apply | ||||||
21 | to initiation, cooperation, or participation in an | ||||||
22 | investigation or proceeding on or after the effective date of | ||||||
23 | this Act. | ||||||
24 | (g) Beginning 18 months after the effective date of this | ||||||
25 | Act, a hospital shall post in an appropriate location in each | ||||||
26 | unit a conspicuous notice in a form specified by the Director |
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1 | that shall do each of the following:
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2 | (1) explain the rights of nurses and other individuals | ||||||
3 | under this Section; and | ||||||
4 | (2) include a statement that a nurse or other | ||||||
5 | individual may file a complaint with the Director against a | ||||||
6 | hospital that violates the provisions of this Act and | ||||||
7 | provide instructions on how to file this complaint.
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8 | Section 35. Penalties. The Director may impose civil | ||||||
9 | penalties or suspend, revoke, or place conditional provisions | ||||||
10 | upon a license of a hospital for a violation of any provision | ||||||
11 | of this Act. The Department shall adopt by rule a schedule | ||||||
12 | establishing the amount of civil penalty that may be imposed | ||||||
13 | for any violation of Sections 15, 20, 25, or 30 of this Act | ||||||
14 | when there is a reasonable belief that safe patient care has | ||||||
15 | been or may be negatively impacted. Each violation of a | ||||||
16 | staffing plan shall be considered a separate violation. | ||||||
17 | In addition to any other monies set aside and appropriated | ||||||
18 | to the Department for nursing scholarships awarded pursuant to | ||||||
19 | the Nursing Education Scholarship Law, revenues collected from | ||||||
20 | fines incurred under this Act shall be allocated to the | ||||||
21 | Department for that same purpose.
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