093_HB1264

 
                                     LRB093 08007 AMC 08205 b

 1        AN ACT in relation to health.

 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    Staffing Requirements for Patient Safety Act.

 6        Section 5. Definitions. In this Act:
 7        "Appropriate  State  regulatory agency" or "agency" means
 8    the State agency  that  licenses  the  affected  health  care
 9    facility.
10        "Employee"  means an individual employed by a health care
11    facility who is involved in direct patient care activities or
12    clinical services and who receives an hourly wage.
13        "Employer" means an individual, partnership, association,
14    or corporation or person or groups of persons acting directly
15    or indirectly in the interest of a health care facility.
16        "Health  care  facility"  means  any  of  the   following
17    facilities:
18             (1)  An institution, place, building, or agency that
19        (i)  is  required  to  be  licensed  under  the  Hospital
20        Licensing Act or is subject to the University of Illinois
21        Hospital Act or (ii)  is  privately  owned  and  provides
22        mental health services.
23             (2)  A  hospital,  mental health facility, or prison
24        health care unit maintained by the State, a unit of local
25        government, or any department or agency of the State or a
26        unit of local government.
27        "Nurse" means  an  advanced  practice  nurse,  registered
28    professional  nurse,  or licensed practical nurse, practicing
29    under the scope of practice as licensed and  defined  in  the
30    Nursing and Advanced Practice Nursing Act.
31        "Nurse   executive   or   nurse  administrator"  means  a
 
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 1    registered professional nurse responsible and accountable for
 2    day-to-day   operations   related   to   nursing,   including
 3    development  and  review  of  the  facility  staffing  plans,
 4    implementation of patient classification systems,  overseeing
 5    of nurse staffing, and analysis of patient outcomes.
 6        "Overtime"   means   work  in  excess  of  an  agreed-to,
 7    predetermined scheduled work shift not to exceed 12 hours, or
 8    work in excess of 40 hours in one week, except in the case of
 9    an unforeseen emergent circumstance when overtime is required
10    only as a last resort.
11        "Patient classification system" means a mechanism used by
12    a health care facility to  determine  and  differentiate  the
13    health  care  needs of all patients receiving care within the
14    facility.
15        "Unforeseen emergent circumstance" means  a  circumstance
16    in  which  the employer has no foreseeable control, as in the
17    instance of war, a national disaster,  a  declared  state  of
18    emergency,  or  another  situation  in  which the health care
19    facility has no other option but to require that an  employee
20    continue  working.   "Unforeseen  emergent circumstance" does
21    not mean a situation in which  the  employer  has  reasonable
22    knowledge  of  a decreased facility staffing plan, including,
23    but not limited to, scheduled vacations, employee illness, or
24    increased patient census.

25        Section 10. Ensuring minimum nurse staffing requirements.
26        (a) A health care facility  shall  require  each  patient
27    care  unit  in  the  facility to meet or exceed minimum nurse
28    staffing requirements established for each work shift  by  an
29    assessment  of  patient  health  care  needs  conducted  by a
30    registered  professional  nurse  directly   responsible   for
31    patient  care  using  the patient classification system under
32    Section 20 of this Act.  The staffing  requirement  shall  be
33    implemented  through  a  staffing  plan that is developed for
 
                            -3-      LRB093 08007 AMC 08205 b
 1    each patient care unit.
 2        (b)  The staffing  plan  shall  be  developed  under  the
 3    direction  of  the health care facility's nurse administrator
 4    or nurse executive.  To determine the appropriate application
 5    of the  staffing  plan,  the  nurse  administrator  or  nurse
 6    executive  shall  develop  the staffing plan in collaboration
 7    with registered professional nurses directly responsible  for
 8    patient  care.   The  staffing  plan  shall be developed in a
 9    manner that enables the patient care unit to meet  or  exceed
10    the  nurse  staffing  requirements  that are derived from the
11    computation used in the patient classification system.
12        (c) The staffing plan developed  for  each  patient  care
13    unit  for  each work shift must be consistent with acceptable
14    and prevailing standards of safe nursing care  and  with  the
15    American  Nurses Association's principles for nurse staffing.
16    The staffing plan must take into account  factors  including,
17    but not be limited to, all of the following:
18             (1)  Acuity of patient's illnesses.
19             (2)   Use of specialized equipment and technology in
20        providing patient care.
21             (3)   Complexity  of  clinical  judgment  needed  to
22        design, implement, and evaluate patient care plans.
23             (4)  Ability of the patients to provide self-care.
24             (5)  Patient care delivery systems at the facility.
25             (6)   Health  care  facility-based  patient  outcome
26        indicators, as developed by nationally recognized nursing
27        organizations,    including    the     American    Nurses
28        Association.
29             (7)  Educational needs of  the  patients  and  their
30        family  members or others who may assist in the patients'
31        care.
32             (8)  Cognitive needs of the patients.
33             (9)   Risk  management  needs  resulting  from   the
34        facility's record of malpractice and other instances.
 
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 1             (10)  Functions necessary to support the delivery of
 2        quality patient care.
 3             (11) Clinical  competencies  required  to  meet  the
 4        specific needs of the patient populations.
 5             (12)   Experience   level   and   education  of  the
 6        facility's licensed nurses.
 7             (13)  State  and   federal   laws   and   regulatory
 8        requirements regarding patient care.
 9             (14)  State  and  federal  labor  laws  and ratified
10        collective bargaining agreements, if applicable.
11             (15) Expected temporary vacancies for paid or unpaid
12        leave.
13             (16) Procedures for  limiting  patient  census  when
14        available nursing staff is not sufficient to meet patient
15        needs.
16             (17) Amount and degree of nursing interventions.
17             (18)  Any  other elements considered appropriate and
18        specified in  rules  adopted  by  the  appropriate  State
19        regulatory agency.
20        (d)  Meeting the staffing requirements of this Section is
21    the  minimum  action  that  a health care facility must take.
22    The facility may employ  additional  registered  professional
23    nurses to ensure that the facility's patients receive quality
24    health care.
25        (e)  This   Section   does  not  apply  to  any  facility
26    maintained by the Department of Corrections,  the  Department
27    of   Human   Services,  or  the  Cook  County  Department  of
28    Corrections.

29        Section 15. Patient classification committee.
30        (a)  Each  health  care  facility   shall   establish   a
31    multi-disciplinary committee for the purpose of selecting the
32    patient  classification  system  to  be  used in establishing
33    staffing requirements pursuant to Section  10  of  this  Act.
 
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 1    The  facility  shall  appoint  members  of  the  committee in
 2    accordance with the following:
 3             (1)  Fifty percent  of  the  committee's  membership
 4        shall  be comprised of administrative staff of the health
 5        care facility.
 6             (2)  Fifty percent of the committee's members  shall
 7        be  comprised  of  professionals providing direct care to
 8        patients,  provided  that  those  professionals  must  be
 9        registered nurses,  physicians,  and  other  health  care
10        professionals   providing   direct  health  care  to  the
11        facility's patients.
12        (b)  This  Section  does  not  apply  to   any   facility
13    maintained  by  the Department of Corrections, the Department
14    of  Human  Services,  or  the  Cook  County   Department   of
15    Corrections.

16        Section 20.  Patient classification system.
17        (a)  The  patient  classification  committee  of a health
18    care facility shall select a  patient  classification  system
19    that does all of the following:
20             (1)   Computes   staffing   requirements   that  are
21        appropriate to ensure that all patients in  the  facility
22        receive  quality  health care according to an analysis of
23        their individual and aggregate needs.
24             (2) Specifies staffing requirements to be filled  by
25        licensed  nurses  and  other  personnel  utilized  in the
26        provision of direct patient care or the support of  other
27        unit  activities.  These  staffing  requirements shall be
28        specified to fulfill  patient  care  needs  under  normal
29        circumstances     and    during    unforeseen    emergent
30        circumstances, which includes a circumstance in which the
31        absence of a licensed nurse or other personnel  providing
32        direct care could not be foreseen.
33             (3)  Includes  methods  to  ensure  the validity and
 
                            -6-      LRB093 08007 AMC 08205 b
 1        reliability of its projection of staffing requirements.
 2             (4) Incorporates standards that are consistent  with
 3        acceptable  and prevailing standards of safe nursing care
 4        and with the American Nurses Association's principles for
 5        nurse staffing.
 6        (b)  This  Section  does  not  apply  to   any   facility
 7    maintained  by  the Department of Corrections, the Department
 8    of  Human  Services,  or  the  Cook  County   Department   of
 9    Corrections.

10        Section 25.  Internal review.
11        (a)  Each  health  care facility's patient classification
12    committee shall develop an internal review mechanism for  the
13    committee to use under this Section in evaluating whether the
14    facility's   patient   classification   system   results   in
15    sufficient  staffing  requirements  to  meet  the health care
16    needs of  the  facility's  patients.    The  committee  shall
17    develop a review mechanism that takes into account changes in
18    the  characteristics  of  the facility's work environment, as
19    well as changes that may have occurred in the overall  health
20    acuity  level  of the patients being treated in the facility.
21    Evaluation tools that may be used  in  the  review  mechanism
22    include the following:
23             (1)  Patient outcome indicators that have been shown
24        to correlate with nurse staffing, as those indicators are
25        developed by nationally recognized nursing organizations.
26             (2) Acceptable  and  prevailing  standards  of  safe
27        nursing care.
28             (3)  Facility  reports and analysis of incidents and
29        injuries to patients, nursing staff, and other personnel.
30             (4)  Available  reports  and  surveys   of   patient
31        satisfaction and nurse satisfaction that correlate to the
32        quality of nursing care provided in the facility.
33             (5)  Criteria  required  by State or federal law for
 
                            -7-      LRB093 08007 AMC 08205 b
 1        assessing the quality  of  patient  care  provided  by  a
 2        health care facility.
 3             (6)  American  Nurses  Credentialing  Center  Magnet
 4        Hospital elements.
 5             (7)  Any  other  criteria the patient classification
 6        committee considers appropriate.
 7        (b) Not later than 6 months after the effective  date  of
 8    this  Act,  each  committee shall complete its development of
 9    the internal review mechanism and conduct an internal  review
10    of   the  patient  classification  system  it  has  selected.
11    Thereafter, the committee shall conduct an internal review of
12    the system at least once each year.
13        (c) Whenever a  committee  determines  that  the  patient
14    classification  system  that the committee has selected for a
15    facility no longer meets the staffing requirements  necessary
16    to meet the health care needs of the facility's patients, the
17    committee  shall  select  a  different patient classification
18    system pursuant to this Section.
19        (d)  This  Section  does  not  apply  to   any   facility
20    maintained  by  the Department of Corrections, the Department
21    of  Human  Services,  or  the  Cook  County   Department   of
22    Corrections.

23        Section 30.  Posting requirement.
24        (a)  A  health  care  facility  shall make available in a
25    convenient location in the facility  a  monthly  report  that
26    describes  the  preceding month's staffing requirements.  The
27    report shall compare the staffing requirements to the  actual
28    staffing  that  occurred  for that month.  The facility shall
29    make the monthly report available to any interested party for
30    inspection and copying for at least 3 years.
31        (b)  This  Section  does  not  apply  to   any   facility
32    maintained  by  the Department of Corrections, the Department
33    of  Human  Services,  or  the  Cook  County   Department   of
 
                            -8-      LRB093 08007 AMC 08205 b
 1    Corrections.

 2        Section 35. Overtime.
 3        (a)  No  employee  of a health care facility may have his
 4    or her license, registration, or certification, as  the  case
 5    may  be,  subjected  to disciplinary action by an appropriate
 6    State regulatory  agency  for  a  potential  violation  of  a
 7    regulating  Act  if  the  employee  does not continue to work
 8    after the end of  the  employee's  designated,  predetermined
 9    shift if the following also occurs:
10             (1)  the  employee has not accepted an assignment to
11        work overtime; and
12             (2)  the employee notifies the employee's supervisor
13        that  he  or  she  is  unable  to  accept  the   overtime
14        assignment.
15        (b)  No  employee  of  a  health  care  facility  may  be
16    compelled  to  work  overtime  if  the  employee is in such a
17    fatigued condition that he or  she  could  pose  a  potential
18    danger  or  threat  to  the  safety  of  patients  under  the
19    employee's care because of that fatigued condition.
20        (c)  A  health  care  facility may require an employee to
21    accept  overtime  in  the  case  of  an  unforeseen  emergent
22    circumstance as defined in Section 5 of this Act.

23        Section 40. Quality-of-care policies.
24        (a) In maintaining the quality of care  provided  by  its
25    licensed  nurses,  a  health  care  facility  shall implement
26    policies to ensure all of the following:
27             (1) That  the  specific  needs  of  various  patient
28        populations    determine    the    appropriate   clinical
29        competencies required of the nurses  practicing  in  that
30        area.
31             (2)  That  licensed  nurses are given an appropriate
32        orientation to a patient care unit when first assigned to
 
                            -9-      LRB093 08007 AMC 08205 b
 1        the unit.
 2             (3) That clinical support from a proficient licensed
 3        nurse is readily available to a licensed nurse who may be
 4        less proficient.
 5        (b) The policies implemented under subsection (a) of this
 6    Section shall be applied to a  licensed  nurse  used  by  the
 7    facility who is not considered part of the facility's regular
 8    nursing  staff,  such  as  a supplemental licensed nurse or a
 9    licensed nurse obtained from an agency  that  makes  licensed
10    nurses available to employers on a temporary basis.

11        Section  45.  Work  environment. With respect to the work
12    environment  created  by  a  health  care  facility  for  its
13    licensed nurses and personnel who assist in the provision  of
14    patient  care,  the  facility  must  comply  with  all of the
15    following:
16             (1)  The  facility  must  implement  policies   that
17        reflect an organizational climate committed to filling in
18        a  timely  manner  the  positions of employment that have
19        been included in the facility's budget.
20             (2) The facility must employ a sufficient number  of
21        employees   to   perform   duties  that  are  non-nursing
22        functions, such as  housekeeping,  clerical  duties,  and
23        administrative  duties.   The  facility may not eliminate
24        such non-nursing positions as a means of  complying  with
25        this subsection if the result is that licensed nurses are
26        required to carry out the duties of the individuals whose
27        positions have been eliminated.

28        Section 50.  Pilot programs.
29        (a)  Alternative   methods   of  ensuring  minimum  nurse
30    staffing requirements  may  be  tested  and  evaluated.   The
31    alternative  methods  must  use  clearly  defined measurement
32    tools to ensure allocation of appropriate number of staff  to
 
                            -10-     LRB093 08007 AMC 08205 b
 1    determine  nursing care needs of patients.  Alternative tools
 2    or methods of measurements must  be  peer  reviewed,  provide
 3    nursing  coverage  of patient needs, and be evaluated monthly
 4    to determine whether  the  alternative  method  fulfills  the
 5    intent  of  this Act.  Measurement tools that may be utilized
 6    to determine the effectiveness  of  any  pilot  program  must
 7    include, but need not be limited to, the following:
 8             (1)  Patient  outcome  indicators  as  developed  by
 9        nationally  recognized nursing organizations, such as the
10        American Nurses Association.
11             (2)  American  Nurses  Credentialing  Center  Magnet
12        Hospital elements.
13             (3) Facility reports and analyses of  incidents  and
14        injuries   to   nursing   staff  and  other  health  care
15        personnel.
16             (4) Surveys and reports of nursing staff.
17             (5) Other elements deemed appropriate and adopted in
18        rules by the appropriate State regulatory agency.
19        (b)  If any pilot method of  determining  nurse  staffing
20    fails  to address patient needs and fails to provide adequate
21    nursing care with appropriate support for any 4-week  period,
22    the  program  shall  be disbanded and an appropriate staffing
23    plan and patient classification system must be instituted.

24        Section 55.  Prohibitions.
25        (a) Except as provided in  Section  60  of  this  Act,  a
26    health care facility must do both of the following:
27             (1)    Comply   with   the   staffing   requirements
28        established under Section 10 of this Act.
29             (2) Comply with the provisions of Sections 35 and 45
30        of this Act.
31        (b) If subdivisions (a)(1) and (a)(2) of this Section are
32    both violated in the same work shift,  each  violation  is  a
33    separate  violation.   If  subdivisions  (a)(1) and (a)(2) of
 
                            -11-     LRB093 08007 AMC 08205 b
 1    this Section are violated in different patient care units  at
 2    the same time, each violation is a separate violation.
 3        (c)  A nurse or other health care professional may file a
 4    complaint  with  the  Department  of Public Health alleging a
 5    violation of subdivision (a)(1)  or  (a)(2)  by  a  privately
 6    owned health care facility.

 7        Section  60.   Unforeseen  emergent circumstance staffing
 8    plan.
 9        (a) Section 55 of this Act does not apply when a staffing
10    shortage occurs as a direct result of an unforeseen  emergent
11    circumstance.
12        (b)  A  health  care facility shall develop and implement
13    policies that establish mechanisms for  rapid  deployment  of
14    personnel  during  an  unforeseen emergent circumstance.  The
15    policies  must  promote  the  identification   and   use   of
16    appropriate mixes of nursing staff and other personnel.

17        Section 65. Penalties and sanctions.
18        (a)   If   the   appropriate   State   regulatory  agency
19    determines, after  an  investigation,  that  a  violation  of
20    subdivision  (a)(1)  or  (a)(2) of Section 55 of this Act has
21    occurred, the agency shall impose a civil penalty against the
22    facility in accordance with subsection (b) of  this  Section.
23    In determining the amount of the civil penalty to be imposed,
24    the  agency shall consider the severity of the violation, the
25    facility's efforts to  correct  the  violation,  whether  the
26    violation  has  been  corrected,  and  whether the facility's
27    failure to correct the violation is the result of  a  willful
28    disregard of the requirements of this Act.
29        (a-5)  An investigation under subsection (a) must include
30    an  investigation  of  (i)  whether  a patient classification
31    committee was created pursuant to Section 15 and (ii) whether
32    the  committee  was  implementing  staffing  requirements  as
 
                            -12-     LRB093 08007 AMC 08205 b
 1    required under this Act.
 2        (b) In the case of a  first  violation,  the  appropriate
 3    State  regulatory  agency  shall impose a civil penalty in an
 4    amount that is not less that $2,000 for each  week  in  which
 5    the  violation occurs. In the case of a subsequent violation,
 6    for each day of the first week in which the violation occurs,
 7    the agency shall impose a civil penalty in an amount that  is
 8    not  less than $8,000 and not more than $15,000.  During each
 9    week thereafter, the agency shall impose a civil penalty  for
10    each day of violation in an amount that is 3 times the amount
11    imposed per day in the immediately preceding week.
12        (c)  A State regulatory agency may impose a civil penalty
13    under this Section only after notice to the facility  and  an
14    opportunity for the facility to be heard on the matter.
15        (d)  The  Attorney  General  may  bring  an action in the
16    circuit court to enforce the collection of any civil  penalty
17    imposed under this Section.
18        (e)  This  Section applies only to privately owned health
19    care facilities.

20        Section 70. Injunctive relief.
21        (a) Through the Attorney General or a  State's  Attorney,
22    the  Department  of  Public  Health  may  apply  for an order
23    enjoining any person from  violating  subdivision  (a)(1)  or
24    (a)(2) of Section 55 of this Act.
25        (b) On the filing of a verified petition, the court shall
26    conduct an expedited hearing on the petition, irrespective of
27    the position of the proceeding on the court's calendar.  On a
28    showing  that  the  violation  has  occurred, the court shall
29    grant an order  enjoining  the  violation.   In  addition  to
30    granting  an  order enjoining the violation, the court may do
31    either or both of the following:
32             (1) On a showing that a person's violation has  been
33        willful,  the  court  may  issue an order terminating the
 
                            -13-     LRB093 08007 AMC 08205 b
 1        facility's authority to participate in  any  State-funded
 2        program that reimburses the facility for providing health
 3        care services.
 4             (2)  On  a  showing  that  a  person's violation has
 5        resulted in  imminent  danger  of  harm  or  death  to  a
 6        patient,  the  court  may  issue  an  order requiring the
 7        facility to close the patient  care  unit  in  which  the
 8        violation has occurred.

 9        Section 75.  Private right of action.
10        (a)  Any  person  who  suffers  damage  as  a result of a
11    violation  of  this  Act  committed  by  an  employer  or  an
12    employer's representative may bring  an  action  against  the
13    employer  in  the  circuit  court.  Upon  a  finding that the
14    employer  or  the  employer's  representative   committed   a
15    violation  of this Act, the court may award the plaintiff his
16    or her actual damages together with  his  or  her  reasonable
17    attorney's fees incurred in maintaining the action.
18        (b) In an action brought under this Section, any evidence
19    that  an  employee  was required to work overtime in a manner
20    inconsistent  with  Section  35  of  this   Act   creates   a
21    presumption   that   the   employee's  employer  committee  a
22    violation of  this  Act.   To  rebut  this  presumption,  the
23    employer must prove that an unforeseen emergent circumstance,
24    which  required  overtime work only as a last resort, existed
25    at the time the employee was required or compelled to work.
26        (c)  This Section applies only to a health care  facility
27    that  is maintained by the State, a unit of local government,
28    or a department or agency of the State or  a  unit  of  local
29    government.

30        Section  80.   Posting of Act summary. Every employer who
31    is subject to any provision of this Act must keep  a  summary
32    of  this  Act  approved  by the Director of Labor posted in a
 
                            -14-     LRB093 08007 AMC 08205 b
 1    conspicuous and accessible place in  or  about  the  premises
 2    wherever  any  person  subject  to this Act is employed.  The
 3    Department of Labor must furnish copies  of  the  summary  on
 4    request to employers, without charge.

 5        Section  85.  Adoption of rules.  Each  appropriate State
 6    regulatory agency shall adopt rules, as each agency considers
 7    necessary to implement this Act.

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