Rep. Mary E. Flowers

Filed: 3/2/2012

 

 


 

 


 
09700HB0282ham001LRB097 06642 DRJ 67048 a

1
AMENDMENT TO HOUSE BILL 282

2    AMENDMENT NO. ______. Amend House Bill 282 by replacing
3everything after the enacting clause with the following:
 
4
"Article 1. General

 
5    Section 1-1. Short title. This Act may be cited as the
6Hospital Patient Protection Act.
 
7
Article 5. Definitions

 
8    Section 5-1. Definitions. The definitions set forth in this
9Article apply unless the context requires otherwise.
 
10    Section 5-5. Acuity-based patient classification system.
11"Acuity-based patient classification system" or "system" means
12a standardized set of criteria based on scientific data that
13acts as a measurement instrument and that is used to predict

 

 

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1registered nursing care requirements for individual patients
2based on the severity of a patient's illness (including
3co-morbidities), the need for specialized equipment and
4technology, the intensity of required nursing interventions,
5and the complexity of clinical nursing judgment required to
6design, implement, and evaluate a patient's nursing care plan
7consistent with professional standards, the ability for
8self-care (including motor, sensory, and cognitive deficits),
9the need for advocacy intervention, the licensure of the
10personnel required for care, the patient care delivery system,
11the unit's geographic layout, and generally accepted standards
12of nursing practice, as well as elements reflective of the
13unique nature of the acute-care hospital's patient population.
14The system determines the additional number of direct care
15registered nurses and other licensed and unlicensed nursing
16staff the hospital must assign, based on the independent
17professional judgment of the direct care registered nurse, to
18meet the individual patient needs at all times.
 
19    Section 5-10. Clinical judgment. "Clinical judgment" means
20the application of the direct care registered nurse's
21knowledge, skill, and expertise and experience in making
22independent decisions about patient care.
 
23    Section 5-15. Clinical supervision. "Clinical supervision"
24means the assignment and direction of patient care tasks

 

 

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1required in the implementation of nursing care for a patient to
2other licensed nursing staff or to unlicensed staff by a direct
3care registered nurse in the exclusive interests of the
4patient.
 
5    Section 5-20. Competence. "Competence" means the ability
6of a direct care registered nurse to act and integrate the
7knowledge, skills, abilities, and independent professional
8judgment that underpin safe, therapeutic, and effective
9patient care.
 
10    Section 5-25. Critical access hospital. "Critical access
11hospital" means a health facility designated as such pursuant
12to a Medicare rural hospital flexibility program as defined in
1342 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
16unit established to safeguard and protect patients whose
17severity of illness, including all co-morbidities, requires
18continuous monitoring and complex interventions by a direct
19care registered nurse and whose restorative measures and level
20of nursing intensity requires intensive care through direct
21observation by a direct care registered nurse, complex
22monitoring, intensive intricate assessment, specialized rapid
23intervention, evaluation, and education or teaching of the

 

 

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1patient and his or her family or other representatives by a
2competent and experienced direct care registered nurse. The
3term includes an intensive care unit, a burn center, a coronary
4care unit, or an acute respiratory unit.
 
5    Section 5-35. Department. "Department" means the
6Department of Public Health.
 
7    Section 5-40. Direct care registered nurse. "Direct care
8registered nurse" means a competent registered nurse who has
9accepted a direct care, hands-on patient care assignment to
10implement medical and nursing regimens while exercising
11independent professional judgment at all times in the interest
12of the patient.
 
13    Section 5-45. Hospital. "Hospital" means a general
14hospital, psychiatric hospital, short-term acute-care
15hospital, long-term acute-care hospital, or critical access
16hospital, or any institution, place, building, or agency,
17public or private, whether organized for profit or not, devoted
18primarily to the maintenance and operation of facilities for
19the diagnosis, prevention, and treatment of physical or mental
20human illness, including convalescence and rehabilitation and
21including care during and after pregnancy, or care of 2 or more
22unrelated persons admitted for over night stay or longer, in
23order to obtain medical, including nursing, care of illness,

 

 

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1disease, 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
4intensive care critical care unit, burn unit, labor and
5delivery room (ante-partum and post-partum), newborn nursery,
6post-anesthesia service area, emergency department, operating
7room, pediatric unit, step-down or intermediate care unit,
8specialty care unit, telemetry unit, general medical/surgical
9care unit, psychiatric unit, rehabilitation unit, or skilled
10nursing unit.
 
11    Section 5-55. Long-term acute-care hospital. "Long-term
12acute-care hospital" means any hospital or health care facility
13that specializes in providing acute care to medically complex
14patients with an anticipated length of stay of more than 25
15days. The term includes both free-standing and
16"hospital-within-hospital" models of long-term acute-care
17facilities.
 
18    Section 5-60. Medical/surgical unit. "Medical/surgical
19unit" means a unit established to safeguard and protect
20patients whose severity of illness, including all
21co-morbidities, requires continuous observation and complex
22interventions, and whose restorative measures and level of
23nursing intensity require continuous care by a competent and

 

 

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1experienced direct care registered nurse. These units may
2include general medical and post-surgical patients requiring
3less than intensive care or step-down care and may include
4mixed patient populations of diverse diagnoses and diverse age
5groups excluding pediatric patients.
 
6    Section 5-65. Nursing intensity. "Nursing intensity"
7means a direct observation or monitoring by a direct care
8registered nurse, multiple assessments, specialized
9intervention, evaluation, education or teaching of the patient
10and his or her family or other representatives, and
11documentation.
 
12    Section 5-70. Patient advocacy. "Patient advocacy" means
13the professional obligation and right of a registered nurse or
14a registered professional nurse to act as a patient advocate,
15as circumstances require, by initiating action to improve
16health care or change decisions or activities which in the
17professional judgment of the registered nurse are against the
18interests or wishes of the patient, or by giving the patient
19the opportunity to make informed decisions about health care
20before it is provided.
 
21    Section 5-75. Patient assessment. "Patient assessment"
22means the utilization of critical thinking, which is the
23intellectually disciplined process of actively and skillfully

 

 

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1interpreting, applying, analyzing, synthesizing, or evaluating
2data obtained through direct observation and communication
3with others.
 
4    Section 5-80. Professional judgment. "Professional
5judgment" means the intellectual (educated, informed, and
6experienced) process that a direct care registered nurse
7exercises in forming an opinion and reaching a clinical
8decision, in the patient's best interest, based upon analysis
9of data, information, and scientific evidence.
 
10    Section 5-85. Rehabilitation unit. "Rehabilitation unit"
11means a functional clinical unit for the provision of those
12rehabilitation services that restore an ill or injured patient
13to the highest level of self-sufficiency in the shortest
14possible time, compatible with the patient's physical,
15intellectual, and emotional or psychological capabilities and
16in accordance with planned goals and objectives.
 
17    Section 5-90. Skilled nursing unit. "Skilled nursing unit"
18means a functional clinical unit (i) for the provision of
19skilled nursing care and supportive care to patients whose
20primary need is for the availability of skilled nursing care on
21a long-term basis, who are admitted after at least a 48-hour
22period of continuous inpatient care, and (ii) which provides at
23least the following: medical, nursing, dietary, and

 

 

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1pharmaceutical services and an activity program.
 
2    Section 5-95. Specialty care unit. "Specialty care unit"
3means a unit (i) established to safeguard and protect patients
4whose severity of illness, including all co-morbidities,
5requires continuous observation and complex interventions,
6(ii) whose restorative measures and level of nursing intensity
7require continuous care by a competent and experienced direct
8care registered nurse, (iii) that provides intensity of care
9for a specific medical condition or a specific patient
10population, and (iv) is more comprehensive for the specific
11condition or disease process than is required on
12medical/surgical units. The term includes a hospital unit that
13is not a critical care or intensive care unit, medical/surgical
14unit, rehabilitation unit, skilled nursing unit, step-down
15unit, or telemetry unit.
 
16    Section 5-100. Step-down unit. "Step-down unit" means a
17unit (i) established to safeguard and protect patients whose
18severity of illness, including all co-morbidities, requires
19continuous monitoring and complex interventions and (ii) whose
20restorative measures and level of nursing intensity require
21intermediate intensive care by a competent and experienced
22direct care registered nurse for the immediate amelioration or
23remediation of severe pathology for those patients requiring
24less care than intensive care, but more than is required from

 

 

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1medical/surgical care.
 
2    Section 5-105. Telemetry unit. "Telemetry unit" means a
3unit (i) established to safeguard and protect patients whose
4severity of illness, including all co-morbidities, requires
5continuous monitoring and complex intervention, (ii) whose
6restorative measures and level of nursing intensity require
7intermediate intensive care by a competent and experienced
8direct care registered nurse, and (iii) designated for the
9electronic monitoring, recording, retrieval, and display of
10cardiac electrical signals.
 
11
Article 10. Minimum Safe Staffing Ratios

 
12    Section 10-5. Direct care registered nurse staffing
13generally.
14    (a) Each hospital shall provide minimum staffing by direct
15care registered nurses in accordance with the clinical unit
16direct care registered nurse-to-patient staffing requirements
17and ratios specified in Sections 10-15, 10-20, and 10-25.
18Staffing for care not requiring a direct care registered nurse
19is not included within these ratios and shall be determined
20pursuant to the acuity-based patient classification system
21described in Section 10-40.
22    (b) No hospital shall assign a direct care registered nurse
23to a nursing unit or clinical area unless that hospital and the

 

 

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1direct care registered nurse determine that the direct care
2registered nurse has demonstrated current competence in
3providing care in that area and has also received orientation
4to that hospital's clinical area sufficient to provide
5competent safe, therapeutic, and effective nursing care to
6patients in that area. The policies and procedures of the
7hospital shall contain the hospital's criteria for making this
8determination.
 
9    Section 10-10. Direct care registered nurse-to-patient
10ratios generally.
11    (a) Direct care registered nurse-to-patient ratios
12represent the maximum number of patients that shall be assigned
13to one direct care registered nurse at any one time. For
14purposes of this subsection, "assigned" means that the direct
15care registered nurse has responsibility for the provision of
16care to a particular patient within her or his validated
17competency.
18    (b) There shall be no averaging of the number of patients
19and the total number of direct care registered nurses on the
20unit during any one shift or over any period of time.
21    (c) Only direct care registered nurses providing direct
22patient care shall be included in the ratios. Nurse
23Administrators, Nurse Supervisors, Nurse Managers, Charge
24Nurses, or Case Managers shall not be included in the
25calculation of the direct care registered nurse-to-patient

 

 

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1ratio.
2    (d) Only direct care registered nurses shall relieve other
3direct care registered nurses during breaks, meals, and other
4routine, expected absences from the unit.
 
5    Section 10-15. Direct care registered nurse staffing;
6emergency department.
7    (a) There shall be no fewer than 2 direct care registered
8nurses physically present in the emergency department when a
9patient is present. At least one direct care registered nurse
10shall be assigned to triage patients. Only direct care
11registered nurses shall be assigned to triage patients. The
12direct care registered nurse assigned to triage patients shall
13be immediately available at all times to triage patients when
14they arrive in the emergency department. The direct care
15registered nurse assigned to triage patients shall perform
16triage functions only. Triage direct care registered nurses,
17base radio responder direct care registered nurses, and
18specialty/flight registered nurses do not count in the
19calculation of the direct care registered nurse-to-patient
20ratio.
21    (b) When registered nursing staff, with validated critical
22care competency, are attending critical care patients in the
23emergency department, the direct care registered
24nurse-to-patient ratio shall be 1:2 or fewer critical care
25patients at all times. A patient in the emergency department

 

 

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1shall be considered a critical care patient when the patient
2meets the criteria for admission to a critical care service
3area within the hospital. Only direct care registered nurses
4shall be assigned to critical trauma patients in the emergency
5department, and a minimum direct care registered nurse to
6critical trauma patient ratio of 1:1 shall be maintained at all
7times. A critical trauma patient is a patient who has injuries
8to an anatomic area that (i) require life saving interventions
9or (ii) in conjunction with unstable vital signs, pose an
10immediate threat to life or limb.
 
11    Section 10-20. Direct care registered nurse staffing;
12operating room. The surgical services operating room shall have
13at least one direct care registered nurse assigned to the
14duties of the circulating nurse and a minimum of one additional
15person serving as scrub assistant for each patient-occupied
16operating room.
 
17    Section 10-25. Direct care registered nurse-to-patient
18ratios; hospital clinical units or patient care areas.
19    (a) The direct care registered nurse-to-patient ratio
20shall be 1:1 or fewer at all times when assigned to duties of
21the circulating registered nurse in the operating room or
22during a cesarean delivery; when assigned to an active labor
23patient or a patient with medical or obstetrical complications,
24or when initiating epidural anesthesia in the labor and

 

 

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1delivery suite; when assigned to an unstable or in
2resuscitation period newborn; when assigned to a critical
3trauma patient in the emergency department; or when assigned to
4a patient receiving conscious sedation.
5    (b) The direct care registered nurse-to-patient ratio
6shall be 1:2 or fewer at all times for critical care, intensive
7care, neonatal intensive care, labor and delivery units,
8coronary care, acute respiratory care, post-anesthesia
9recovery (regardless of the type of anesthesia the patient
10received), and burn units/patient care areas; when assigned to
11critical patients in the emergency department; or when assigned
12to immediate post-partum patients.
13    (c) The direct care registered nurse-to-patient ratio
14shall be 1:3 or fewer at all times for the emergency
15department, a step-down or intermediate intensive care,
16pediatric, telemetry, combined labor/delivery/post-partum unit
17or patient care area; when assigned to ante-partum patients who
18are not in active labor; or when assigned to mother-baby
19couplets.
20    (d) The direct care registered nurse-to-patient ratio
21shall be 1:4 or fewer at all times for a medical/surgical,
22pre-surgical/admission, ambulatory surgical, psychiatric, or
23other specialty care unit or patient care area; when assigned
24to post-partum patients, post-surgical gynecological patients,
25or mothers only; when assigned to recently born infants; or
26when assigned to combined post-cesarean delivery mothers and

 

 

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1newborns.
2    (e) The direct care registered nurse-to-patient ratio
3shall be 1:5 or fewer at all times for the well baby nursery or
4a rehabilitation unit or patient care area or for a skilled
5nursing facility.
6    (f) In the event of multiple births, the total number of
7mothers plus infants assigned to a single direct care
8registered nurse shall never exceed 6.
 
9    Section 10-30. Staffing requirements in relation to
10hospital units.
11    (a) Identifying a unit by a name or term other than
12"hospital unit", "clinical patient care area", "critical care
13unit", "intensive care unit", "medical/surgical unit",
14"rehabilitation unit", "skilled nursing unit", "specialty care
15unit", "step-down unit", or "telemetry unit", as defined in
16this Act, does not affect a hospital's requirement to staff the
17unit at the direct care registered nurse-to-patient ratios
18identified for the level of intensity or type of care described
19in this Article.
20    (b) Patients shall be cared for only on units where the
21level of intensity, type of care, and direct care registered
22nurse-to-patient ratios meet the individual requirements and
23needs of each patient. The use of acuity-adjustable units or
24clinical patient care areas is strictly prohibited.
 

 

 

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1    Section 10-35. Use of rapid response teams as first
2responders prohibited. In no case may a hospital use rapid
3response teams as first responders.
 
4    Section 10-40. Additional nursing staff. In addition to any
5other direct care registered nurse-to-patient ratio
6requirements of this Article 10, every hospital shall assign
7additional nursing staff, such as licensed practical nurses,
8certified nursing assistants, and other ancillary staff,
9through the implementation of a valid acuity-based patient
10classification system for determining nursing care needs of
11individual patients that reflects the assessment, made by the
12assigned direct care registered nurse, of patient nursing care
13requirements and provides for shift-by-shift staffing based on
14those requirements.
 
15    Section 10-45. Written staffing plan. A written staffing
16plan shall be developed by every hospital's Chief Nursing
17Officer or a designee, based on individual patient care needs
18determined by the acuity-based patient classification system.
19The staffing plan shall be developed and implemented for each
20patient care unit and shall specify individual patient care
21requirements and the staffing levels or skill mix for direct
22care registered nurses and other licensed and unlicensed
23personnel. In no case shall the staffing level for direct care
24registered nurses on any shift fall below the requirements set

 

 

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1forth in this Article 10.
 
2    Section 10-50. Record of staff assignments. Every hospital
3shall keep a record of the actual direct care registered nurse,
4licensed practical nurse, certified nursing assistant, and
5other ancillary staff assignments to individual patients
6documented on a day-to-day, shift-by-shift basis and must keep
7copies of its staff assignments on file for a period of 2
8years.
 
9    Section 10-55. Patient classification system review
10committee. A hospital shall appoint a patient classification
11system review committee. At least 60% of the members of a
12hospital's patient classification system review committee
13shall be unit-specific competent direct care registered nurses
14who provide direct patient care. The members of the committee
15shall be appointed by the hospital's Chief Nursing Officer,
16except that if direct care registered nurses are represented
17for collective bargaining purposes, all direct care registered
18nurses on the committee shall be appointed by the authorized
19collective bargaining agent.
 
20    Section 10-60. Changes in patient census. Every hospital
21shall plan for routine fluctuations, such as admissions,
22discharges, and transfers, in its patient census. If a health
23care emergency causes a change in the number of patients on a

 

 

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1unit, the hospital must demonstrate that immediate and diligent
2efforts were made to maintain required staffing levels. For
3purposes of this Section, "health care emergency" means an
4emergency declared by the federal government or the head of a
5State or local governmental entity.
 
6    Section 10-65. Department; study of nursing staff. Not
7later than 2 years after the effective date of this Act, the
8Department shall complete and publish a study of licensed and
9unlicensed hospital nursing staff and its effects on patient
10safety and care in hospitals.
 
11    Section 10-70. Prohibited activities.
12    (a) A hospital may not directly assign any unlicensed
13personnel to perform registered-nurse functions in lieu of care
14delivered by a registered nurse and may not assign unlicensed
15personnel to perform registered-nurse functions under the
16supervision of a direct care registered nurse.
17    (b) Unlicensed personnel may not perform tasks that require
18the clinical assessment, judgment, and skill of a licensed
19registered nurse, including, without limitation: nursing
20activities that require nursing assessment and judgment during
21implementation; physical, psychological, and social
22assessments that require nursing judgment, intervention,
23referral, or follow-up; formulation of a plan of nursing care
24and evaluation of the patient's response to the care provided;

 

 

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1and administration of medications.
2    (c) A hospital may not impose mandatory overtime
3requirements to meet the staffing ratios required in this
4Article 10.
5    (d) A hospital may not impose lay-offs of licensed or
6practical nurses, certified nursing assistants, or other
7ancillary staff to meet the direct care registered
8nurse-to-patient ratio requirements of this Article 10.
 
9    Section 10-75. Consumer protection. Every hospital shall
10post on a day-to-day, shift-by-shift basis, in a conspicuous
11place visible to the patients, hospital staff, and public (i)
12the ratios of direct care registered nursing staff to patients
13on each unit, (ii) additional staffing requirements as
14determined by the patient classification system for each unit,
15(iii) the actual staff and staff mix provided, and (iv) the
16variance between required and actual staffing patterns. Every
17hospital shall give to each patient admitted to the hospital
18for inpatient care a toll-free telephone number for the
19Department of Public Health to report inadequate staffing or
20care.
 
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
2license to practice as a registered nurse, employing scientific
3knowledge and experience in the physical, social, and
4biological sciences and exercising independent judgment in
5applying the nursing process, shall directly perform the
6following 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
9reflect all elements of the nursing process, including
10assessment, nursing diagnosis, planning, intervention,
11evaluation, and, as circumstances require, patient advocacy,
12and (ii) shall be initiated by a direct care registered nurse
13at the time of a patient's admission to the hospital.
14    (c) The nursing plan for a patient's care shall be
15discussed with and developed as a result of coordination with
16the patient, the patient's family, or other representatives of
17the patient, when appropriate, and staff of other disciplines
18involved in the care of the patient.
19    (d) The direct care registered nurse shall evaluate the
20effectiveness of the care plan (i) through assessments based on
21direct observation of the patient's physical condition and
22behavior, signs and symptoms of illness, and reactions to
23treatment and (ii) through communication with the patient and
24the health care team members. The direct care registered nurse
25shall modify the plan as needed.
26    (e) Information related to the patient's initial

 

 

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1assessment and reassessments, nursing diagnosis, plan,
2intervention, evaluation, and patient advocacy shall be
3permanently recorded, as narrative registered nurse progress
4notes, 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
8the patient's signs and symptoms of illness, reaction to
9treatment, behavior and physical condition, and (ii)
10interpretation of information obtained from the patient and
11others, including other care givers on the health team.
12Assessment requires data collection by the direct care
13registered nurse and the analysis, synthesis, and evaluation of
14such data.
15    (b) Only a direct care registered nurse is authorized to
16perform patient assessments. A licensed practical nurse may
17assist 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
20be determined by a direct care registered nurse through the
21process of ongoing patient assessments, nursing diagnosis, and
22formulation and adjustment of nursing care plans.
23    (b) The prediction of individual patient nursing care needs
24for prospective assignment of direct care registered nurses

 

 

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1shall be based on individual patient assessments by the direct
2care registered nurse assigned to each patient and in
3accordance with a documented patient classification system as
4provided in Article 10.
 
5    Section 15-20. Independent judgment.
6    (a) Competent performance of the essential functions of a
7direct care registered nurse as described in subdivisions
8(a)(1) through (a)(3) of Section 15-5, Section 15-10, and
9Section 15-15 requires the exercise of independent judgment in
10the interests of the patient. The exercise of such independent
11judgment, unencumbered by the commercial or revenue-generation
12priorities of a hospital or other employing entity of a direct
13care registered nurse, is necessary to assure safe,
14therapeutic, and competent treatment of hospital patients and
15is essential to protect the health and safety of the people of
16Illinois.
17    (b) The exercise of independent judgment by a direct care
18registered nurse in the performance of the essential functions
19described in subdivisions (a)(1) through (a)(3) of Section 15-5
20and as provided in this Act and the Nurse Practice Act shall be
21provided in the exclusive interests of the patient and shall
22not, for any purpose, be considered, relied upon, or
23represented as a job function, authority, responsibility, or
24activity undertaken in any respect for the purpose of serving
25the business, commercial, operational, or other institutional

 

 

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1interests of the hospital.
 
2    Section 15-25. Clinical supervision.
3    (a) In addition to the limitations on assignments of
4patient care tasks provided in subsections (a) and (b) of
5Section 10-70, a direct care registered nurse responsible for a
6patient may assign tasks required in the implementation of
7nursing care for that patient to other licensed nurses or to
8unlicensed 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
17personnel by a direct care registered nurse in the performance
18of the essential functions described in subdivisions (a)(1)
19through (a)(3) of Section 15-5 and as provided in this Act and
20the Nurse Practice Act shall be in the exclusive interests of
21the patient and shall not, for any purpose, be considered,
22relied upon, or represented as a job function, authority,
23responsibility, or activity undertaken in any respect for the
24purpose of serving the business, commercial, operational, or
25other institutional interests of the hospital employer, but

 

 

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1constitute the exercise of professional nursing authority and
2duty exclusively in the interests of the patient.
 
3
Article 20. Patient Advocacy

 
4    Section 20-5. Professional obligation. A registered nurse
5has the professional obligation and therefore the right to act
6as a patient's advocate, as circumstances require, by (i)
7initiating action to improve the patient's health care or to
8change decisions or activities which, in the professional
9judgment of the registered nurse, are against the interests or
10wishes of the patient and (ii) giving the patient the
11opportunity to make informed decisions about his or her health
12care before it is provided.
 
13    Section 20-10. Acceptance of patient care assignments. A
14direct care registered nurse is always responsible for
15providing safe, therapeutic, and competent nursing care to
16assigned patients. Before accepting a patient assignment, a
17direct care registered nurse must have the necessary knowledge,
18judgment, skills, and ability to provide the required care. It
19is the responsibility of the direct care registered nurse to
20determine whether she or he is clinically competent to perform
21the nursing care required by patients in a particular clinical
22unit or with a particular diagnosis, condition, prognosis, or
23other determinative characteristics of nursing care. If a

 

 

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1direct care registered nurse is not clinically competent to
2perform the care required for a patient to be assigned for
3nursing care, she or he should not accept the patient care
4assignment. Such a refusal to accept a patient care assignment
5is an exercise of the direct care registered nurse's duty and
6right of patient advocacy.
 
7    Section 20-15. Acceptance of orders.
8    (a) In the course of performing the responsibilities and
9essential functions described in Article 15, a direct care
10registered nurse assigned to a patient shall receive orders
11initiated by physicians and other legally authorized health
12care professionals within their scope of licensure regarding
13patient care services to be provided to the patient, including,
14without limitation, the administration of medications and
15therapeutic agents necessary to implement a treatment, disease
16prevention, or rehabilitative regimen.
17    (b) The direct care registered nurse shall assess each such
18order before implementation to determine whether the order is:
19(i) in the best interests of the patient; (ii) initiated by a
20person legally authorized to issue the order; and (iii) in
21accordance with applicable law and regulation governing
22nursing care.
23    (c) If a direct care registered nurse determines that the
24criteria described in items (i) through (iii) of subsection (b)
25have not been satisfied with respect to a particular order, or

 

 

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1has some doubt regarding the meaning or conformance of the
2order with those criteria, she or he shall seek clarification
3from the initiator of the order, the patient's physician, or
4another appropriate medical officer. Clarification must be
5obtained prior to implementing the order.
6    If, upon clarification, the direct care registered nurse
7determines that the criteria for implementation of the order
8have not been satisfied, she or he may refuse to implement the
9order on the basis that the order is not in the best interests
10of the patient.
11    Seeking clarification of an order or refusing an order as
12described in this Section constitutes an exercise of the direct
13care registered nurse's duty and right of patient advocacy.
 
14    Section 20-20. Protected speech.
15    (a) Every direct care registered nurse responsible for
16patient care in a hospital shall enjoy the right of free speech
17and shall be protected in the exercise of that right as
18provided in this Section, both during working hours and during
19off-duty hours. The right of free speech protected by this
20Section is a necessary incident of the professional nurse's
21duty of patient advocacy and is essential to protecting the
22health and safety of hospital patients and of the people of
23Illinois.
24    (b) The speech protected by this Section includes, without
25limitation, any type of spoken, gestured, written, printed, or

 

 

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1electronically communicated expression concerning any matter
2related to or affecting safe, therapeutic, and competent direct
3care registered nursing practice at a hospital facility, at
4facilities within a large health delivery system or corporate
5chain which includes a hospital, or more generally within the
6health care industry.
7    The content of speech protected by this Section includes,
8without limitation, the facts and circumstances of particular
9events, patient care practices, institutional actions,
10policies, or conditions which may facilitate or impede
11competent and safe nursing practice or patient care, adverse
12patient outcomes or incidents, sentinel or reportable events,
13and arguments in support of or against hospital policies or
14practices relating to the delivery of nursing care.
15    Protected speech under this Section includes the
16reporting, whether internally, externally, or publicly, of
17actions, conduct, events, practices, or other matters that are
18believed 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
11disclosure of private and confidential patient information,
12except when such disclosure is (i) required by law, (ii)
13compelled by proper legal process, (iii) consented to by the
14patient, or (iv) provided in confidence to a regulatory or
15accreditation agency or other governmental entity for
16investigatory purposes or pursuant to a formal or informal
17complaint of unlawful or improper practices for purposes of
18achieving corrective and remedial action.
19    (d) Engaging in speech activity protected under this
20Section constitutes an exercise of the direct care registered
21nurse's duty and right of patient advocacy. The subject matter
22of protected speech activity as described in this Section is
23presumed to be a matter of public concern, and the disclosures
24protected under this Section are presumed to be in the public
25interest.
 

 

 

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1    Section 20-25. Fiduciary duty; conflict of interest.
2    (a) A direct care registered nurse is in a fiduciary
3relationship to an assigned patient as to matters within the
4scope of practice and professional responsibility of the nurse
5to provide safe, therapeutic, and competent nursing care in the
6interests of the patient. As to such matters, the registered
7nurse responsible for a patient shall perform the essential
8functions of a direct care registered nurse exclusively in the
9interests of the patient and shall not be influenced by the
10interests of any third party or the directives of any such
11third party or by motives other than the accomplishment of her
12or his professional responsibility to provided safe,
13therapeutic, and competent nursing care in the interests and
14for the benefit of the patient.
15    (b) A direct care registered nurse shall not be influenced
16by her or his own personal interests or by the interests or
17demands of a third party which are in conflict with the
18interests of assigned patients in performing the essential
19registered nursing functions required under Article 15. The
20refusal by a direct care registered nurse to engage in activity
21involving such a conflict of interest with respect to nursing
22care for which she or he is responsible shall constitute an
23exercise of the registered nurse's duty and right of patient
24advocacy.
 
25    Section 20-30. Participation in organizations.

 

 

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1    (a) A direct care nurse, as a necessary incident and
2condition of her or his independent duty and right of patient
3advocacy, 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)
15constitutes an exercise of the professional nurse's duty and
16right 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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1ethical obligations, a direct care registered nurse has a duty
2and right to act and provide care exclusively in the interests
3of patients and to act as a patient's advocate, as
4circumstances require, by (i) initiating action to improve
5health care or to change decisions or activities which in the
6professional judgment of the direct care registered nurse are
7against the interests or wishes of an assigned patient or (ii)
8giving a patient the opportunity to make informed decisions
9about health care before it is provided. This Act confirms and
10creates statutory patient advocacy rights for direct care
11registered nurses as provided in this Article 20 and made
12enforceable under Article 25.
13    (c) A patient in a hospital who is aggrieved by the
14hospital's interference with the full and free exercise of
15patient advocacy duties by a direct care registered nurse has
16the right to make or file a complaint and to cooperate, provide
17evidence, testify, or otherwise support or participate in any
18investigation or complaint proceeding conducted pursuant to
19Article 25. A patient shall be considered "aggrieved" for
20purposes of this subsection if the patient's health or safety
21was jeopardized or the patient was exposed to additional risk
22of injury, disease, pain, or suffering as a consequence of
23conditions or circumstances caused in whole or in part by the
24hospital's interference with patient advocacy rights of a
25direct care registered nurse. Actual physical injury, disease,
26pain, or suffering is not required for a patient to have

 

 

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1standing to file a complaint and obtain appropriate remedies
2under Article 25.
3    (d) A direct care registered nurse who is aggrieved by a
4hospital's interference with the full and free exercise of the
5nurse's patient advocacy duties has the right to make or file a
6complaint cooperate, provide evidence, testify, or otherwise
7support or participate in any investigation or complaint
8proceeding conducted pursuant to Article 25.
 
9    Section 20-40. Interference with rights and duties
10prohibited.
11    (a) It is unlawful for a hospital to interfere with,
12restrain, coerce, intimidate, or deny the exercise or the
13attempt to exercise, by any person, of any right provided or
14protected under this Act.
15    (b) It is unlawful for a hospital to discriminate or
16retaliate against any person for opposing any policy, practice,
17or action of the hospital which is alleged to violate, breach,
18or fail to comply with any provision of this Act.
19    (c) No hospital employer shall make, adopt, or enforce any
20rule, regulation, policy, or practice which directly or
21indirectly prohibits, impedes, discourages, intimidates,
22coerces, or induces in any manner a direct care registered
23nurse from engaging in protected speech activities or
24disclosing information as provided in this Article 20.
25    (d) No hospital employer shall make, adopt, or enforce any

 

 

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1rule, regulation, policy, or practice which directly or
2indirectly authorizes, sanctions, permits, excuses, or
3encourages any other person to engage in conduct which is
4likely to prohibit, impede, discourage, intimidate, coerce, or
5induce in any manner a direct care registered nurse from
6engaging in protected speech activities or disclosing
7information as provided in this Article 20.
8    (e) No hospital or other health care institution shall
9engage in the deployment of technology that limits a direct
10care registered nurse (i) in performing functions that are part
11of the nursing process, including full exercise of independent
12clinical judgment in assessment, planning, implementation and
13evaluation of care or (ii) from acting as a patient advocate in
14the exclusive interest of the patient. Technology shall not be
15skill-degrading, interfere with a direct care registered
16nurse's provision of individualized patient care, or override a
17direct care registered nurse's independent professional
18judgment. In addition, there shall be no interference with a
19registered nurse's right to advocate in the exclusive interest
20of a patient.
21    (f) A hospital employer, all management personnel employed
22by a hospital, all personnel with management or supervisory
23authority employed by a hospital, including the registered
24nurse administrator, registered nurse manager, or registered
25nurse supervisor, and all medical personnel who treat patients
26admitted to hospital nursing unit, whether employed by the

 

 

09700HB0282ham001- 34 -LRB097 06642 DRJ 67048 a

1hospital or privileged to admit patients through an affiliated
2medical group or otherwise, are strictly prohibited from
3interfering with the rights and obligations of a direct care
4registered nurses to perform the duties of patient advocacy as
5provided in this Article 20.
6    Prohibited interference with patient advocacy duties of a
7direct care registered nurse includes conduct, actions, or
8omissions which directly or indirectly are likely to prohibit,
9impede, discourage, intimidate, coerce, or induce in any manner
10a direct care registered nurse from taking action indicated or
11authorized by the professional obligations of patient advocacy
12described in this Article 20. Any act of prohibited
13interference committed by an individual within his or her
14course and scope of employment as management, nursing service,
15or medical personnel for a hospital as described in this
16subsection shall be considered prohibited interference by the
17hospital for purposes of this Act.
18    (g) An employee of a hospital employer who has authority to
19take, direct others to take, recommend, or approve any
20personnel action of the employer with respect to a direct care
21registered nurse shall not, with respect to such authority,
22take or fail to take, or threaten to take or fail to take, any
23such action with respect to such nurse because the nurse
24engages in conduct in furtherance of her or his duties and
25rights as described in this Article 20, including, without
26limitation, refusing to obey an order that the direct care

 

 

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1registered nurse has determined, in the exercise of her or his
2independent judgment, should be refused in accordance with the
3direct care registered nurse's duty and right of patient
4advocacy. Any such action or omission undertaken in the course
5or scope of employment for a hospital shall be considered an
6action or omission of the hospital for purposes of this Act.
7    (h) Any employee of a hospital employer who has authority
8to take, direct others to take, recommend, or approve any
9report of any incident, conduct, or circumstances involving a
10direct care registered nurse employed by the hospital to any
11professional licensing board, disciplinary body, or
12investigatory function or officer for purposes of complaint,
13investigation, or imposition of professional discipline or
14other adverse action affecting the direct care registered
15nurse's active license status or good standing to practice as a
16duly licensed registered nurse in the State of Illinois, shall
17not, with respect to such authority, take or fail to take, or
18threaten to take or fail to take, any such action with respect
19to such direct care registered nurse because the direct care
20registered nurse engages in conduct in furtherance of her or
21his duties and rights as described in this Article 20,
22including, without limitation, refusing to obey an order that
23the direct care registered nurse has determined, in the
24exercise of her or his independent judgment, should be refused
25in accordance with the registered nurse's duty of patient
26advocacy.
 

 

 

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1    Section 20-45. Retaliation or discrimination prohibited. A
2hospital employer may not discriminate or retaliate in any
3manner against any patient, employee, or contract employee of
4the hospital, or any other person, because that person has (i)
5presented a grievance or complaint, (ii) initiated or
6cooperated in any investigation or proceeding of any
7governmental entity, regulatory agency, or private
8accreditation body, (iii) made a civil claim or demand, or (iv)
9filed an action relating to the care, services, or conditions
10of 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
14Article 20 is liable to the aggrieved employee for the
15following:
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),
8a hospital employer is liable for such equitable relief as may
9be appropriate, including including the aggrieved employee's
10employment reinstatement.
 
11    Section 25-10. Action to recover damages or equitable
12relief.
13    (a) An action to recover the damages or equitable relief
14described in Section 25-5 may be maintained against any
15hospital employer (including a public agency) in any court of
16competent jurisdiction by any one or more employees for and in
17behalf of the employee or employees as well as other employees
18similarly situated.
19    (b) The court in an action under this Section shall award
20to a prevailing plaintiff reasonable attorney's fees,
21reasonable expert witness fees, and other costs of the action.
22    (c) An action may be brought under this Section not later
23than 2 years after the date of the last event constituting the
24alleged violation for which the action is brought.
25    (d) In the case of an action brought under this Section for

 

 

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1a willful violation, the action may be brought within 3 years
2after the date of the last event constituting the alleged
3violation for which the action is brought.
 
4    Section 25-15. Retaliation against patient; presumption.
5If a hospital engages in any type of discriminatory treatment
6of a patient by whom, or upon whose behalf, a grievance or
7complaint has been submitted, directly or indirectly, to any
8governmental entity, regulatory agency, or private
9accreditation body, and if that discriminatory treatment
10occurs within 180 days after the filing of the grievance or
11complaint, then the hospital's conduct raises a rebuttable
12presumption that the action was taken by the hospital in
13retaliation for the filing of the grievance or complaint.
 
14    Section 25-20. Retaliation against employee; presumption;
15relief.
16    (a) If a hospital (i) engages in any type of discriminatory
17treatment of an employee who has presented a grievance or
18complaint, or initiated, participated in, or cooperated in any
19investigation or proceeding by or before any governmental
20entity or private accreditation body, and (ii) had knowledge of
21the employee's initiation, participation, or cooperation, and
22if that discriminatory treatment occurs within 180 days after
23the filing of the grievance or complaint, then the hospital's
24conduct raises a rebuttable presumption that the

 

 

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1discriminatory action was taken by the hospital in retaliation
2for the filing of the grievance or complaint. For purposes of
3this Section, "discriminatory treatment of an employee"
4includes discharge, demotion, suspension, or any other
5unfavorable change in the terms or conditions of employment, or
6the threat of any such action.
7    (b) An employee who has been discriminated against as
8described in subsection (a) is entitled to reinstatement,
9reimbursement for lost wages and work benefits caused by the
10acts of the employer, and an award of reasonable attorney's
11fees and costs as the prevailing party.
 
12    Section 25-25. Civil penalties.
13    (a) If a hospital employer is found to have violated or
14interfered with any of the rights or protections provided and
15guaranteed under this Article, the Department may assess a
16civil penalty of not more than $25,000 for each such violation
17or occurrence of prohibited conduct.
18    (b) If any member of a hospital's management, nursing
19service, or medical personnel is found to have violated or
20interfered with any of the rights or protections provided and
21guaranteed under this Article, the Department may assess a
22civil penalty of not more than $20,000 for each such violation
23or occurrence of prohibited conduct.
24    (c) A hospital found to have violated or aided and abetted
25a violation of any provision of Article 10 is subject (i) in

 

 

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1addition to any other penalties that may be prescribed by law,
2to enforcement action by the Department, including the use of
3injunctive relief available to force compliance with that
4Article or closure of the hospital and (ii) to a civil money
5penalty assessed by the Department of not more than $25,000 for
6each violation and an additional $10,000 per nursing unit shift
7until the violation is corrected.
8    (d) The Attorney General shall enforce penalties imposed
9under this Section in the county in which the violation
10occurred.
11    (e) The penalties authorized under this Section are in
12addition to any other penalties that may be imposed under this
13Act. Penalties collected pursuant to this Section shall be
14deposited into the General Revenue Fund.
 
15    Section 25-30. Posting of Act provisions. Every hospital
16shall post the provisions of Articles 15 and 20 in a prominent
17place for review by the hospital's employees and patients and
18by the public. The posting shall have a title across the top in
19no less than 35 point, bold typeface stating the following:
20"RIGHTS OF REGISTERED NURSES AS PATIENT ADVOCATES AND OF
21EMPLOYEES AND PATIENTS".
 
22
Article 90. Amendatory Provisions

 
23    Section 90-5. The Hospital Licensing Act is amended by

 

 

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1adding Section 2.5 as follows:
 
2    (210 ILCS 85/2.5 new)
3    Sec. 2.5. Relationship to Hospital Patient Protection Act.
4In the case of a conflict between a provision of this Act and a
5provision of the Hospital Patient Protection Act, the Hospital
6Patient Protection Act shall control.
 
7    Section 90-10. The Nurse Practice Act is amended by adding
8Section 50-17 as follows:
 
9    (225 ILCS 65/50-17 new)
10    Sec. 50-17. Relationship to Hospital Patient Protection
11Act. In the case of a conflict between a provision of this Act
12and a provision of the Hospital Patient Protection Act, the
13Hospital Patient Protection Act shall control.".