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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| (3) Inadequate and poorly monitored registered nurse |
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| staffing practices that result in too few registered nurses |
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| providing direct care jeopardize the delivery of quality |
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| health care.
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| (4) Numerous studies have shown that patient outcomes |
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| are directly correlated to direct care registered nurse |
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| staffing levels.
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| (5) Requirements for direct care registered nurse |
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| staffing ratios will help address the registered nurse |
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| shortage in Illinois by aiding in recruitment of new |
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| registered nurses and improving retention of registered |
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| nurses who are considering leaving direct patient care |
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| because of the demands created by inadequate staffing.
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| (6) Establishing adequate minimum direct care |
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| registered nurse-to-patient ratios that take into account |
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| patient acuity measures will improve the delivery of |
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| quality health care services and patient safety.
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| (7) Establishing safe staffing standards for direct |
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| care registered nurses is a critical component of assuring |
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| that there is adequate hospital staffing at all levels to |
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| improve the delivery of quality care and protect patient |
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| safety.
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| Section 10. Definitions. In this Act:
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| "Acuity system" means an established measurement tool that |
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| does all of the following:
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| (1) Predicts nursing care requirements for individual |
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| patients based on: the severity of the patient's illness; |
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| the need for specialized equipment and technology; the |
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| intensity and complexity of nursing interventions |
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| required; the complexity of clinical nursing judgment |
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| needed to design, implement, and evaluate the patient's |
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| nursing care plan; the ability for self-care, including |
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| motor, sensory, and cognitive deficits; and the licensure |
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| required for care.
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| (2) Details the amount and complexity of nursing care |
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| needed, both in number of nurses and in skill mix of |
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| nursing personnel required, on a daily basis for each |
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| patient in a nursing department or unit.
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| (3) Takes into consideration the patient care services |
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| provided not only by registered nurses but also by direct |
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| care licensed practical nurses and other health care |
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| personnel.
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| (4) Is stated in terms that can be readily used and |
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| understood by nurses.
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| "Department" means the Department of Public Health.
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| "Direct care registered nurse" means an individual who has |
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| been granted a license to practice as a registered nurse and |
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| who provides bedside care for one or more patients.
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| "Director" means the Director of Public Health.
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| "Employment" includes the provision of services under a |
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| contract or other arrangement.
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| "Hospital" means an entity licensed under the Hospital |
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| Licensing Act.
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| "Nurse" and "registered nurse" mean any person licensed as |
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| a registered nurse or a registered professional nurse under the |
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| Nursing and Advanced Practice Nursing Act.
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| "Staffing plan" means a staffing plan required under |
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| Section 15 of this Act.
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| Section 15. Staffing plan required. Not later than one year |
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| after the effective date of this Act, each hospital shall |
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| implement a written staffing plan that (i) provides for safe, |
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| therapeutic, and competent care services, (ii) protects |
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| patient safety, and (iii) is consistent with the requirements |
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| of this Act. |
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| Section 20. Minimum direct care registered |
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| nurse-to-patient ratios. |
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| (a) For the purposes of this Section:
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| "Assigned" means that the registered nurse has |
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| responsibility for the provision of care to a particular |
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| patient within his or her scope of practice.
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| "Declared state of emergency" means a state of emergency |
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| that has been declared by the federal government or the head of |
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| the appropriate State or local governmental agency having |
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| authority to declare that the State, county, municipality, or |
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| locality is in a state of emergency, but does not include |
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| consistent understaffing.
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| (b) A hospital's staffing plan shall provide that, during |
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| each shift within a unit of the hospital, a direct care |
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| registered nurse shall not be assigned to more than the |
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| following number of patients in that unit:
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| (1) One patient in operating room units, trauma |
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| emergency units, and for patients receiving conscious |
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| sedation, at all times.
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| (2) Two patients in critical care units, including |
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| emergency critical care and intensive care units, newborn |
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| intensive care units, labor and delivery units, and |
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| post-anesthesia units at all times.
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| (3) Three patients in ante-partum units, emergency |
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| room units, pediatrics units, step-down units, and |
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| telemetry units at all times.
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| (4) Four patients in intermediate care nursery units, |
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| specialty care units, medical/surgical units, postpartum |
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| (mothers only) units, and acute care psychiatric units at |
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| all times.
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| (5) Five patients in rehabilitation units, skilled |
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| nursing units, and well-baby nursery units at all times.
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| (6) Six patients in postpartum (3 couplets) units and |
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| well-baby nursery units at all times.
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| Registered nurse-to-patient ratios represent the maximum |
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| number of patients who may be assigned to one registered nurse |
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| at any one time. There shall be no averaging of the number of |
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| patients and the total number of registered nurses on the unit |
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| during any one shift nor over any period of time. The |
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| registered nurse-to-patient ratio must be maintained at all |
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| times throughout each shift. Only nurses providing direct |
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| patient care shall be included in the ratios.
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| Staffing for care not requiring a registered nurse is not |
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| included within these ratios. Additional staff in excess of |
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| these prescribed ratios, including non-licensed staff, shall |
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| be assigned in accordance with the hospital's documented |
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| patient acuity system for determining nursing care |
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| requirements, considering factors that include the severity of |
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| the illness, the need for specialized equipment and technology, |
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| the complexity of clinical judgment needed to design, |
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| implement, and evaluate the patient care plan, the ability for |
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| self-care, and the licensure of the personnel required for |
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| care.
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| Nurse administrators, nurse supervisors, nurse managers, |
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| charge nurses, and other licensed nurses shall be included in |
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| the calculation of the licensed nurse-to-patient ratio only |
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| when those licensed nurses are engaged in providing direct |
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| patient care. When a nurse administrator, nurse supervisor, |
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| nurse manager, charge nurse, or other licensed nurse is engaged |
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| in activities other than direct patient care, that nurse shall |
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| not be included in the calculation of the ratio. Nurse |
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| administrators, nurse supervisors, nurse managers, and charge |
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| nurses who have demonstrated current competence to the hospital |
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| in providing care on a particular unit may relieve nurses |
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| during breaks, meals, and other routine, expected absences from |
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| the unit.
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| (c) The names used to identify clinical units in subsection |
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| (b) reflect common usage and understanding. Each identified |
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| unit provides care to distinct patient types and conditions; |
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| each unit provides nursing care in accordance with general |
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| direct care registered nursing practice standards and |
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| unit-specific standards and competency requirements; and |
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| direct care registered nurse staffing levels for each shift in |
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| each unit are determined on the basis of patient assessments |
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| performed by direct care registered nurses with demonstrated |
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| competency on the unit and in accordance with unit-specific |
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| standards regarding nursing care requirements for patients |
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| served by the unit. These unit-specific characteristics |
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| determine the applicable minimum direct care registered |
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| nurse-to-patient staffing ratio for each unit.
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| (d) Identifying a unit by a name or term other than those |
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| used in subsection (b) does not affect the requirement to staff |
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| at the direct care registered nurse-to-patient ratios |
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| identified for the level of intensity or type of care described |
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| in this Section.
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| (e) Patients shall be cared for only on units where the |
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| level of intensity, type of care, and direct care registered |
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| nurse-to-patients ratios meet the individual requirements and |
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| needs of each patient.
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09500HB0392ham001 |
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| (f) Within one year after the effective date of this Act, |
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| the Department shall adopt rules providing specific guidance on |
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| the implementation of the minimum direct care registered |
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| nurse-to-patient ratios. The Department shall adopt these |
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| rules in accordance with the Department's licensing and |
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| certification rules and other professional and vocational |
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| rules under Illinois law.
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| (g) The Director may apply minimum direct care registered |
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| nurse-to-patient ratios established in subsection (b) of this |
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| Section to a type of hospital unit not referred to in that |
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| subsection (b) if that other unit performs a function similar |
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| to the function performed by the unit referred to in subsection |
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| (b).
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| (h) If necessary to protect patient safety, the Director |
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| may prescribe regulations that (i) increase minimum direct care |
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| registered nurse-to-patient ratios under this Section to |
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| further limit the number of patients that may be assigned to |
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| each direct care nurse or (ii) add minimum direct care |
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| registered nurse-to-patient ratios for units not referred to in |
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| subsections (b) and (d).
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| (i) The requirements established under this Section do not |
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| apply during a declared state of emergency if a hospital is |
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| requested or expected to provide an exceptional level of |
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| emergency or other medical services.
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| (j) Nursing personnel from temporary nursing agencies |
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| shall not be assigned to a patient care unit without having |
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| demonstrated clinical and supervisory competence.
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| (k) The Department shall adopt rules prescribing the time |
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| by which the requirements of this Section must be implemented. |
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| That time shall be as soon as practicable after the effective |
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| date of this Act, but in no event later that 2 years after the |
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| effective date of this Act.
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| Section 25. Development and reevaluation of staffing plan. |
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| (a) In developing the staffing plan, a hospital shall |
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| provide for direct care registered nurse-to-patient ratios |
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| above the minimum direct care registered nurse-to-patient |
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| ratios required under Section 20 of this Act if appropriate, |
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| based upon consideration of the following factors:
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| (1) The number and individualized needs of patients and |
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| the acuity level of patients as determined by the |
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| application of an acuity system on a shift-by-shift basis.
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| (2) The anticipated admissions, discharges, and |
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| transfers of patients during each shift that impacts direct |
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| patient care.
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| (3) Specialized experience required of direct care |
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| registered nurses on a particular unit.
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| (4) Staffing levels and services provided by other |
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| health care personnel in meeting direct patient care needs |
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| not required by a direct care registered nurse.
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| (5) The level of technology available that affects the |
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| delivery of direct patient care.
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09500HB0392ham001 |
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| (6) The level of familiarity with hospital practices, |
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| policies, and procedures by temporary agency direct care |
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| registered nurses used during a shift. |
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| (7) Obstacles to efficiency in the delivery of patient |
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| care presented by physical layout.
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| (b) A hospital shall specify the system used to document |
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| actual staffing in each unit for each shift.
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| (c) A hospital shall annually evaluate (i) its staffing |
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| plan in each unit in relation to actual patient care |
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| requirements and (ii) the accuracy of its acuity system and |
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| shall update its staffing plan and acuity system to the extent |
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| appropriate based on that evaluation.
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| (d) A hospital's staffing plan shall be developed, and |
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| subsequent reevaluations shall be conducted, under this |
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| Section by a review committee. At least half the members of the |
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| review committee shall be unit-specific direct care registered |
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| nurses who provide direct patient care. If direct care |
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| registered nurses are represented under a collective |
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| bargaining agreement, the appointment of those nurse members |
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| shall be made by the authorized collective bargaining agent.
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| (e) A hospital shall submit to the Director its staffing |
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| plan and any annual updates under subsection (c).
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| (f) Nothing in this Act shall be construed to permit |
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| conduct prohibited under the National Labor Relations Act or |
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| under the Federal Labor Relations Act.
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09500HB0392ham001 |
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| Section 30. Protection of nurses and other individuals. |
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| (a) A nurse may refuse to accept an assignment as a nurse |
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| in a hospital if either of the following conditions apply:
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| (1) the assignment would violate the provisions of |
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| Section 15, 20, or 25; or
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| (2) the nurse is not prepared by education, training, |
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| or experience to fulfill the assignment without |
8 |
| compromising the safety of any patient or jeopardizing his |
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| or her license.
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| The requirements of this subsection (a) shall apply to |
11 |
| refusals occurring on or after the effective date of this Act, |
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| except that the requirements of paragraph (2) of this |
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| subsection (a) shall not apply to refusals in any hospital |
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| before the requirements of Section 15 of this Act apply to that |
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| hospital.
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| (b) A hospital may not discharge, discriminate, or |
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| retaliate in any manner with respect to any aspect of |
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| employment, including discharge, promotion, compensation, or |
19 |
| terms, conditions, or privileges of employment, against a nurse |
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| based on the nurse's refusal of a work assignment under |
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| subsection (a). The requirements of this subsection (b) shall |
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| apply to refusals occurring on or after the effective date of |
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| the Act.
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| (c) A hospital may not file a complaint or a report against |
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| a nurse with the appropriate State professional disciplinary |
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| agency because of the nurse's refusal of a work assignment |
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| under subsection (a). The requirements of this subsection (c) |
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| shall apply to refusals occurring on or after the effective |
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| date of this Act.
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| (d) Any nurse who has been discharged, discriminated |
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| against, or retaliated against in violation of this Section may |
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| bring an action in the circuit court seeking relief as |
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| authorized in items (1) through (5) of this subsection. A nurse |
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| who prevails in such an action shall be entitled to one or more |
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| of the following:
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| (1) Reinstatement.
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| (2) Reimbursement of lost wages, compensation, and |
12 |
| benefits.
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| (3) Attorney's fees.
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| (4) Court costs.
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| (5) Other damages.
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| The requirements of this subsection (d) shall apply to |
17 |
| refusals occurring on or after the effective date of this Act.
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| (e) A nurse or other individual may file a complaint with |
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| the Director against a hospital that violates the provisions of |
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| this Act. For any complaint filed under this subsection, the |
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| Director shall do all of the following:
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| (1) Receive and investigate the complaint.
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| (2) Determine whether a violation of this Act as |
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| alleged in the complaint has occurred.
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| (3) If such a violation has occurred, issue an order |
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| that the complaining nurse or individual shall not suffer |
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| any retaliation in accordance with subsection (b), (c), or |
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| (f).
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| (f) A hospital may not discriminate or retaliate in any |
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| manner with respect to any aspect of employment, including |
5 |
| hiring, discharge, promotion, compensation, or terms, |
6 |
| conditions, or privileges of employment, against any |
7 |
| individual who, individually or in conjunction with another |
8 |
| person or persons, does any of the following:
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9 |
| (1) Reports a violation or a suspected violation of |
10 |
| this Act to the Director, a public regulatory agency, a |
11 |
| private accreditation body, or the management personnel of |
12 |
| the hospital.
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| (2) Initiates, cooperates, or otherwise participates |
14 |
| in an investigation or proceeding brought by the Director, |
15 |
| a public regulatory agency, or a private accreditation body |
16 |
| concerning matters covered by this Act. |
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| (3) Informs or discusses with other individuals or with |
18 |
| representatives of hospital employees a violation or |
19 |
| suspected violation of this Act.
|
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| The requirements of this subsection (f) shall apply to |
21 |
| those actions set forth in paragraphs (1) through (3) of this |
22 |
| subsection (f) and occurring on or after the effective date of |
23 |
| this Act. The requirements of this subsection (f) shall apply |
24 |
| to initiation, cooperation, or participation in an |
25 |
| investigation or proceeding on or after the effective date of |
26 |
| this Act.
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09500HB0392ham001 |
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LRB095 05277 DRJ 32282 a |
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| (g) Beginning 18 months after the effective date of this |
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| Act, a hospital shall post in an appropriate location in each |
3 |
| unit a conspicuous notice in a form specified by the Director |
4 |
| that does each of the following:
|
5 |
| (1) Explains the rights of nurses and other individuals |
6 |
| under this Section. |
7 |
| (2) Includes a statement that a nurse or other |
8 |
| individual may file a complaint with the Director against a |
9 |
| hospital that violates the provisions of this Act, and |
10 |
| provides instructions on how to file such a complaint.
|
11 |
| Section 35. Penalties. The Director may impose |
12 |
| administrative penalties or suspend, revoke, or place |
13 |
| conditional provisions upon a license of a hospital for a |
14 |
| violation of any provision of this Act. The Department shall |
15 |
| adopt by rule a schedule establishing the amount of an |
16 |
| administrative penalty that may be imposed for any violation of |
17 |
| Section 15, 20, 25, or 30 of this Act when there is a |
18 |
| reasonable belief that safe patient care has been or may be |
19 |
| negatively impacted. Each violation of a staffing plan shall be |
20 |
| considered a separate violation of this Act.
Before imposing a |
21 |
| penalty under this Section, the Director shall afford the |
22 |
| hospital an opportunity to request a hearing and present |
23 |
| evidence on the matter. |
24 |
| In addition to other moneys set aside and appropriated to |
25 |
| the Department for nursing scholarships awarded pursuant to the |