Full Text of HB2604 101st General Assembly
HB2604ham002 101ST GENERAL ASSEMBLY | Rep. Fred Crespo Filed: 3/26/2019
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| 1 | | AMENDMENT TO HOUSE BILL 2604
| 2 | | AMENDMENT NO. ______. Amend House Bill 2604 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the Safe | 5 | | Patient Limits Act. | 6 | | Section 5. Definitions. In this Act:
| 7 | | "Couplet" means one mother and one baby.
| 8 | | "Critical trauma patient" means a patient who has an injury | 9 | | to an anatomic area that (i) requires life-saving | 10 | | interventions, or (ii) in conjunction with unstable vital | 11 | | signs, poses an immediate threat to life or limb. | 12 | | "Department" means the Department of Public Health. | 13 | | "Direct care registered professional nurse" means a | 14 | | registered professional nurse whose primary role is to provide | 15 | | direct hands-on patient care. | 16 | | "Facility" means a hospital licensed under the Hospital |
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| 1 | | Licensing Act or organized under the University of Illinois | 2 | | Hospital Act, a private or State-owned and State-operated | 3 | | general acute care hospital, an LTAC hospital as defined in | 4 | | Section 10 of the Long Term Acute Care Hospital Quality | 5 | | Improvement Transfer Program Act, an ambulatory surgical | 6 | | treatment center as defined in Section 3 of the Ambulatory | 7 | | Surgical Treatment Center Act, an acute psychiatric hospital, | 8 | | an acute care specialty hospital, or an acute care unit within | 9 | | a health care facility. "Facility" does not include: (1) the | 10 | | Alton Mental Health Center, at Alton; (2) the Chicago-Read | 11 | | Mental Health Center, at Chicago; (3) the Clyde L. Choate | 12 | | Mental Health and Developmental Center, at Anna; (4) the Elgin | 13 | | Mental Health Center, at Elgin; (5) the John J. Madden Mental | 14 | | Health Center, at Chicago; (6) the Andrew McFarland Mental | 15 | | Health Center, at Springfield; and (7) the Chester Mental | 16 | | Health Center, at Chester.
| 17 | | "Health care workforce" means personnel employed by or | 18 | | contracted to work at a facility that have an effect upon the | 19 | | delivery of quality care to patients, including, but not | 20 | | limited to, registered nurses, licensed practical nurses, | 21 | | unlicensed assistive personnel, service, maintenance, | 22 | | clerical, professional, and technical workers, and other | 23 | | health care workers.
| 24 | | "Immediate postpartum patients" means those patients who | 25 | | have given birth within the previous 2 hours.
| 26 | | "Nursing care" means care that falls within the scope of |
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| 1 | | practice as described in Section 55-30 or 60-35 of the Nurse | 2 | | Practice Act or is otherwise encompassed within recognized | 3 | | standards of nursing practice. | 4 | | "Rapid response team" means a team of health care providers | 5 | | that provide care to hospitalized patients with early signs of | 6 | | deterioration to prevent respiratory or cardiac arrest. | 7 | | "Registered nurse" or "registered professional nurse" | 8 | | means a person who is licensed as a registered professional | 9 | | nurse under the Nurse Practice Act and practices nursing as | 10 | | described in Section 60-35 of the Nurse Practice Act. | 11 | | "Specialty care unit" means a unit which is organized, | 12 | | operated, and maintained to provide care for a specific medical | 13 | | condition or a specific patient population. | 14 | | For the purposes of this Act, a patient is considered | 15 | | assigned to a registered nurse if the registered nurse accepts | 16 | | responsibility for the patient's nursing care. | 17 | | Section 10. Maximum patient assignments for registered | 18 | | nurses.
| 19 | | (a) The maximum number of patients assigned to a registered | 20 | | nurse in a facility shall not exceed the limits provided in | 21 | | this Section. However, nothing shall preclude a facility from | 22 | | assigning fewer patients to a registered nurse than the limits | 23 | | provided in this Section.
The requirements of this Section | 24 | | apply at all times during each shift within each clinical unit | 25 | | and each patient care area. |
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| 1 | | The requirements of this Section do not apply to: (1) the | 2 | | Alton Mental Health Center, at Alton; (2) the Chicago-Read | 3 | | Mental Health Center, at Chicago; (3) the Clyde L. Choate | 4 | | Mental Health and Developmental Center, at Anna; (4) the Elgin | 5 | | Mental Health Center, at Elgin; (5) the John J. Madden Mental | 6 | | Health Center, at Chicago; (6) the Andrew McFarland Mental | 7 | | Health Center, at Springfield; and (7) the Chester Mental | 8 | | Health Center, at Chester | 9 | | (b) In all units with critical care or intensive care | 10 | | patients, including, but not limited to, coronary care, acute | 11 | | respiratory, burn, or neonatal intensive care patients, the | 12 | | maximum patient assignment of critical care patients to a | 13 | | registered nurse is 2. | 14 | | (c) In all units with step-down or intermediate care | 15 | | patients, the maximum patient assignment of step-down or | 16 | | intermediate care patients to a registered nurse is 3.
| 17 | | (d) In all units with postanesthesia care patients, the | 18 | | maximum patient assignment of postanesthesia care patients | 19 | | under the age of 18 to a registered nurse is one. The maximum | 20 | | patient assignment of postanesthesia care patients 18 years of | 21 | | age or older to a registered nurse is 2.
| 22 | | (e) In all units with operating room patients, the maximum | 23 | | patient assignment of operating room patients to a registered | 24 | | nurse is one, provided that a minimum of one additional person | 25 | | serves as a scrub assistant for each patient.
| 26 | | (f) In the emergency department:
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| 1 | | (1) In a unit providing basic emergency medical | 2 | | services or comprehensive emergency medical services, the | 3 | | maximum patient assignment at any time to a registered | 4 | | nurse is 3.
| 5 | | (2) The maximum assignment of critical care emergency | 6 | | patients to a registered nurse is 2. A patient in the | 7 | | emergency department shall be considered a critical care | 8 | | patient when the patient meets the criteria for admission | 9 | | to a critical care service area within the hospital.
| 10 | | (3) The maximum assignment of critical trauma patients | 11 | | in an emergency unit to a registered nurse is one. | 12 | | (4) At least one direct care registered professional | 13 | | nurse shall be assigned to triage patients. The direct care | 14 | | registered professional nurse assigned to triage patients | 15 | | shall be immediately available at all times to triage | 16 | | patients when they arrive in the emergency department. The | 17 | | direct care registered professional nurse assigned to | 18 | | triage patients shall perform triage functions only. | 19 | | (g) In all units with maternal child care patients:
| 20 | | (1) The maximum patient assignment to a registered | 21 | | nurse of antepartum patients requiring continuous fetal | 22 | | monitoring is 2.
| 23 | | (2) The maximum patient assignment of other antepartum | 24 | | patients to a registered nurse is 3.
| 25 | | (3) The maximum patient assignment of active labor | 26 | | patients to a registered nurse is one.
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| 1 | | (4) The maximum patient assignment during birth is one | 2 | | registered nurse responsible for the mother and, for each | 3 | | baby born, one registered nurse whose sole responsibility | 4 | | is that baby.
| 5 | | (5) The maximum patient assignment of immediate | 6 | | postpartum patients is one couplet, and in the case of | 7 | | multiple births, one nurse for each additional baby. | 8 | | (6) The maximum patient assignment of postpartum | 9 | | patients to a registered nurse is 6 patients or 3 couplets.
| 10 | | (h) In all units with pediatric patients, the maximum | 11 | | patient assignment of pediatric patients to a registered nurse | 12 | | is 3.
| 13 | | (i) In all units with psychiatric patients, the maximum | 14 | | patient assignment of psychiatric patients to a registered | 15 | | nurse is 4.
| 16 | | (j) In all units with medical and surgical patients, the | 17 | | maximum patient assignment of medical or surgical patients to a | 18 | | registered nurse is 4.
| 19 | | (k) In all units with telemetry patients, the maximum | 20 | | patient assignment of telemetry patients to a registered nurse | 21 | | is 3.
| 22 | | (l) In all units with observational patients, the maximum | 23 | | patient assignment of observational patients to a registered | 24 | | nurse is 3.
| 25 | | (m) In all units with acute rehabilitation patients, the | 26 | | maximum patient assignment of acute rehabilitation patients to |
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| 1 | | a registered nurse is 4.
| 2 | | (n) In all specialty care units, the maximum patient | 3 | | assignment to a registered nurse is 4. | 4 | | (o) In all units with conscious sedation patients, the | 5 | | maximum patient assignment of conscious sedation patients to a | 6 | | registered nurse is one. | 7 | | (p) In any unit not otherwise listed in this Section, the | 8 | | maximum patient assignment to a registered nurse is 4. | 9 | | Section 15. Use of rapid response teams as first responders | 10 | | prohibited. A rapid response team nurse shall not be given | 11 | | direct care patient assignments while assigned as a nurse | 12 | | responsible for responding to a rapid response team request. | 13 | | Section 20. Implementation by a facility. | 14 | | (a) A facility shall implement the patient limits | 15 | | established by Section 10 without diminishing the staffing | 16 | | levels of the facility's health care workforce, as defined in | 17 | | Section 5. | 18 | | (b) There shall be no averaging of the number of patients | 19 | | and the total number of registered nurses in each clinical unit | 20 | | or patient care area in order to meet the limits established | 21 | | under this Act. | 22 | | (c) Only registered nurses providing direct patient care | 23 | | shall count toward the patient limits under Section 10. Nurse | 24 | | administrators, nurse supervisors, nurse managers, charge |
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| 1 | | nurses, case managers, ancillary staff, unlicensed personnel, | 2 | | or any other hospital administrator or supervisor shall not | 3 | | count toward the patient limits under Section 10. | 4 | | (d) Identifying a clinical unit or patient care area by a | 5 | | name or term other than those listed in this Act does not | 6 | | affect a facility's requirement to staff the unit consistent | 7 | | with the patient limits identified for the level of intensity | 8 | | or type of care described in this Act. | 9 | | (e) A registered nurse providing direct care to a patient | 10 | | has the authority to determine if a change in the patient's | 11 | | status places the patient in a different category requiring a | 12 | | different patient limit under Section 10. | 13 | | (f) A registered nurse may determine that additional | 14 | | ancillary staff, such as licensed practical nurses, certified | 15 | | nursing assistants, or other ancillary staff, excluding | 16 | | medical assistants, are needed in order to provide safe care. | 17 | | (g) A facility shall not employ video monitors or any form | 18 | | of electronic visualization of a patient as a substitute for | 19 | | the direct observation required for patient assessment by the | 20 | | registered nurse or for patient protection. Video monitors or | 21 | | any form of electronic visualization of a patient shall not | 22 | | constitute compliance with the patient limits under Section 10. | 23 | | Section 25. Changes in patient census. | 24 | | (a) A facility shall plan for routine fluctuations in its | 25 | | patient
census, including, but not limited to, admissions, |
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| 1 | | discharges, and transfers. | 2 | | (b) If a health care emergency causes a change in the
| 3 | | number of patients in a clinical care unit or patient care
| 4 | | area, a facility must be able to demonstrate that immediate and | 5 | | diligent efforts were made to maintain required staffing levels | 6 | | under this Act. For purposes of this subsection, "health care | 7 | | emergency" means an emergency declared by the federal | 8 | | government or the head of a State or local governmental entity. | 9 | | Section 30. Record of staff assignments. A facility shall | 10 | | keep a record of the actual direct care registered professional | 11 | | nurse, licensed practical nurse, certified nursing assistant, | 12 | | and other ancillary staff assignments to individual patients | 13 | | documented on a day-to-day, shift-by-shift basis and shall keep | 14 | | copies of its staff assignments on file for a period of 7 | 15 | | years. | 16 | | Section 35. Implementation by the Department. The | 17 | | Department shall adopt rules governing the implementation and | 18 | | operation of this Act. | 19 | | Section 40. Patient acuity systems. Nothing in this Act | 20 | | precludes the use of patient acuity systems consistent with | 21 | | Section 10.10 of the Hospital Licensing Act. However, the | 22 | | maximum patient assignments in Section 10 shall not be exceeded | 23 | | regardless of the use and application of any patient acuity |
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| 1 | | system. | 2 | | Any method, software, or tool used to create or evaluate a | 3 | | staffing plan adopted by a facility shall be established in | 4 | | coordination with direct care registered professional nurses | 5 | | and shall be transparent in all respects, including disclosure | 6 | | of detailed documentation of the methodology used to determine | 7 | | nurse staffing and identifying each factor, assumption, and | 8 | | value used in applying the methodology. The Department shall | 9 | | establish procedures to ensure that the documentation | 10 | | submitted under this Section is available for public inspection | 11 | | in its entirety. | 12 | | Section 45. Training. All facilities shall adopt written | 13 | | policies and procedures for the training and orientation of | 14 | | nursing staff. No registered nurse shall be assigned to a | 15 | | nursing unit or clinical area unless that nurse has first | 16 | | received training and orientation in that clinical area that is | 17 | | sufficient to provide competent care to patients in that area | 18 | | and has demonstrated competence in providing care in that area. | 19 | | Section 50. Enforcement.
A facility's failure to adhere to | 20 | | the limits set by Section 10 shall be reported by the | 21 | | Department to the Attorney General for enforcement, for which | 22 | | the Attorney General may bring action in a court of competent | 23 | | jurisdiction seeking injunctive relief and civil penalties. A | 24 | | separate and distinct violation, for which the facility shall |
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| 1 | | be subject to a civil penalty of up to $25,000, shall be deemed | 2 | | to have been committed on each day during which any violation | 3 | | continues after receipt of written notice of the violation from | 4 | | the Department by the facility. The requirements of this Act, | 5 | | and its enforcement, shall be suspended during a public health | 6 | | emergency declared by the State or federal government.
| 7 | | Section 55. Nurse rights and protections. | 8 | | (a) A registered professional nurse may object to or refuse | 9 | | to participate in any activity, practice, assignment, or task | 10 | | if: | 11 | | (1) in good faith, the nurse reasonably believes it to | 12 | | be a violation of the direct care registered professional | 13 | | nurse-to-patient ratios established under this Act; or | 14 | | (2) the nurse is not prepared by education, training, | 15 | | or experience to fulfill the assignment without | 16 | | compromising the safety of any patient or jeopardizing the | 17 | | license of the nurse. | 18 | | (b) A facility shall not retaliate, discriminate, or | 19 | | otherwise take adverse action in any manner with respect to any | 20 | | aspect of a nurse's employment, including discharge, | 21 | | promotion, compensation, or terms, conditions, or privileges | 22 | | of employment, based on the nurse's refusal to complete an | 23 | | assignment under subsection (a). | 24 | | (c) A facility shall not file a complaint against a | 25 | | registered professional nurse with the Board of Nursing based |
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| 1 | | on the nurse's refusal to complete an assignment under | 2 | | subsection (a). | 3 | | (d) A facility shall not retaliate, discriminate, or | 4 | | otherwise take adverse action in any manner against any person | 5 | | or with respect to any aspect of a nurse's employment, | 6 | | including discharge, promotion, compensation, or terms, | 7 | | conditions, or privileges of employment, based on that nurse's | 8 | | or that person's opposition to any hospital policy, practice, | 9 | | or action that the nurse in good faith believes violates this | 10 | | Act. | 11 | | (e) A facility shall not retaliate, discriminate, or | 12 | | otherwise take adverse action against any patient or employee | 13 | | of the facility or any other individual on the basis that the | 14 | | patient, employee, or individual, in good faith, individually | 15 | | or in conjunction with another person or persons, has presented | 16 | | a grievance or complaint, or has initiated or cooperated in any | 17 | | investigation or proceeding of any governmental entity, | 18 | | regulatory agency, or private accreditation body, made a civil | 19 | | claim or demand, or filed an action relating to the care, | 20 | | services, or conditions of the facility or of any affiliated or | 21 | | related facilities. | 22 | | (f) A facility shall not do either of the following: | 23 | | (1) Interfere with, restrain, or deny the exercise of, | 24 | | or attempt to deny the exercise of, a right conferred under | 25 | | this Act. | 26 | | (2) Coerce or intimidate any individual regarding the |
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| 1 | | exercise of, or an attempt to exercise, a right conferred | 2 | | by this Act.
| 3 | | Section 60. Severability.
The provisions of this Act are | 4 | | severable, and if any clause, sentence, paragraph, subsection, | 5 | | or Section of this law or any application thereof shall be | 6 | | adjudged by any court of competent jurisdiction to be invalid, | 7 | | such judgment shall not affect, impair, or invalidate the | 8 | | remainder thereof but shall be confined in its operation to the | 9 | | clause, sentence, paragraph, subsection, Section, or | 10 | | application adjudged invalid and such clause, sentence, | 11 | | paragraph, subsection, Section, or application shall be | 12 | | reformed and construed so that it would be valid to the maximum | 13 | | extent permitted.
| 14 | | Section 85. The Hospital Licensing Act is amended by | 15 | | changing Section 10.10 as follows: | 16 | | (210 ILCS 85/10.10) | 17 | | Sec. 10.10. Nurse Staffing by Patient Acuity.
| 18 | | (a) Findings. The Legislature finds and declares all of the | 19 | | following: | 20 | | (1) The State of Illinois has a substantial interest in | 21 | | promoting quality care and improving the delivery of health | 22 | | care services. | 23 | | (2) Evidence-based studies have shown that the basic |
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| 1 | | principles of staffing in the acute care setting should be | 2 | | based on the complexity of patients' care needs aligned | 3 | | with available nursing skills to promote quality patient | 4 | | care consistent with professional nursing standards. | 5 | | (3) Compliance with this Section promotes an | 6 | | organizational climate that values registered nurses' | 7 | | input in meeting the health care needs of hospital | 8 | | patients. | 9 | | (b) Definitions. As used in this Section: | 10 | | "Acuity model" means an assessment tool selected and | 11 | | implemented by a hospital, as recommended by a nursing care | 12 | | committee, that assesses the complexity of patient care needs | 13 | | requiring professional nursing care and skills and aligns | 14 | | patient care needs and nursing skills consistent with | 15 | | professional nursing standards. | 16 | | "Department" means the Department of Public Health. | 17 | | "Direct patient care" means care provided by a registered | 18 | | professional nurse with direct responsibility to oversee or | 19 | | carry out medical regimens or nursing care for one or more | 20 | | patients. | 21 | | "Nursing care committee" means an existing or newly created | 22 | | hospital-wide committee or committees of nurses whose | 23 | | functions, in part or in whole, contribute to the development, | 24 | | recommendation, and review of the hospital's nurse staffing | 25 | | plan established pursuant to subsection (d). | 26 | | "Registered professional nurse" means a person licensed as |
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| 1 | | a Registered Nurse under the Nurse
Practice Act. | 2 | | "Written staffing plan for nursing care services" means a | 3 | | written plan for guiding the assignment of patient care nursing | 4 | | staff based on multiple nurse and patient considerations that | 5 | | yield minimum staffing levels for inpatient care units and the | 6 | | adopted acuity model aligning patient care needs with nursing | 7 | | skills required for quality patient care consistent with | 8 | | professional nursing standards. | 9 | | (c) Written staffing plan. | 10 | | (1) Every hospital shall implement a written | 11 | | hospital-wide staffing plan, recommended by a nursing care | 12 | | committee or committees, that provides for minimum direct | 13 | | care professional registered nurse-to-patient staffing | 14 | | needs for each inpatient care unit. The written | 15 | | hospital-wide staffing plan shall include, but need not be | 16 | | limited to, the following considerations: | 17 | | (A) The complexity of complete care, assessment on | 18 | | patient admission, volume of patient admissions, | 19 | | discharges and transfers, evaluation of the progress | 20 | | of a patient's problems, ongoing physical assessments, | 21 | | planning for a patient's discharge, assessment after a | 22 | | change in patient condition, and assessment of the need | 23 | | for patient referrals. | 24 | | (B) The complexity of clinical professional | 25 | | nursing judgment needed to design and implement a | 26 | | patient's nursing care plan, the need for specialized |
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| 1 | | equipment and technology, the skill mix of other | 2 | | personnel providing or supporting direct patient care, | 3 | | and involvement in quality improvement activities, | 4 | | professional preparation, and experience. | 5 | | (C) Patient acuity and the number of patients for | 6 | | whom care is being provided. | 7 | | (D) The ongoing assessments of a unit's patient | 8 | | acuity levels and nursing staff needed shall be | 9 | | routinely made by the unit nurse manager or his or her | 10 | | designee. | 11 | | (E) The identification of additional registered | 12 | | nurses available for direct patient care when | 13 | | patients' unexpected needs exceed the planned workload | 14 | | for direct care staff. | 15 | | (2) In order to provide staffing flexibility to meet | 16 | | patient needs, every hospital shall identify an acuity | 17 | | model for adjusting the staffing plan for each inpatient | 18 | | care unit. | 19 | | (3) The written staffing plan shall be posted in a | 20 | | conspicuous and accessible location for both patients and | 21 | | direct care staff, as required under the Hospital Report | 22 | | Card Act. A copy of the written staffing plan shall be | 23 | | provided to any member of the general public upon request. | 24 | | (d) Nursing care committee. | 25 | | (1) Every hospital shall have a nursing care committee. | 26 | | A hospital shall appoint members of a committee whereby at |
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| 1 | | least 50% of the members are registered professional nurses | 2 | | providing direct patient care. | 3 | | (2) A nursing care committee's recommendations must be | 4 | | given significant regard and weight in the hospital's | 5 | | adoption and implementation of a written staffing plan.
| 6 | | (3) A nursing care committee or committees shall | 7 | | recommend a written staffing plan for the hospital based on | 8 | | the principles from the staffing components set forth in | 9 | | subsection (c). In particular, a committee or committees | 10 | | shall provide input and feedback on the following: | 11 | | (A) Selection, implementation, and evaluation of | 12 | | minimum staffing levels for inpatient care units. | 13 | | (B) Selection, implementation, and evaluation of | 14 | | an acuity model to provide staffing flexibility that | 15 | | aligns changing patient acuity with nursing skills | 16 | | required. | 17 | | (C) Selection, implementation, and evaluation of a | 18 | | written staffing plan incorporating the items | 19 | | described in subdivisions (c)(1) and (c)(2) of this | 20 | | Section. | 21 | | (D) Review the following: nurse-to-patient | 22 | | staffing guidelines for all inpatient areas; and | 23 | | current acuity tools and measures in use. | 24 | | (4) A nursing care committee must address the items | 25 | | described in subparagraphs (A) through (D) of paragraph (3) | 26 | | semi-annually. |
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| 1 | | (e) Nothing in this Section 10.10 shall be construed to | 2 | | limit, alter, or modify any of the terms, conditions, or | 3 | | provisions of a collective bargaining agreement entered into by | 4 | | the hospital.
| 5 | | (f) Delegation of nursing interventions by a registered | 6 | | professional nurse must be in accordance with Section 50-75 of | 7 | | the Nurse Practice Act. | 8 | | (g) A hospital shall not mandate that a registered | 9 | | professional nurse delegate a nursing intervention, including, | 10 | | but not limited to, medication administration, nursing | 11 | | judgment, comprehensive patient assessment, development of the | 12 | | plan of care, or evaluation of care. A delegation of a nursing | 13 | | intervention granted by a registered professional nurse shall | 14 | | not be re-delegated to another.
| 15 | | (Source: P.A. 96-328, eff. 8-11-09; 97-423, eff. 1-1-12; | 16 | | 97-813, eff. 7-13-12.) | 17 | | Section 90. The Nurse Practice Act is amended by adding | 18 | | Section 50-15.15 as follows: | 19 | | (225 ILCS 65/50-15.15 new) | 20 | | Sec. 50-15.15. Clinical professional judgment. | 21 | | (a) Performance of the scope of practice of a direct care | 22 | | registered professional nurse requires the exercise of | 23 | | professional judgment in the exclusive interests of the | 24 | | patient. The exercise of such professional judgment, |
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| 1 | | unencumbered by the commercial or revenue-generation | 2 | | priorities of a hospital, long term acute care hospital, or | 3 | | ambulatory surgical treatment center or other employing entity | 4 | | of a direct care registered professional nurse, is necessary to | 5 | | ensure safe, therapeutic, effective, and competent treatment | 6 | | of patients and is essential to protect the health and safety | 7 | | of the people of Illinois. | 8 | | (b) The exercise of professional judgment by a direct care | 9 | | registered professional nurse in the performance of the scope | 10 | | of practice of the registered professional nurse under Section | 11 | | 60-35 or the scope of practice of the advanced practice | 12 | | registered nurse under Section 65-30 shall be provided in the | 13 | | exclusive interests of the patient and shall not, for any | 14 | | purpose, be considered, relied upon, or represented as a job | 15 | | function, authority, responsibility, or activity undertaken in | 16 | | any respect for the purpose of serving the business, | 17 | | commercial, operational, or other institutional interests of | 18 | | the employer. | 19 | | (c) No hospital, long term acute care hospital, ambulatory | 20 | | surgical treatment center, or other health care institution | 21 | | shall adopt policies that: | 22 | | (1) limit a direct care registered professional nurse | 23 | | in performing duties that are part of the nursing process, | 24 | | including full exercise of professional judgment in | 25 | | assessment, planning, implementation and evaluation of | 26 | | care; or |
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| 1 | | (2) limit a direct care registered professional nurse | 2 | | in acting as a patient advocate in the exclusive interests | 3 | | of the patient. ".
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