093_HB2377

 
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 1        AN ACT concerning health care.

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


 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
 7    all of the following:
 8        (a)  Health  care services are becoming complex and it is
 9    increasingly difficult  for  patients  to  access  integrated
10    services.
11        (b)  Quality  of  patient  care is jeopardized because of
12    staffing changes implemented in response to managed care.
13        (c)  To ensure the adequate  protection  of  patients  in
14    acute   care   settings,   it  is  essential  that  qualified
15    registered nurses be accessible and  available  to  meet  the
16    needs of patients.
17        (d)  The  basic  principles of staffing in the acute care
18    setting should be based on  the  patient's  care  needs,  the
19    severity  of  condition,  services needed, and the complexity
20    surrounding those services.

21        Section 10.  Definitions. As used in this Act:
22        "Critical care unit" means a unit that is established  to
23    safeguard  and  protect patients whose medical conditions are
24    severe enough to require continuous  monitoring  and  complex
25    intervention by registered nurses.
26        "Hospital  unit"  means  a critical care unit, burn unit,
27    labor  and  delivery  room,  postanesthesia   service   area,
28    emergency   department,   operating   room,  pediatric  unit,
29    step-down or intermediate care  unit,  specialty  care  unit,
 
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 1    telemetry  unit,  general  medical  care  unit, subacute care
 2    unit, and transitional inpatient care unit.
 3        "Nurse" and "registered nurse" means any person  licensed
 4    as  a registered nurse or registered professional nurse under
 5    the Nursing and Advanced Practice Nursing Act.

 6        Section 15.  Nurse-to-patient ratios. By January 1, 2004,
 7    the Department  of  Public  Health  shall  adopt  rules  that
 8    establish   minimum,   specific,   and  numerical  registered
 9    nurse-to-patient ratios by  registered  nurse  classification
10    and  by  hospital  unit  for  all  health facilities licensed
11    pursuant to the Hospital Licensing Act. The Department  shall
12    adopt   these  rules  in  accordance  with  the  Department's
13    licensing and certification rules and other professional  and
14    vocational  rules  under  Illinois  law. The Department shall
15    review these rules 5 years after adoption and shall report to
16    the  General  Assembly  regarding   any   proposed   changes.
17    Flexibility  shall  be considered by the Department for rural
18    general acute care hospitals in  response  to  their  special
19    needs.    The rules addressing the emergency department shall
20    distinguish between regularly scheduled core staff registered
21    nurses and additional registered nurses required to care  for
22    critical care patients in the emergency department.
23        These  ratios  shall  constitute  the  minimum  number of
24    registered nurses that  shall  be  allocated  at  all  times.
25    Additional  staff  shall  be  assigned  in  accordance with a
26    documented  patient  classification  system  for  determining
27    nursing care requirements,  including  the  severity  of  the
28    illness;  the  need for specialized equipment and technology,
29    the  complexity  of  clinical  judgment  needed  to   design,
30    implement, and evaluate the patient care plan and the ability
31    for  self-care;  and  the licensure of the personnel required
32    for care.  All licensed health facilities shall adopt written
33    policies and  procedures  for  training  and  orientation  of
 
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 1    nursing staff.

 2        Section 20.  Floating.
 3        (a)  No  registered  nurse shall be assigned to a nursing
 4    unit or clinical area unless that nurse  has  first  received
 5    orientation  in  that  clinical  area  sufficient  to provide
 6    competent care to patients in that area and has  demonstrated
 7    current competence in providing care in that area.
 8        (b)  The  written policies and procedures for orientation
 9    of nursing staff shall require that all  temporary  personnel
10    shall  receive  orientation  and  be  subject  to  competency
11    validation.
12        (c)  The  rules  adopted  by the Department shall augment
13    and not replace existing nurse-to-patient ratios  that  exist
14    in rules or law.

15        Section   25.  Registered   nurse  staff  planning.  Each
16    hospital  shall  be  responsible  for  the  development   and
17    implementation  of  a written hospital-wide staffing plan for
18    nursing services.  A  hospital  shall  have  a  process  that
19    ensures  the consideration of input from direct care clinical
20    staff  in  the   development,   implementation,   monitoring,
21    evaluation, and modification of the staffing plan. At least 6
22    of  the  members  of  the  committee charged with developing,
23    implementing,  monitoring,  evaluating,  and  modifying   the
24    staffing  plan shall be nurses and at least half of the nurse
25    members shall be registered nurses who provide direct patient
26    care.  The staffing plan shall include:
27             (1)  Competency  validation  for  registered  nurses
28        based  on   the   statutorily   recognized   duties   and
29        responsibilities   of   the   registered  nurse  and  the
30        standards which are specific to each patient care unit.
31             (2)  A   patient    classification    system    that
32        establishes  staffing  requirements by unit, patient, and
 
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 1        shift; determines  staff  resource  allocation  based  on
 2        nursing  care  requirements for each shift and each unit;
 3        establishes a method by which the hospital validates  the
 4        reliability  of  the  patient  classification system; and
 5        incorporates a method  by  which  the  hospital  improves
 6        patient outcomes based on clinical data.
 7             (3)  Written nursing service policies and procedures
 8        based  on  current  standards  of  nursing  practice  and
 9        consistent  with  the  nursing  process,  which includes:
10        assessment, nursing  diagnosis,  planning,  intervention,
11        evaluation,    and   patient   advocacy.   The   hospital
12        administration and the governing body  shall  review  and
13        approve  all  policies  and  procedures  that  relate  to
14        nursing service at least once every 3 years.
15             (4)  Provisions  for  a  complete orientation to the
16        hospital and assigned patient care unit before  receiving
17        patient   care  assignments,  and  a  written,  organized
18        in-service  education  program  for  all   patient   care
19        personnel, including temporary staff.
20        The  Department  of  Public  Health may establish by rule
21    additional criteria for staffing plans.

22        Section 30.  Penalties. The Department of  Public  Health
23    may  impose  civil  penalties  or  suspend,  revoke, or place
24    conditional provisions upon a license of  a  hospital  for  a
25    violation  of any provision of this Act. The Department shall
26    adopt by rule a schedule establishing  the  amount  of  civil
27    penalty  that may be imposed for any violation of Sections 15
28    through 25 of this Act when there is a reasonable belief that
29    safe patient care has been or  may  be  negatively  impacted.
30    Each  violation  of  a  staffing  plan  shall be considered a
31    separate violation.

32        Section 35.  Nursing scholarship appropriations. Revenues
 
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 1    collected  from  fines  incurred  under  this  Act  shall  be
 2    allocated to the Department  of  Public  Health  for  nursing
 3    scholarships   awarded  pursuant  to  the  Nursing  Education
 4    Scholarship Law in addition to any other monies set aside and
 5    appropriated to the Department of Public Health  for  nursing
 6    scholarships   awarded  pursuant  to  the  Nursing  Education
 7    Scholarship Law.

 8        Section 99. Effective date.  This Act takes  effect  upon
 9    becoming law.