HB3890 EngrossedLRB103 30120 CPF 56544 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Hospital Licensing Act is amended by
5changing Section 10.10 as follows:
 
6    (210 ILCS 85/10.10)
7    Sec. 10.10. Nurse Staffing by Patient Acuity.
8    (a) Findings. The Legislature finds and declares all of
9the following:
10        (1) The State of Illinois has a substantial interest
11    in promoting quality care and improving the delivery of
12    health care services.
13        (2) Evidence-based studies have shown that the basic
14    principles of staffing in the acute care setting should be
15    based on the complexity of patients' care needs aligned
16    with available nursing skills to promote quality patient
17    care consistent with professional nursing standards.
18        (3) Compliance with this Section promotes an
19    organizational climate that values registered nurses'
20    input in meeting the health care needs of hospital
21    patients.
22    (b) Definitions. As used in this Section:
23    "Acuity model" means an assessment tool selected and

 

 

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1implemented by a hospital, as recommended by a nursing care
2committee, that assesses the complexity of patient care needs
3requiring professional nursing care and skills and aligns
4patient care needs and nursing skills consistent with
5professional nursing standards.
6    "Department" means the Department of Public Health.
7    "Direct patient care" means care provided by a registered
8professional nurse with direct responsibility to oversee or
9carry out medical regimens or nursing care for one or more
10patients.
11    "Nursing care committee" means a hospital-wide committee
12or committees of nurses whose functions, in part or in whole,
13contribute to the development, recommendation, and review of
14the hospital's nurse staffing plan established pursuant to
15subsection (d).
16    "Registered professional nurse" means a person licensed as
17a Registered Nurse under the Nurse Practice Act.
18    "Written staffing plan for nursing care services" means a
19written plan for the assignment of patient care nursing staff
20based on multiple nurse and patient considerations that yield
21minimum staffing levels for inpatient care units and the
22adopted acuity model aligning patient care needs with nursing
23skills required for quality patient care consistent with
24professional nursing standards.
25    (c) Written staffing plan.
26        (1) Every hospital shall implement a written

 

 

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1    hospital-wide staffing plan, prepared by a nursing care
2    committee or committees, that provides for minimum direct
3    care professional registered nurse-to-patient staffing
4    needs for each inpatient care unit, including inpatient
5    emergency departments. If the staffing plan prepared by
6    the nursing care committee is not adopted by the hospital,
7    or if substantial changes are proposed to it, the chief
8    nursing officer shall either: (i) provide a written
9    explanation to the committee of the reasons the plan was
10    not adopted; or (ii) provide a written explanation of any
11    substantial changes made to the proposed plan prior to it
12    being adopted by the hospital. The written hospital-wide
13    staffing plan shall include, but need not be limited to,
14    the following considerations:
15            (A) The complexity of complete care, assessment on
16        patient admission, volume of patient admissions,
17        discharges and transfers, evaluation of the progress
18        of a patient's problems, ongoing physical assessments,
19        planning for a patient's discharge, assessment after a
20        change in patient condition, and assessment of the
21        need for patient referrals.
22            (B) The complexity of clinical professional
23        nursing judgment needed to design and implement a
24        patient's nursing care plan, the need for specialized
25        equipment and technology, the skill mix of other
26        personnel providing or supporting direct patient care,

 

 

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1        and involvement in quality improvement activities,
2        professional preparation, and experience.
3            (C) Patient acuity and the number of patients for
4        whom care is being provided.
5            (D) The ongoing assessments of a unit's patient
6        acuity levels and nursing staff needed shall be
7        routinely made by the unit nurse manager or his or her
8        designee.
9            (E) The identification of additional registered
10        nurses available for direct patient care when
11        patients' unexpected needs exceed the planned workload
12        for direct care staff.
13        (2) In order to provide staffing flexibility to meet
14    patient needs, every hospital shall identify an acuity
15    model for adjusting the staffing plan for each inpatient
16    care unit.
17        (2.5) Each hospital shall implement the staffing plan
18    and assign nursing personnel to each inpatient care unit,
19    including inpatient emergency departments, in accordance
20    with the staffing plan.
21            (A) A registered nurse may report to the nursing
22        care committee any variations where the nurse
23        personnel assignment in an inpatient care unit is not
24        in accordance with the adopted staffing plan and may
25        make a written report to the nursing care committee
26        based on the variations.

 

 

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1            (B) Shift-to-shift adjustments in staffing levels
2        required by the staffing plan may be made by the
3        appropriate hospital personnel overseeing inpatient
4        care operations. If a registered nurse in an inpatient
5        care unit objects to a shift-to-shift adjustment, the
6        registered nurse may submit a written report to the
7        nursing care committee.
8            (C) The nursing care committee shall develop a
9        process to examine and respond to written reports
10        submitted under subparagraphs (A) and (B) of this
11        paragraph (2.5), including the ability to determine if
12        a specific written report is resolved or should be
13        dismissed.
14        (3) The written staffing plan shall be posted, either
15    by physical or electronic means, in a conspicuous and
16    accessible location for both patients and direct care
17    staff, as required under the Hospital Report Card Act. A
18    copy of the written staffing plan shall be provided to any
19    member of the general public upon request.
20    (d) Nursing care committee.
21        (1) Every hospital shall have a nursing care committee
22    that meets at least 6 times per year. A hospital shall
23    appoint members of a committee whereby at least 55% of the
24    members are registered professional nurses providing
25    direct inpatient care, one of whom shall be selected
26    annually by the direct inpatient care nurses to serve as

 

 

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1    co-chair of the committee.
2        (2) (Blank).
3        (2.5) A nursing care committee shall prepare and
4    recommend to hospital administration the hospital's
5    written hospital-wide staffing plan. If the staffing plan
6    is not adopted by the hospital, the chief nursing officer
7    shall provide a written statement to the committee prior
8    to a staffing plan being adopted by the hospital that: (A)
9    explains the reasons the committee's proposed staffing
10    plan was not adopted; and (B) describes the changes to the
11    committee's proposed staffing or any alternative to the
12    committee's proposed staffing plan.
13        (3) A nursing care committee's or committees' written
14    staffing plan for the hospital shall be based on the
15    principles from the staffing components set forth in
16    subsection (c). In particular, a committee or committees
17    shall provide input and feedback on the following:
18            (A) Selection, implementation, and evaluation of
19        minimum staffing levels for inpatient care units.
20            (B) Selection, implementation, and evaluation of
21        an acuity model to provide staffing flexibility that
22        aligns changing patient acuity with nursing skills
23        required.
24            (C) Selection, implementation, and evaluation of a
25        written staffing plan incorporating the items
26        described in subdivisions (c)(1) and (c)(2) of this

 

 

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1        Section.
2            (D) Review the nurse staffing plans for all
3        inpatient areas and current acuity tools and measures
4        in use. The nursing care committee's review shall
5        consider:
6                (i) patient outcomes;
7                (ii) complaints regarding staffing, including
8            complaints about a delay in direct care nursing or
9            an absence of direct care nursing;
10                (iii) the number of hours of nursing care
11            provided through an inpatient hospital unit
12            compared with the number of inpatients served by
13            the hospital unit during a 24-hour period;
14                (iv) the aggregate hours of overtime worked by
15            the nursing staff;
16                (v) the extent to which actual nurse staffing
17            for each hospital inpatient unit differs from the
18            staffing specified by the staffing plan; and
19                (vi) any other matter or change to the
20            staffing plan determined by the committee to
21            ensure that the hospital is staffed to meet the
22            health care needs of patients.
23        (4) A nursing care committee must issue a written
24    report addressing the items described in subparagraphs (A)
25    through (D) of paragraph (3) semi-annually. A written copy
26    of this report shall be made available to direct inpatient

 

 

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1    care nurses by making available a paper copy of the
2    report, distributing it electronically, or posting it on
3    the hospital's website.
4        (5) A nursing care committee must issue a written
5    report at least annually to the hospital governing board
6    that addresses items including, but not limited to: the
7    items described in paragraph (3); changes made based on
8    committee recommendations and the impact of such changes;
9    and recommendations for future changes related to nurse
10    staffing.
11        (6) A nursing care committee must annually notify the
12    hospital nursing staff of the staff's rights under this
13    Section. The annual notice must provide a phone number and
14    an email address for staff to report noncompliance with
15    the nursing staff's rights as described in this Section.
16    The notice must be provided by email or by regular mail in
17    a manner that effectively facilitates receipt of the
18    notice. The Department shall monitor and enforce the
19    requirements of this paragraph (6).
20    (e) Nothing in this Section 10.10 shall be construed to
21limit, alter, or modify any of the terms, conditions, or
22provisions of a collective bargaining agreement entered into
23by the hospital.
24    (f) No hospital may discipline, discharge, or take any
25other adverse employment action against an employee solely
26because the employee expresses a concern or complaint

 

 

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1regarding an alleged violation of this Section or concerns
2related to nurse staffing.
3    (g) Any employee of a hospital may file a complaint with
4the Department regarding an alleged violation of this Section.
5The Department must forward notification of the alleged
6violation to the hospital in question within 10 business days
7after the complaint is filed. Upon receiving a complaint of a
8violation of this Section, the Department may take any action
9authorized under Sections 7 or 9 of this Act.
10(Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
11102-813, eff. 5-13-22.)