Full Text of HB0282 97th General Assembly
HB0282ham001 97TH GENERAL ASSEMBLY | Rep. Mary E. Flowers Filed: 3/2/2012
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| 1 | | AMENDMENT TO HOUSE BILL 282
| 2 | | AMENDMENT NO. ______. Amend House Bill 282 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Article 1. General | 5 | | Section 1-1. Short title. This Act may be cited as the | 6 | | Hospital Patient Protection Act. | 7 | | Article 5. Definitions | 8 | | Section 5-1. Definitions. The definitions set forth in this | 9 | | Article apply unless the context requires otherwise. | 10 | | Section 5-5. Acuity-based patient classification system. | 11 | | "Acuity-based patient classification system" or "system" means | 12 | | a standardized set of criteria based on scientific data that | 13 | | acts as a measurement instrument and that is used to predict |
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| 1 | | registered nursing care requirements for individual patients | 2 | | based on the severity of a patient's illness (including | 3 | | co-morbidities), the need for specialized equipment and | 4 | | technology, the intensity of required nursing interventions, | 5 | | and the complexity of clinical nursing judgment required to | 6 | | design, implement, and evaluate a patient's nursing care plan | 7 | | consistent with professional standards, the ability for | 8 | | self-care (including motor, sensory, and cognitive deficits), | 9 | | the need for advocacy intervention, the licensure of the | 10 | | personnel required for care, the patient care delivery system, | 11 | | the unit's geographic layout, and generally accepted standards | 12 | | of nursing practice, as well as elements reflective of the | 13 | | unique nature of the acute-care hospital's patient population. | 14 | | The system determines the additional number of direct care | 15 | | registered nurses and other licensed and unlicensed nursing | 16 | | staff the hospital must assign, based on the independent | 17 | | professional judgment of the direct care registered nurse, to | 18 | | meet the individual patient needs at all times. | 19 | | Section 5-10. Clinical judgment. "Clinical judgment" means | 20 | | the application of the direct care registered nurse's | 21 | | knowledge, skill, and expertise and experience in making | 22 | | independent decisions about patient care. | 23 | | Section 5-15. Clinical supervision. "Clinical supervision" | 24 | | means the assignment and direction of patient care tasks |
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| 1 | | required in the implementation of nursing care for a patient to | 2 | | other licensed nursing staff or to unlicensed staff by a direct | 3 | | care registered nurse in the exclusive interests of the | 4 | | patient. | 5 | | Section 5-20. Competence. "Competence" means the ability | 6 | | of a direct care registered nurse to act and integrate the | 7 | | knowledge, skills, abilities, and independent professional | 8 | | judgment that underpin safe, therapeutic, and effective | 9 | | patient care. | 10 | | Section 5-25. Critical access hospital. "Critical access | 11 | | hospital" means a health facility designated as such pursuant | 12 | | to a Medicare rural hospital flexibility program as defined in | 13 | | 42 U.S.C. 1395x(mm). | 14 | | Section 5-30. Critical care unit or intensive care unit. | 15 | | "Critical care unit" or "intensive care unit" means a hospital | 16 | | unit established to
safeguard and protect patients whose | 17 | | severity of illness, including all co-morbidities, requires | 18 | | continuous monitoring and complex interventions by a direct | 19 | | care registered nurse and whose restorative measures and level | 20 | | of nursing intensity requires intensive care through direct | 21 | | observation by a direct care registered nurse, complex | 22 | | monitoring, intensive intricate assessment, specialized rapid | 23 | | intervention, evaluation, and education or teaching of the |
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| 1 | | patient and his or her family or other representatives by a | 2 | | competent and experienced direct care registered nurse. The | 3 | | term includes an intensive care unit, a burn center, a coronary | 4 | | care unit, or an acute respiratory unit. | 5 | | Section 5-35. Department. "Department" means the | 6 | | Department of Public Health. | 7 | | Section 5-40. Direct care registered nurse. "Direct care | 8 | | registered nurse" means a competent registered nurse who has | 9 | | accepted a direct care, hands-on patient care assignment to | 10 | | implement medical and nursing regimens while exercising | 11 | | independent professional judgment at all times in the interest | 12 | | of the patient. | 13 | | Section 5-45. Hospital. "Hospital" means a general | 14 | | hospital, psychiatric hospital, short-term
acute-care | 15 | | hospital, long-term acute-care hospital, or critical access | 16 | | hospital, or any institution, place, building, or agency, | 17 | | public or private, whether organized for profit or not, devoted | 18 | | primarily to the maintenance and operation of facilities for | 19 | | the diagnosis, prevention, and treatment of physical or mental | 20 | | human illness, including convalescence and rehabilitation and | 21 | | including care during and after pregnancy, or care of 2 or more | 22 | | unrelated persons admitted for over night stay or longer, in | 23 | | order to obtain medical, including nursing, care of illness, |
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| 1 | | disease, injury, infirmity, or deformity. | 2 | | Section 5-50. Hospital unit or clinical patient care area. | 3 | | "Hospital unit" or "clinical patient care area" means an | 4 | | intensive
care critical care unit, burn unit, labor and | 5 | | delivery room (ante-partum and post-partum), newborn nursery, | 6 | | post-anesthesia service area, emergency department, operating | 7 | | room, pediatric unit, step-down or intermediate care unit, | 8 | | specialty care unit, telemetry unit, general medical/surgical | 9 | | care unit, psychiatric unit, rehabilitation unit, or skilled | 10 | | nursing unit. | 11 | | Section 5-55. Long-term acute-care hospital. "Long-term | 12 | | acute-care hospital" means any hospital or health care facility | 13 | | that specializes in providing acute care to medically complex | 14 | | patients with an anticipated length of stay of more than 25 | 15 | | days. The term includes both free-standing and | 16 | | "hospital-within-hospital" models of long-term acute-care | 17 | | facilities. | 18 | | Section 5-60. Medical/surgical unit. "Medical/surgical | 19 | | unit" means a unit established to safeguard and protect | 20 | | patients whose severity of illness, including all | 21 | | co-morbidities, requires continuous observation and complex | 22 | | interventions, and whose restorative measures and level of | 23 | | nursing intensity require continuous care by a competent and |
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| 1 | | experienced direct care registered nurse. These units may | 2 | | include general medical and post-surgical patients requiring | 3 | | less than intensive care or step-down care and may include | 4 | | mixed patient populations of diverse diagnoses and diverse age | 5 | | groups excluding pediatric patients. | 6 | | Section 5-65. Nursing intensity. "Nursing intensity" | 7 | | means a direct observation or monitoring by a direct care | 8 | | registered nurse, multiple assessments, specialized | 9 | | intervention, evaluation, education or teaching of the patient | 10 | | and his or her family or other representatives, and | 11 | | documentation. | 12 | | Section 5-70. Patient advocacy. "Patient advocacy" means | 13 | | the professional obligation and right of a registered nurse or | 14 | | a registered professional nurse to act as a patient advocate, | 15 | | as circumstances require, by initiating action to improve | 16 | | health care or change decisions or activities which in the | 17 | | professional judgment of the registered nurse are against the | 18 | | interests or wishes of the patient, or by giving the patient | 19 | | the opportunity to make informed decisions about health care | 20 | | before it is provided. | 21 | | Section 5-75. Patient assessment. "Patient assessment" | 22 | | means the utilization of critical thinking, which is the | 23 | | intellectually disciplined process of actively and skillfully |
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| 1 | | interpreting, applying, analyzing, synthesizing, or evaluating | 2 | | data obtained through direct observation and communication | 3 | | with others. | 4 | | Section 5-80. Professional judgment. "Professional | 5 | | judgment" means the intellectual (educated, informed, and | 6 | | experienced) process that a direct care registered nurse | 7 | | exercises in forming an opinion and reaching a clinical | 8 | | decision, in the patient's best interest, based upon analysis | 9 | | of data, information, and scientific evidence.
| 10 | | Section 5-85. Rehabilitation unit. "Rehabilitation unit" | 11 | | means a functional clinical unit for the provision of those | 12 | | rehabilitation services that restore an ill or injured patient | 13 | | to the highest level of self-sufficiency in the shortest | 14 | | possible time, compatible with the patient's physical, | 15 | | intellectual, and emotional or psychological capabilities and | 16 | | in accordance with planned goals and objectives. | 17 | | Section 5-90. Skilled nursing unit. "Skilled nursing unit" | 18 | | means a functional clinical unit (i) for the provision of | 19 | | skilled nursing care and supportive care to patients whose | 20 | | primary need is for the availability of skilled nursing care on | 21 | | a long-term basis, who are admitted after at least a 48-hour | 22 | | period of continuous inpatient care, and (ii) which provides at | 23 | | least the following: medical, nursing, dietary, and |
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| 1 | | pharmaceutical services and an activity program. | 2 | | Section 5-95. Specialty care unit. "Specialty care unit" | 3 | | means a unit (i) established to safeguard and protect patients | 4 | | whose severity of illness, including all co-morbidities, | 5 | | requires continuous observation and complex interventions, | 6 | | (ii) whose restorative measures and level of nursing intensity | 7 | | require continuous care by a competent and experienced direct | 8 | | care registered nurse, (iii) that provides intensity of care | 9 | | for a specific medical condition or a specific patient | 10 | | population, and (iv) is more comprehensive for the specific | 11 | | condition or disease process than is required on | 12 | | medical/surgical units. The term includes a hospital unit that | 13 | | is not a critical care or intensive care unit, medical/surgical | 14 | | unit, rehabilitation unit, skilled nursing unit, step-down | 15 | | unit, or telemetry unit. | 16 | | Section 5-100. Step-down unit. "Step-down unit" means a | 17 | | unit (i) established to safeguard and protect
patients whose | 18 | | severity of illness, including all co-morbidities, requires | 19 | | continuous monitoring and complex interventions and (ii) whose | 20 | | restorative measures and level of nursing intensity require | 21 | | intermediate intensive care by a competent and experienced | 22 | | direct care registered nurse for the immediate amelioration or | 23 | | remediation of severe pathology for those patients requiring | 24 | | less care than intensive care, but more than is required from |
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| 1 | | medical/surgical care. | 2 | | Section 5-105. Telemetry unit. "Telemetry unit" means a | 3 | | unit (i) established to safeguard and protect patients whose | 4 | | severity of illness, including all co-morbidities, requires | 5 | | continuous monitoring and complex intervention, (ii) whose | 6 | | restorative measures and level of nursing intensity require | 7 | | intermediate intensive care by a competent and experienced | 8 | | direct care registered nurse, and (iii) designated for the | 9 | | electronic monitoring, recording, retrieval, and display of | 10 | | cardiac electrical signals. | 11 | | Article 10. Minimum Safe Staffing Ratios | 12 | | Section 10-5. Direct care registered nurse staffing | 13 | | generally. | 14 | | (a) Each hospital shall provide minimum staffing by direct
| 15 | | care registered nurses in accordance with the clinical unit | 16 | | direct care registered nurse-to-patient staffing requirements | 17 | | and ratios specified in Sections 10-15, 10-20, and 10-25. | 18 | | Staffing for care not requiring a direct care registered nurse | 19 | | is not included within these ratios and shall be determined | 20 | | pursuant to the acuity-based patient classification system | 21 | | described in Section 10-40. | 22 | | (b) No hospital shall assign a direct care registered nurse | 23 | | to a nursing unit or clinical area unless that hospital and the |
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| 1 | | direct care registered nurse determine that the direct care | 2 | | registered nurse has demonstrated current competence in | 3 | | providing care in that area and has also received orientation | 4 | | to that hospital's clinical area sufficient to provide | 5 | | competent safe, therapeutic, and effective nursing care to | 6 | | patients in that area. The policies and procedures of the | 7 | | hospital shall contain the hospital's criteria for making this | 8 | | determination. | 9 | | Section 10-10. Direct care registered nurse-to-patient | 10 | | ratios generally. | 11 | | (a) Direct care registered nurse-to-patient ratios | 12 | | represent the maximum number of patients that shall be assigned | 13 | | to one direct care registered nurse at any one time. For | 14 | | purposes of this subsection, "assigned" means that the direct | 15 | | care registered nurse has responsibility for the provision of | 16 | | care to a particular patient within her or his validated | 17 | | competency. | 18 | | (b) There shall be no averaging of the number of patients | 19 | | and the total number of direct care registered nurses on the | 20 | | unit during any one shift or over any period of time. | 21 | | (c) Only direct care registered nurses providing direct | 22 | | patient care shall be included in the ratios. Nurse | 23 | | Administrators, Nurse Supervisors, Nurse Managers, Charge | 24 | | Nurses, or Case Managers shall not be included in the | 25 | | calculation of the direct care registered nurse-to-patient |
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| 1 | | ratio. | 2 | | (d) Only direct care registered nurses shall relieve other | 3 | | direct care registered nurses during breaks, meals, and other | 4 | | routine, expected absences from the unit. | 5 | | Section 10-15. Direct care registered nurse staffing; | 6 | | emergency department. | 7 | | (a) There shall be no fewer than 2 direct care registered | 8 | | nurses physically present in the emergency department when a | 9 | | patient is present. At least one direct care registered nurse | 10 | | shall be assigned to triage patients. Only direct care | 11 | | registered nurses shall be assigned to triage patients. The | 12 | | direct care registered nurse assigned to triage patients shall | 13 | | be immediately available at all times to triage patients when | 14 | | they arrive in the emergency department. The direct care | 15 | | registered nurse assigned to triage patients shall perform | 16 | | triage functions only. Triage direct care registered nurses, | 17 | | base radio responder direct care registered nurses, and | 18 | | specialty/flight registered nurses do not count in the | 19 | | calculation of the direct care registered nurse-to-patient | 20 | | ratio. | 21 | | (b) When registered nursing staff, with validated critical | 22 | | care competency, are attending critical care patients in the | 23 | | emergency department, the direct care registered | 24 | | nurse-to-patient ratio shall be 1:2 or fewer critical care | 25 | | patients at all times. A patient in the emergency department |
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| 1 | | shall be considered a critical care patient when the patient | 2 | | meets the criteria for admission to a critical care service | 3 | | area within the hospital. Only direct care registered nurses | 4 | | shall be assigned to critical trauma patients in the emergency | 5 | | department, and a minimum direct care registered nurse to | 6 | | critical trauma patient ratio of 1:1 shall be maintained at all | 7 | | times. A critical trauma patient is a patient who has injuries | 8 | | to an anatomic area that (i) require life saving interventions | 9 | | or (ii) in conjunction with unstable vital signs, pose an | 10 | | immediate threat to life or limb. | 11 | | Section 10-20. Direct care registered nurse staffing; | 12 | | operating room. The surgical services operating room shall have | 13 | | at least one direct care registered nurse assigned to the | 14 | | duties of the circulating nurse and a minimum of one additional | 15 | | person serving as scrub assistant for each patient-occupied | 16 | | operating room.
| 17 | | Section 10-25. Direct care registered nurse-to-patient | 18 | | ratios; hospital clinical units or patient care areas. | 19 | | (a) The direct care registered nurse-to-patient ratio | 20 | | shall be 1:1 or fewer at all times when
assigned to duties of | 21 | | the circulating registered nurse in the operating room or | 22 | | during a cesarean delivery; when assigned to an active labor | 23 | | patient or a patient with medical or obstetrical complications, | 24 | | or when initiating epidural anesthesia in the labor and |
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| 1 | | delivery suite; when assigned to an unstable or in | 2 | | resuscitation period newborn; when assigned to a critical | 3 | | trauma patient in the emergency department; or when assigned to | 4 | | a patient receiving conscious sedation. | 5 | | (b) The direct care registered nurse-to-patient ratio | 6 | | shall be 1:2 or fewer at all times for
critical care, intensive | 7 | | care, neonatal intensive care, labor and delivery units, | 8 | | coronary care, acute respiratory care, post-anesthesia | 9 | | recovery (regardless of the type of anesthesia the patient | 10 | | received), and burn units/patient care areas; when assigned to | 11 | | critical patients in the emergency department; or when assigned | 12 | | to immediate post-partum patients. | 13 | | (c) The direct care registered nurse-to-patient ratio | 14 | | shall be 1:3 or fewer at all times for the
emergency | 15 | | department, a step-down or intermediate intensive care, | 16 | | pediatric, telemetry, combined labor/delivery/post-partum unit | 17 | | or patient care area; when assigned to ante-partum patients who | 18 | | are not in active labor; or when assigned to mother-baby | 19 | | couplets. | 20 | | (d) The direct care registered nurse-to-patient ratio | 21 | | shall be 1:4 or fewer at all times for a
medical/surgical, | 22 | | pre-surgical/admission, ambulatory surgical, psychiatric, or | 23 | | other specialty care unit or patient care area; when assigned | 24 | | to post-partum patients, post-surgical gynecological patients, | 25 | | or mothers only; when assigned to recently born infants; or | 26 | | when assigned to combined post-cesarean delivery mothers and |
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| 1 | | newborns. | 2 | | (e) The direct care registered nurse-to-patient ratio | 3 | | shall be 1:5 or fewer at all times for the well baby
nursery or | 4 | | a rehabilitation unit or patient care area or for a skilled | 5 | | nursing facility. | 6 | | (f) In the event of multiple births, the total number of | 7 | | mothers plus infants assigned to a single direct care | 8 | | registered nurse shall never exceed 6. | 9 | | Section 10-30. Staffing requirements in relation to | 10 | | hospital units. | 11 | | (a) Identifying a unit by a name or term other than | 12 | | "hospital unit", "clinical patient care area", "critical care | 13 | | unit", "intensive care unit", "medical/surgical unit", | 14 | | "rehabilitation unit", "skilled nursing unit", "specialty care | 15 | | unit", "step-down unit", or "telemetry unit", as defined in | 16 | | this Act, does not affect a hospital's requirement to staff the | 17 | | unit at the direct care registered nurse-to-patient ratios | 18 | | identified for the level of intensity or type of care described | 19 | | in this Article. | 20 | | (b) Patients shall be cared for only on units where the | 21 | | level of intensity, type of care, and direct care registered | 22 | | nurse-to-patient ratios meet the individual requirements and | 23 | | needs of each patient. The use of acuity-adjustable units or | 24 | | clinical patient care areas is strictly prohibited. |
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| 1 | | Section 10-35. Use of rapid response teams as first | 2 | | responders prohibited. In no case may a hospital use rapid | 3 | | response teams as first responders. | 4 | | Section 10-40. Additional nursing staff. In addition to any | 5 | | other direct care registered nurse-to-patient ratio | 6 | | requirements of this Article 10, every hospital shall assign | 7 | | additional nursing staff, such as licensed practical nurses, | 8 | | certified nursing assistants, and other ancillary staff, | 9 | | through the implementation of a valid acuity-based patient | 10 | | classification system for determining nursing care needs of | 11 | | individual patients that reflects the assessment, made by the | 12 | | assigned direct care registered nurse, of patient nursing care | 13 | | requirements and provides for shift-by-shift staffing based on | 14 | | those requirements. | 15 | | Section 10-45. Written staffing plan. A written staffing | 16 | | plan shall be developed by every hospital's Chief Nursing | 17 | | Officer or a designee, based on individual patient care needs | 18 | | determined by the acuity-based patient classification system. | 19 | | The staffing plan shall be developed and implemented for each | 20 | | patient care unit and shall specify individual patient care | 21 | | requirements and the staffing levels or skill mix for direct | 22 | | care registered nurses and other licensed and unlicensed | 23 | | personnel. In no case shall the staffing level for direct care | 24 | | registered nurses on any shift fall below the requirements set |
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| 1 | | forth in this Article 10. | 2 | | Section 10-50. Record of staff assignments. Every hospital | 3 | | shall keep a record of the actual direct care registered nurse, | 4 | | licensed practical nurse, certified nursing assistant, and | 5 | | other ancillary staff assignments to individual patients | 6 | | documented on a day-to-day, shift-by-shift basis and must keep | 7 | | copies of its staff assignments on file for a period of 2 | 8 | | years. | 9 | | Section 10-55. Patient classification system review | 10 | | committee. A hospital shall appoint a patient classification | 11 | | system review committee. At least 60% of the members of a | 12 | | hospital's patient classification system review committee | 13 | | shall be unit-specific competent direct care registered nurses | 14 | | who provide direct patient care. The members of the committee | 15 | | shall be appointed by the hospital's Chief Nursing Officer, | 16 | | except that if direct care registered nurses are represented | 17 | | for collective bargaining purposes, all direct care registered | 18 | | nurses on the committee shall be appointed by the authorized | 19 | | collective bargaining agent. | 20 | | Section 10-60. Changes in patient census. Every hospital | 21 | | shall plan for routine fluctuations, such as admissions, | 22 | | discharges, and transfers, in its patient census. If a health | 23 | | care emergency causes a change in the number of patients on a |
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| 1 | | unit, the hospital must demonstrate that immediate and diligent | 2 | | efforts were made to maintain required staffing levels. For | 3 | | purposes of this Section, "health care emergency" means an | 4 | | emergency declared by the federal government or the head of a | 5 | | State or local governmental entity. | 6 | | Section 10-65. Department; study of nursing staff. Not | 7 | | later than 2 years after the effective date of this Act, the | 8 | | Department shall complete and publish a study of licensed and | 9 | | unlicensed hospital nursing staff and its effects on patient | 10 | | safety and care in hospitals. | 11 | | Section 10-70. Prohibited activities. | 12 | | (a) A hospital may not directly assign any unlicensed | 13 | | personnel to perform registered-nurse functions in lieu of care | 14 | | delivered by a registered nurse and may not assign unlicensed | 15 | | personnel to perform registered-nurse functions under the | 16 | | supervision of a direct care registered nurse. | 17 | | (b) Unlicensed personnel may not perform tasks that require | 18 | | the clinical assessment, judgment, and skill of a licensed | 19 | | registered nurse, including, without limitation: nursing | 20 | | activities that require nursing assessment and judgment during | 21 | | implementation; physical, psychological, and social | 22 | | assessments that require nursing judgment, intervention, | 23 | | referral, or follow-up; formulation of a plan of nursing care | 24 | | and evaluation of the patient's response to the care provided; |
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| 1 | | and administration of medications.
| 2 | | (c) A hospital may not impose mandatory overtime | 3 | | requirements to meet the staffing ratios required in this | 4 | | Article 10. | 5 | | (d) A hospital may not impose lay-offs of licensed or | 6 | | practical nurses, certified nursing assistants, or other | 7 | | ancillary staff to meet the direct care registered | 8 | | nurse-to-patient ratio requirements of this Article 10. | 9 | | Section 10-75. Consumer protection. Every hospital shall | 10 | | post on a day-to-day, shift-by-shift basis, in a conspicuous | 11 | | place visible to the patients, hospital staff, and public (i) | 12 | | the ratios of direct care registered nursing staff to patients | 13 | | on each unit, (ii) additional staffing requirements as | 14 | | determined by the patient classification system for each unit, | 15 | | (iii) the actual staff and staff mix provided, and (iv) the | 16 | | variance between required and actual staffing patterns. Every | 17 | | hospital shall give to each patient admitted to the hospital | 18 | | for inpatient care a toll-free telephone number for the | 19 | | Department of Public Health to report inadequate staffing or | 20 | | care. | 21 | | Article 15. Direct Care Registered Nurse
| 22 | | Functions Relating to Patient Care | 23 | | Section 15-5. Functions generally.
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| 1 | | (a) A direct care professional nurse, holding a valid | 2 | | license to practice as a registered nurse, employing scientific | 3 | | knowledge and experience in the physical, social, and | 4 | | biological sciences and exercising independent judgment in | 5 | | applying the nursing process, shall directly perform the | 6 | | following essential functions:
| 7 | | (1) Continuous and ongoing assessments of a patient's | 8 | | condition based upon the independent professional judgment | 9 | | of the direct care registered nurse. | 10 | | (2) Planning, clinical supervision, implementation, | 11 | | and evaluation of the nursing care provided to each | 12 | | patient. The implementation of nursing care may be assigned | 13 | | by the direct care registered nurse responsible for the | 14 | | patient to other licensed nursing staff or to unlicensed | 15 | | staff, subject to any limitations of the licensure, | 16 | | certification, level of validated competency, or | 17 | | applicable law concerning such staff. In any case, however: | 18 | | (A) The direct care registered nurse assigned to a | 19 | | patient must determine in her or his professional | 20 | | judgment that nursing personnel to be assigned patient | 21 | | care tasks possess the necessary preparation and | 22 | | capability to competently perform the assigned tasks. | 23 | | (B) The direct care registered nurse may assign the | 24 | | implementation of nursing care only when circumstances | 25 | | permit the direct care registered nurse to effectively | 26 | | supervise nursing care provided pursuant to the |
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| 1 | | assignment. | 2 | | (3) Assessment, planning, implementation, and | 3 | | evaluation of patient education, including ongoing | 4 | | discharge teaching of each patient. Any assignment of | 5 | | specific patient education tasks to patient care personnel | 6 | | shall be made by the direct care registered nurse | 7 | | responsible for the patient.
| 8 | | (b) The planning and delivery of patient care (i) shall | 9 | | reflect all elements of the nursing process, including | 10 | | assessment, nursing diagnosis, planning, intervention, | 11 | | evaluation, and, as circumstances require, patient advocacy, | 12 | | and (ii) shall be initiated by a direct care registered nurse | 13 | | at the time of a patient's admission to the hospital. | 14 | | (c) The nursing plan for a patient's care shall be | 15 | | discussed with and developed as a result of coordination with | 16 | | the patient, the patient's family, or other representatives of | 17 | | the patient, when appropriate, and staff of other disciplines | 18 | | involved in the care of the patient. | 19 | | (d) The direct care registered nurse shall evaluate the | 20 | | effectiveness of the care plan (i) through assessments based on | 21 | | direct observation of the patient's physical condition and | 22 | | behavior, signs and symptoms of illness, and reactions to | 23 | | treatment and (ii) through communication with the patient and | 24 | | the health care team members. The direct care registered nurse | 25 | | shall modify the plan as needed. | 26 | | (e) Information related to the patient's initial |
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| 1 | | assessment and reassessments, nursing diagnosis, plan, | 2 | | intervention, evaluation, and patient advocacy shall be | 3 | | permanently recorded, as narrative registered nurse progress | 4 | | notes, in the patient's medical record. The practice of | 5 | | "charting by exception" is expressly prohibited. | 6 | | Section 15-10. Patient assessment. | 7 | | (a) Patient assessment requires (i) direct observation of | 8 | | the patient's signs and symptoms of illness, reaction to | 9 | | treatment, behavior and physical condition, and (ii) | 10 | | interpretation of information obtained from the patient and | 11 | | others, including other care givers on the health team. | 12 | | Assessment requires data collection by the direct care | 13 | | registered nurse and the analysis, synthesis, and evaluation of | 14 | | such data. | 15 | | (b) Only a direct care registered nurse is authorized to | 16 | | perform patient assessments. A licensed practical nurse may | 17 | | assist a direct care registered nurse in data collection. | 18 | | Section 15-15. Determining nursing care needs of patients. | 19 | | (a) The nursing care needs of an individual patient shall | 20 | | be determined by a direct care registered nurse through the | 21 | | process of ongoing patient assessments, nursing diagnosis, and | 22 | | formulation and adjustment of nursing care plans. | 23 | | (b) The prediction of individual patient nursing care needs | 24 | | for prospective assignment of direct care registered nurses |
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| 1 | | shall be based on individual patient assessments by the direct | 2 | | care registered nurse assigned to each patient and in | 3 | | accordance with a documented patient classification system as | 4 | | provided in Article 10. | 5 | | Section 15-20. Independent judgment. | 6 | | (a) Competent performance of the essential functions of a | 7 | | direct care registered nurse as described in subdivisions | 8 | | (a)(1) through (a)(3) of Section 15-5, Section 15-10, and | 9 | | Section 15-15 requires the exercise of independent judgment in | 10 | | the interests of the patient. The exercise of such independent | 11 | | judgment, unencumbered by the commercial or revenue-generation | 12 | | priorities of a hospital or other employing entity of a direct | 13 | | care registered nurse, is necessary to assure safe, | 14 | | therapeutic, and competent treatment of hospital patients and | 15 | | is essential to protect the health and safety of the people of | 16 | | Illinois. | 17 | | (b) The exercise of independent judgment by a direct care | 18 | | registered nurse in the performance of the essential functions | 19 | | described in subdivisions (a)(1) through (a)(3) of Section 15-5 | 20 | | and as provided in this Act and the Nurse Practice Act shall be | 21 | | provided in the exclusive interests of the patient and shall | 22 | | not, for any purpose, be considered, relied upon, or | 23 | | represented as a job function, authority, responsibility, or | 24 | | activity undertaken in any respect for the purpose of serving | 25 | | the business, commercial, operational, or other institutional |
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| 1 | | interests of the hospital. | 2 | | Section 15-25. Clinical supervision. | 3 | | (a) In addition to the limitations on assignments of | 4 | | patient care tasks provided in subsections (a) and (b) of | 5 | | Section 10-70, a direct care registered nurse responsible for a | 6 | | patient may assign tasks required in the implementation of | 7 | | nursing care for that patient to other licensed nurses or to | 8 | | unlicensed personnel only if she or he: | 9 | | (1) determines that the personnel to whom the tasks are | 10 | | assigned have statutory authority to define the tasks and | 11 | | possess the necessary training, experience, and capability | 12 | | to competently and safely perform the tasks to be assigned; | 13 | | and | 14 | | (2) effectively supervises the clinical functions and | 15 | | nursing care tasks performed by the assigned personnel. | 16 | | (b) The exercise of clinical supervision of nursing care | 17 | | personnel by a direct care registered nurse in the performance | 18 | | of the essential functions described in subdivisions (a)(1) | 19 | | through (a)(3) of Section 15-5 and as provided in this Act and | 20 | | the Nurse Practice Act shall be in the exclusive interests of | 21 | | the patient and shall not, for any purpose, be considered, | 22 | | relied upon, or represented as a job function, authority, | 23 | | responsibility, or activity undertaken in any respect for the | 24 | | purpose of serving the business, commercial, operational, or | 25 | | other institutional interests of the hospital employer, but |
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| 1 | | constitute the exercise of professional nursing authority and | 2 | | duty exclusively in the interests of the patient. | 3 | | Article 20. Patient Advocacy | 4 | | Section 20-5. Professional obligation. A registered nurse | 5 | | has the professional obligation and therefore the right to act | 6 | | as a patient's advocate, as circumstances require, by (i) | 7 | | initiating action to improve the patient's health care or to | 8 | | change decisions or activities which, in the professional | 9 | | judgment of the registered nurse, are against the interests or | 10 | | wishes of the patient and (ii) giving the patient the | 11 | | opportunity to make informed decisions about his or her health | 12 | | care before it is provided. | 13 | | Section 20-10. Acceptance of patient care assignments. A | 14 | | direct care registered nurse is always responsible for | 15 | | providing safe, therapeutic, and competent nursing care to | 16 | | assigned patients. Before accepting a patient assignment, a | 17 | | direct care registered nurse must have the necessary knowledge, | 18 | | judgment, skills, and ability to provide the required care. It | 19 | | is the responsibility of the direct care registered nurse to | 20 | | determine whether she or he is clinically competent to perform | 21 | | the nursing care required by patients in a particular clinical | 22 | | unit or with a particular diagnosis, condition, prognosis, or | 23 | | other determinative characteristics of nursing care. If a |
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| 1 | | direct care registered nurse is not clinically competent to | 2 | | perform the care required for a patient to be assigned for | 3 | | nursing care, she or he should not accept the patient care | 4 | | assignment. Such a refusal to accept a patient care assignment | 5 | | is an exercise of the direct care registered nurse's duty and | 6 | | right of patient advocacy. | 7 | | Section 20-15. Acceptance of orders. | 8 | | (a) In the course of performing the responsibilities and | 9 | | essential functions described in Article 15, a direct care | 10 | | registered nurse assigned to a patient shall receive orders | 11 | | initiated by physicians and other legally authorized health | 12 | | care professionals within their scope of licensure regarding | 13 | | patient care services to be provided to the patient, including, | 14 | | without limitation, the administration of medications and | 15 | | therapeutic agents necessary to implement a treatment, disease | 16 | | prevention, or rehabilitative regimen. | 17 | | (b) The direct care registered nurse shall assess each such | 18 | | order before implementation to determine whether the order is: | 19 | | (i) in the best interests of the patient; (ii) initiated by a | 20 | | person legally authorized to issue the order; and (iii) in | 21 | | accordance with applicable law and regulation governing | 22 | | nursing care. | 23 | | (c) If a direct care registered nurse determines that the | 24 | | criteria described in items (i) through (iii) of subsection (b) | 25 | | have not been satisfied with respect to a particular order, or |
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| 1 | | has some doubt regarding the meaning or conformance of the | 2 | | order with those criteria, she or he shall seek clarification | 3 | | from the initiator of the order, the patient's physician, or | 4 | | another appropriate medical officer. Clarification must be | 5 | | obtained prior to implementing the order. | 6 | | If, upon clarification, the direct care registered nurse | 7 | | determines that the criteria for implementation of the order | 8 | | have not been satisfied, she or he may refuse to implement the | 9 | | order on the basis that the order is not in the best interests | 10 | | of the patient. | 11 | | Seeking clarification of an order or refusing an order as | 12 | | described in this Section constitutes an exercise of the direct | 13 | | care registered nurse's duty and right of patient advocacy.
| 14 | | Section 20-20. Protected speech. | 15 | | (a) Every direct care registered nurse responsible for | 16 | | patient care in a hospital shall enjoy the right of free speech | 17 | | and shall be protected in the exercise of that right as | 18 | | provided in this Section, both during working hours and during | 19 | | off-duty hours. The right of free speech protected by this | 20 | | Section is a necessary incident of the professional nurse's | 21 | | duty of patient advocacy and is essential to protecting the | 22 | | health and safety of hospital patients and of the people of | 23 | | Illinois. | 24 | | (b) The speech protected by this Section includes, without | 25 | | limitation, any type of spoken, gestured, written, printed, or |
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| 1 | | electronically communicated expression concerning any matter | 2 | | related to or affecting safe, therapeutic, and competent direct | 3 | | care registered nursing practice at a hospital facility, at | 4 | | facilities within a large health delivery system or corporate | 5 | | chain which includes a hospital, or more generally within the | 6 | | health care industry.
| 7 | | The content of speech protected by this Section includes, | 8 | | without limitation, the facts and circumstances of particular | 9 | | events, patient care practices, institutional actions, | 10 | | policies, or conditions which may facilitate or impede | 11 | | competent and safe nursing practice or patient care, adverse | 12 | | patient outcomes or incidents, sentinel or reportable events, | 13 | | and arguments in support of or against hospital policies or | 14 | | practices relating to the delivery of nursing care. | 15 | | Protected speech under this Section includes the | 16 | | reporting, whether internally, externally, or publicly, of | 17 | | actions, conduct, events, practices, or other matters that are | 18 | | believed to do any of the following: | 19 | | (1) Constitute a violation of federal, State, or local | 20 | | laws or regulations. | 21 | | (2) Constitute a breach of applicable codes of | 22 | | professional ethics, including the professional and | 23 | | ethical obligations of direct care registered nurses. | 24 | | (3) Concern matters which the reporting direct care | 25 | | registered nurse believes are appropriate or required for | 26 | | disclosure in furtherance and support of the nurse's |
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| 1 | | exercise of patient advocacy duties to improve health care | 2 | | or change decisions or activities which in the professional | 3 | | judgment of the direct care registered nurse are against | 4 | | the interests or wishes of a patient, or to ensure that a | 5 | | patient is afforded a meaningful opportunity to make | 6 | | informed decisions about health care before it is provided. | 7 | | (4) Concern matters described in paragraph (3) made in | 8 | | aid and support of the exercise of patient advocacy duties | 9 | | of direct care registered nurse colleagues.
| 10 | | (c) Nothing in this Section is intended to authorize | 11 | | disclosure of private and confidential patient information, | 12 | | except when such disclosure is (i) required by law, (ii) | 13 | | compelled by proper legal process, (iii) consented to by the | 14 | | patient, or (iv) provided in confidence to a regulatory or | 15 | | accreditation agency or other governmental entity for | 16 | | investigatory purposes or pursuant to a formal or informal | 17 | | complaint of unlawful or improper practices for purposes of | 18 | | achieving corrective and remedial action. | 19 | | (d) Engaging in speech activity protected under this | 20 | | Section constitutes an exercise of the direct care registered | 21 | | nurse's duty and right of patient advocacy. The subject matter | 22 | | of protected speech activity as described in this Section is | 23 | | presumed to be a matter of public concern, and the disclosures | 24 | | protected under this Section are presumed to be in the public | 25 | | interest. |
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| 1 | | Section 20-25. Fiduciary duty; conflict of interest. | 2 | | (a) A direct care registered nurse is in a fiduciary | 3 | | relationship to an assigned patient as to matters within the | 4 | | scope of practice and professional responsibility of the nurse | 5 | | to provide safe, therapeutic, and competent nursing care in the | 6 | | interests of the patient. As to such matters, the registered | 7 | | nurse responsible for a patient shall perform the essential | 8 | | functions of a direct care registered nurse exclusively in the | 9 | | interests of the patient and shall not be influenced by the | 10 | | interests of any third party or the directives of any such | 11 | | third party or by motives other than the accomplishment of her | 12 | | or his professional responsibility to provided safe, | 13 | | therapeutic, and competent nursing care in the interests and | 14 | | for the benefit of the patient. | 15 | | (b) A direct care registered nurse shall not be influenced | 16 | | by her or his own personal interests or by the interests or | 17 | | demands of a third party which are in conflict with the | 18 | | interests of assigned patients in performing the essential | 19 | | registered nursing functions required under Article 15. The | 20 | | refusal by a direct care registered nurse to engage in activity | 21 | | involving such a conflict of interest with respect to nursing | 22 | | care for which she or he is responsible shall constitute an | 23 | | exercise of the registered nurse's duty and right of patient | 24 | | advocacy. | 25 | | Section 20-30. Participation in organizations. |
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| 1 | | (a) A direct care nurse, as a necessary incident and | 2 | | condition of her or his independent duty and right of patient | 3 | | advocacy, shall have the right to do the following: | 4 | | (1) To form, join, or participate in independent | 5 | | hospital-based professional practice committees, general | 6 | | and specialty registered nursing professional | 7 | | associations, patient advocacy organizations, and labor | 8 | | organizations. | 9 | | (2) To seek representation to engage in collective | 10 | | bargaining with her or his hospital employer, or to seek | 11 | | other mutual aid or protection in exercising the | 12 | | professional duty and public health responsibility of | 13 | | patient advocacy. | 14 | | (b) Engaging in activity described in subsection (a) | 15 | | constitutes an exercise of the professional nurse's duty and | 16 | | right of patient advocacy. | 17 | | Section 20-35. Protected rights. | 18 | | (a) Any person has the right to: | 19 | | (1) Oppose any policy, practice, or action of any | 20 | | hospital that is alleged to violate, breach, or fail to | 21 | | comply with any provision of this Act. | 22 | | (2) Cooperate, provide evidence, testify, or otherwise | 23 | | support or participate in any investigation or complaint | 24 | | proceeding conducted pursuant to Section 20-45. | 25 | | (b) By virtue of her or his professional license and |
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| 1 | | ethical obligations, a direct care registered nurse has a duty | 2 | | and right to act and provide care exclusively in the interests | 3 | | of patients and to act as a patient's advocate, as | 4 | | circumstances require, by (i) initiating action to improve | 5 | | health care or to change decisions or activities which in the | 6 | | professional judgment of the direct care registered nurse are | 7 | | against the interests or wishes of an assigned patient or (ii) | 8 | | giving a patient the opportunity to make informed decisions | 9 | | about health care before it is provided. This Act confirms and | 10 | | creates statutory patient advocacy rights for direct care | 11 | | registered nurses as provided in this Article 20 and made | 12 | | enforceable under Article 25. | 13 | | (c) A patient in a hospital who is aggrieved by the | 14 | | hospital's interference with the full and free exercise of | 15 | | patient advocacy duties by a direct care registered nurse has | 16 | | the right to make or file a complaint and to cooperate, provide | 17 | | evidence, testify, or otherwise support or participate in any | 18 | | investigation or complaint proceeding conducted pursuant to | 19 | | Article 25. A patient shall be considered "aggrieved" for | 20 | | purposes of this subsection if the patient's health or safety | 21 | | was jeopardized or the patient was exposed to additional risk | 22 | | of injury, disease, pain, or suffering as a consequence of | 23 | | conditions or circumstances caused in whole or in part by the | 24 | | hospital's interference with patient advocacy rights of a | 25 | | direct care registered nurse. Actual physical injury, disease, | 26 | | pain, or suffering is not required for a patient to have |
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| 1 | | standing to file a complaint and obtain appropriate remedies | 2 | | under Article 25. | 3 | | (d) A direct care registered nurse who is aggrieved by a | 4 | | hospital's interference with the full and free exercise of the | 5 | | nurse's patient advocacy duties has the right to make or file a | 6 | | complaint cooperate, provide evidence, testify, or otherwise | 7 | | support or participate in any investigation or complaint | 8 | | proceeding conducted pursuant to Article 25. | 9 | | Section 20-40. Interference with rights and duties | 10 | | prohibited. | 11 | | (a) It is unlawful for a hospital to interfere with, | 12 | | restrain, coerce, intimidate, or deny the exercise or the | 13 | | attempt to exercise, by any person, of any right provided or | 14 | | protected under this Act. | 15 | | (b) It is unlawful for a hospital to discriminate or | 16 | | retaliate against any person for opposing any policy, practice, | 17 | | or action of the hospital which is alleged to violate, breach, | 18 | | or fail to comply with any provision of this Act. | 19 | | (c) No hospital employer shall make, adopt, or enforce any | 20 | | rule, regulation, policy, or practice which directly or | 21 | | indirectly prohibits, impedes, discourages, intimidates, | 22 | | coerces, or induces in any manner a direct care registered | 23 | | nurse from engaging in protected speech activities or | 24 | | disclosing information as provided in this Article 20. | 25 | | (d) No hospital employer shall make, adopt, or enforce any |
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| 1 | | rule, regulation, policy, or practice which directly or | 2 | | indirectly authorizes, sanctions, permits, excuses, or | 3 | | encourages any other person to engage in conduct which is | 4 | | likely to prohibit, impede, discourage, intimidate, coerce, or | 5 | | induce in any manner a direct care registered nurse from | 6 | | engaging in protected speech activities or disclosing | 7 | | information as provided in this Article 20. | 8 | | (e) No hospital or other health care institution shall | 9 | | engage in the deployment of technology that limits a direct | 10 | | care registered nurse (i) in performing functions that are part | 11 | | of the nursing process, including full exercise of independent | 12 | | clinical judgment in assessment, planning, implementation and | 13 | | evaluation of care or (ii) from acting as a patient advocate in | 14 | | the exclusive interest of the patient. Technology shall not be | 15 | | skill-degrading, interfere with a direct care registered | 16 | | nurse's provision of individualized patient care, or override a | 17 | | direct care registered nurse's independent professional | 18 | | judgment. In addition, there shall be no interference with a | 19 | | registered nurse's right to advocate in the exclusive interest | 20 | | of a patient. | 21 | | (f) A hospital employer, all management personnel employed | 22 | | by a hospital, all personnel with management or supervisory | 23 | | authority employed by a hospital, including the registered | 24 | | nurse administrator, registered nurse manager, or registered | 25 | | nurse supervisor, and all medical personnel who treat patients | 26 | | admitted to hospital nursing unit, whether employed by the |
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| 1 | | hospital or privileged to admit patients through an affiliated | 2 | | medical group or otherwise, are strictly prohibited from | 3 | | interfering with the rights and obligations of a direct care | 4 | | registered nurses to perform the duties of patient advocacy as | 5 | | provided in this Article 20. | 6 | | Prohibited interference with patient advocacy duties of a | 7 | | direct care registered nurse includes conduct, actions, or | 8 | | omissions which directly or indirectly are likely to prohibit, | 9 | | impede, discourage, intimidate, coerce, or induce in any manner | 10 | | a direct care registered nurse from taking action indicated or | 11 | | authorized by the professional obligations of patient advocacy | 12 | | described in this Article 20. Any act of prohibited | 13 | | interference committed by an individual within his or her | 14 | | course and scope of employment as management, nursing service, | 15 | | or medical personnel for a hospital as described in this | 16 | | subsection shall be considered prohibited interference by the | 17 | | hospital for purposes of this Act. | 18 | | (g) An employee of a hospital employer who has authority to | 19 | | take, direct others to take, recommend, or approve any | 20 | | personnel action of the employer with respect to a direct care | 21 | | registered nurse shall not, with respect to such authority, | 22 | | take or fail to take, or threaten to take or fail to take, any | 23 | | such action with respect to such nurse because the nurse | 24 | | engages in conduct in furtherance of her or his duties and | 25 | | rights as described in this Article 20, including, without | 26 | | limitation, refusing to obey an order that the direct care |
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| 1 | | registered nurse has determined, in the exercise of her or his | 2 | | independent judgment, should be refused in accordance with the | 3 | | direct care registered nurse's duty and right of patient | 4 | | advocacy. Any such action or omission undertaken in the course | 5 | | or scope of employment for a hospital shall be considered an | 6 | | action or omission of the hospital for purposes of this Act. | 7 | | (h) Any employee of a hospital employer who has authority | 8 | | to take, direct others to take, recommend, or approve any | 9 | | report of any incident, conduct, or circumstances involving a | 10 | | direct care registered nurse employed by the hospital to any | 11 | | professional licensing board, disciplinary body, or | 12 | | investigatory function or officer for purposes of complaint, | 13 | | investigation, or imposition of professional discipline or | 14 | | other adverse action affecting the direct care registered | 15 | | nurse's active license status or good standing to practice as a | 16 | | duly licensed registered nurse in the State of Illinois, shall | 17 | | not, with respect to such authority, take or fail to take, or | 18 | | threaten to take or fail to take, any such action with respect | 19 | | to such direct care registered nurse because the direct care | 20 | | registered nurse engages in conduct in furtherance of her or | 21 | | his duties and rights as described in this Article 20, | 22 | | including, without limitation, refusing to obey an order that | 23 | | the direct care registered nurse has determined, in the | 24 | | exercise of her or his independent judgment, should be refused | 25 | | in accordance with the registered nurse's duty of patient | 26 | | advocacy. |
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| 1 | | Section 20-45. Retaliation or discrimination prohibited. A | 2 | | hospital employer may not discriminate or retaliate in any | 3 | | manner against any patient, employee, or contract employee of | 4 | | the hospital, or any other person, because that person has (i) | 5 | | presented a grievance or complaint, (ii) initiated or | 6 | | cooperated in any investigation or proceeding of any | 7 | | governmental entity, regulatory agency, or private | 8 | | accreditation body, (iii) made a civil claim or demand, or (iv) | 9 | | filed an action relating to the care, services, or conditions | 10 | | of that hospital or of any affiliated or related facility. | 11 | | Article 25. Enforcement of Rights. | 12 | | Section 25-5. Liability for damages or equitable relief. | 13 | | (a) A hospital employer who violates any provision of | 14 | | Article 20 is liable to the aggrieved employee for the | 15 | | following: | 16 | | (1) Damages equal to the amount of: | 17 | | (A) any wages, salary, employment benefits, or | 18 | | other compensation denied or lost to the employee by | 19 | | reason of the violation; or | 20 | | (B) in a case in which wages, salary, employment | 21 | | benefits, or other compensation have not been denied or | 22 | | lost to the employee, any actual monetary loss | 23 | | sustained by the employee as a direct result of the |
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| 1 | | violation.
| 2 | | (2) Interest on the amount of damages described in | 3 | | paragraph (1), calculated at the prevailing rate. | 4 | | (3) An additional amount as liquidated damages equal to | 5 | | the sum of the amount of damages described in paragraph (1) | 6 | | and the interest described in paragraph (2). | 7 | | (b) In addition to the relief set forth in subsection (a), | 8 | | a hospital employer is liable for such equitable relief as may | 9 | | be appropriate, including including the aggrieved employee's | 10 | | employment reinstatement. | 11 | | Section 25-10. Action to recover damages or equitable | 12 | | relief. | 13 | | (a) An action to recover the damages or equitable relief | 14 | | described in Section 25-5 may be maintained against any | 15 | | hospital employer (including a public agency) in any court of | 16 | | competent jurisdiction by any one or more employees for and in | 17 | | behalf of the employee or employees as well as other employees | 18 | | similarly situated. | 19 | | (b) The court in an action under this Section shall award | 20 | | to a prevailing plaintiff reasonable attorney's fees, | 21 | | reasonable expert witness fees, and other costs of the action. | 22 | | (c) An action may be brought under this Section not later | 23 | | than 2 years after the date of the last event constituting the | 24 | | alleged violation for which the action is brought. | 25 | | (d) In the case of an action brought under this Section for |
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| 1 | | a willful violation, the action may be brought within 3 years | 2 | | after the date of the last event constituting the alleged | 3 | | violation for which the action is brought. | 4 | | Section 25-15. Retaliation against patient; presumption. | 5 | | If a hospital engages in any type of discriminatory treatment | 6 | | of a patient by whom, or upon whose behalf, a grievance or | 7 | | complaint has been submitted, directly or indirectly, to any | 8 | | governmental entity, regulatory agency, or private | 9 | | accreditation body, and if that discriminatory treatment | 10 | | occurs within 180 days after the filing of the grievance or | 11 | | complaint, then the hospital's conduct raises a rebuttable | 12 | | presumption that the action was taken by the hospital in | 13 | | retaliation for the filing of the grievance or complaint.
| 14 | | Section 25-20. Retaliation against employee; presumption; | 15 | | relief. | 16 | | (a) If a hospital (i) engages in any type of discriminatory | 17 | | treatment of an employee who has presented a grievance or | 18 | | complaint, or initiated, participated in, or cooperated in any | 19 | | investigation or proceeding by or before any governmental | 20 | | entity or private accreditation body, and (ii) had knowledge of | 21 | | the employee's initiation, participation, or cooperation, and | 22 | | if that discriminatory treatment occurs within 180 days after | 23 | | the filing of the grievance or complaint, then the hospital's | 24 | | conduct raises a rebuttable presumption that the |
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| 1 | | discriminatory action was taken by the hospital in retaliation | 2 | | for the filing of the grievance or complaint. For purposes of | 3 | | this Section, "discriminatory treatment of an employee" | 4 | | includes discharge, demotion, suspension, or any other | 5 | | unfavorable change in the terms or conditions of employment, or | 6 | | the threat of any such action. | 7 | | (b) An employee who has been discriminated against as | 8 | | described in subsection (a) is entitled to reinstatement, | 9 | | reimbursement for lost wages and work benefits caused by the | 10 | | acts of the employer, and an award of reasonable attorney's | 11 | | fees and costs as the prevailing party.
| 12 | | Section 25-25. Civil penalties. | 13 | | (a) If a hospital employer is found to have violated or | 14 | | interfered with any of the rights or protections provided and | 15 | | guaranteed under this Article, the Department may assess a | 16 | | civil penalty of not more than $25,000 for each such violation | 17 | | or occurrence of prohibited conduct. | 18 | | (b) If any member of a hospital's management, nursing | 19 | | service, or medical personnel is found to have violated or | 20 | | interfered with any of the rights or protections provided and | 21 | | guaranteed under this Article, the Department may assess a | 22 | | civil penalty of not more than $20,000 for each such violation | 23 | | or occurrence of prohibited conduct. | 24 | | (c) A hospital found to have violated or aided and abetted | 25 | | a violation of any provision of Article 10 is subject (i) in |
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| 1 | | addition to any other penalties that may be prescribed by law, | 2 | | to enforcement action by the Department, including the use of | 3 | | injunctive relief available to force compliance with that | 4 | | Article or closure of the hospital and (ii) to a civil money | 5 | | penalty assessed by the Department of not more than $25,000 for | 6 | | each violation and an additional $10,000 per nursing unit shift | 7 | | until the violation is corrected. | 8 | | (d) The Attorney General shall enforce penalties imposed | 9 | | under this Section in the county in which the violation | 10 | | occurred. | 11 | | (e) The penalties authorized under this Section are in | 12 | | addition to any other penalties that may be imposed under this | 13 | | Act. Penalties collected pursuant to this Section shall be | 14 | | deposited into the General Revenue Fund. | 15 | | Section 25-30. Posting of Act provisions. Every hospital | 16 | | shall post the provisions of Articles 15 and 20 in a prominent | 17 | | place for review by the hospital's employees and patients and | 18 | | by the public. The posting shall have a title across the top in | 19 | | no less than 35 point, bold typeface stating the following: | 20 | | "RIGHTS OF REGISTERED NURSES AS PATIENT ADVOCATES AND OF | 21 | | EMPLOYEES AND PATIENTS".
| 22 | | Article 90. Amendatory Provisions | 23 | | Section 90-5. The Hospital Licensing Act is amended by |
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| 1 | | adding Section 2.5 as follows: | 2 | | (210 ILCS 85/2.5 new) | 3 | | Sec. 2.5. Relationship to Hospital Patient Protection Act. | 4 | | In the case of a conflict between a provision of this Act and a | 5 | | provision of the Hospital Patient Protection Act, the Hospital | 6 | | Patient Protection Act shall control. | 7 | | Section 90-10. The Nurse Practice Act is amended by adding | 8 | | Section 50-17 as follows: | 9 | | (225 ILCS 65/50-17 new) | 10 | | Sec. 50-17. Relationship to Hospital Patient Protection | 11 | | Act. In the case of a conflict between a provision of this Act | 12 | | and a provision of the Hospital Patient Protection Act, the | 13 | | Hospital Patient Protection Act shall control. ".
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