Illinois General Assembly - Full Text of SB2314
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Full Text of SB2314  103rd General Assembly




State of Illinois
2023 and 2024


Introduced 2/10/2023, by Sen. Celina Villanueva


New Act
210 ILCS 85/10.10
225 ILCS 65/50-15.15 new

    Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in the Act. Provides that the maximum patient assignments may not be exceeded, regardless of the use and application of any patient acuity system. Requires the Department of Public Health to adopt rules governing the implementation and administration of the Act. Provides that all facilities shall adopt written policies and procedures for the training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides requirements for the Act's implementation. Establishes recordkeeping requirements. Provides rights and protections for nurses. Contains a severability provision and other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Makes changes concerning staffing plans. Amends the Nurse Practice Act. Requires the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice to be provided in the exclusive interests of the patient.

LRB103 30711 CPF 57186 b





SB2314LRB103 30711 CPF 57186 b

1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the Safe
5Patient Limits Act.
6    Section 5. Definitions. In this Act:
7    "Couplet" means one postpartum patient and one baby.
8    "Critical trauma patient" means a patient who has an
9injury to an anatomic area that (i) requires life-saving
10interventions or (ii) in conjunction with unstable vital
11signs, poses an immediate threat to life or limb.
12    "Department" means the Department of Public Health.
13    "Direct care registered professional nurse" means a
14registered professional nurse who has accepted a hands-on,
15in-person patient care assignment and whose primary role is to
16provide hands-on, in-person patient care.
17    "Facility" means a hospital licensed under the Hospital
18Licensing Act or organized under the University of Illinois
19Hospital Act, a private or State-owned and State-operated
20general acute care hospital, an LTAC hospital as defined in
21Section 10 of the Long Term Acute Care Hospital Quality
22Improvement Transfer Program Act, an ambulatory surgical
23treatment center as defined in Section 3 of the Ambulatory



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1Surgical Treatment Center Act, a freestanding emergency center
2licensed under the Emergency Medical Services Systems Act, a
3birth center licensed under the Birth Center Licensing Act, an
4acute psychiatric hospital, an acute care specialty hospital,
5or an acute care unit within a health care facility.
6    "Health care emergency" means an emergency that is
7declared by an authorized person within federal, State, or
8local government and is related to circumstances that are
9unpredictable and unavoidable, affect the delivery of medical
10care, and require an immediate or exceptional level of
11emergency or other medical services at the specific facility.
12"Health care emergency" does not include a state of emergency
13that results from a labor dispute in the health care industry
14or consistent understaffing.
15    "Health care workforce" means personnel employed by or
16contracted to work at a facility that have an effect upon the
17delivery of quality care to patients, including, but not
18limited to, registered nurses, licensed practical nurses,
19unlicensed assistive personnel, service, maintenance,
20clerical, professional, and technical workers, and other
21health care workers.
22    "Immediate postpartum patient" means a patient who has
23given birth within the previous 2 hours.
24    "Nursing care" means care that falls within the scope of
25practice described in Section 55-30 or 60-35 of the Nurse
26Practice Act or is otherwise encompassed within recognized



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1standards of nursing practice.
2    "Rapid response team" means a team of health care
3providers that provide care to patients with early signs of
4deterioration to prevent respiratory or cardiac arrest.
5    "Registered nurse" or "registered professional nurse"
6means a person who is licensed as a registered professional
7nurse under the Nurse Practice Act and practices nursing as
8described in Section 60-35 of the Nurse Practice Act.
9    "Specialty care unit" means a unit that is organized,
10operated, and maintained to provide care for a specific
11medical condition or a specific patient population.
12    Section 10. Maximum patient assignments for registered
14    (a) The maximum number of patients assigned to a
15registered nurse in a facility shall not exceed the limits
16provided in this Section. However, nothing shall preclude a
17facility from assigning fewer patients to a registered nurse
18than the limits provided in this Section. The requirements of
19this Section apply at all times during each shift within each
20clinical unit and each patient care area. For the purposes of
21this Act, a patient is assigned to a registered nurse if the
22registered nurse accepts responsibility for the patient's
23nursing care.
24    (b) In all units with critical care or intensive care
25patients, including, but not limited to, coronary care, acute



SB2314- 4 -LRB103 30711 CPF 57186 b

1respiratory care, medical, burn, pediatric, or neonatal
2intensive care patients, the maximum patient assignment of
3critical care patients to a registered nurse is one.
4    (c) In all units with step-down or intermediate intensive
5care patients, the maximum patient assignment of step-down or
6intermediate intensive care patients to a registered nurse is
8    (d) In all units with postanesthesia care patients,
9regardless of the type of anesthesia administered, the maximum
10patient assignment of postanesthesia care patients or patients
11being monitored for the effects of any anesthetizing agent to
12a registered nurse is one.
13    (e) In all units with operating room patients, the maximum
14patient assignment of operating room patients to a registered
15nurse is one, provided that a minimum of one additional person
16serves as a scrub assistant for each patient.
17    (f) In the emergency department:
18        (1) In a unit providing basic emergency services or
19    comprehensive emergency services, the maximum patient
20    assignment at any time to a registered nurse is 3.
21        (2) The maximum assignment of critical care emergency
22    patients to a registered nurse is one. A patient in the
23    emergency department shall be considered a critical care
24    patient when the patient meets the criteria for admission
25    to a critical care service area within the facility.
26        (3) The maximum assignment of critical trauma patients



SB2314- 5 -LRB103 30711 CPF 57186 b

1    in an emergency unit to a registered nurse is one.
2        (4) At least one direct care registered professional
3    nurse shall be assigned to triage patients. The direct
4    care registered professional nurse assigned to triage
5    patients shall be immediately available at all times to
6    triage patients when they arrive in the emergency
7    department. The direct care registered professional nurse
8    assigned to triage patients shall perform triage functions
9    only and may not be assigned the responsibility of the
10    base radio. Triage, radio, or flight registered nurses
11    shall not be counted in the calculation of direct care
12    registered nurse staffing levels.
13    (g) In all units with maternal child care patients the
14maximum patient assignment:
15        (1) to a registered nurse of antepartum patients
16    requiring continuous fetal monitoring is 2;
17        (2) of other antepartum patients who are not in active
18    labor to a registered nurse is 3;
19        (3) of active labor patients to a registered nurse is
20    one;
21        (4) of patients with medical or obstetrical
22    complications during the initiation of epidural anesthesia
23    or during circulation for a caesarean section delivery to
24    a registered nurse is one;
25        (5) during birth is one registered nurse responsible
26    for the patient in labor and, for each newborn, one



SB2314- 6 -LRB103 30711 CPF 57186 b

1    registered nurse whose sole responsibility is that newborn
2    patient;
3        (6) of postpartum patients when the parent has given
4    birth within the previous 2 hours is one registered nurse
5    for each couplet, and in the case of multiple births, one
6    registered nurse for each additional newborn;
7        (7) of couplets to a registered nurse is 2;
8        (8) of patients receiving postpartum or postoperative
9    gynecological care to a registered nurse is 4 when the
10    registered nurse has been assigned only to patients
11    receiving postpartum or postoperative gynecological care;
12        (9) of newborn patients when the patient is unstable,
13    as assessed by a direct care registered professional
14    nurse, to a registered nurse is one; and
15        (10) of newborn patients to a registered nurse is 2
16    when the patients are receiving intermediate care or the
17    nurse has been assigned to a patient care unit that
18    receives newborn patients requiring intermediate care,
19    including, but not limited to, an intermediate care
20    nursery.
21    (h) In all units with pediatric patients, the maximum
22patient assignment of pediatric patients to a registered nurse
23is 3.
24    (i) In all units with psychiatric patients, the maximum
25patient assignment of psychiatric patients to a registered
26nurse is 4.



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1    (j) In all units with medical and surgical patients, the
2maximum patient assignment of medical or surgical patients to
3a registered nurse is 4.
4    (k) In all units with telemetry patients, the maximum
5patient assignment of telemetry patients to a registered nurse
6is 3.
7    (l) In all units with observational patients, the maximum
8patient assignment of observational patients to a registered
9nurse is 3.
10    (m) In all units with acute rehabilitation patients, the
11maximum patient assignment of acute rehabilitation patients to
12a registered nurse is 4.
13    (n) In all units with conscious sedation patients, the
14maximum patient assignment of conscious sedation patients to a
15registered nurse is one.
16    (o) In any unit not otherwise listed in this Section,
17including all specialty care units not otherwise listed in
18this Section, the maximum patient assignment to a registered
19nurse is 4.
20    Section 15. Use of rapid response teams as first
21responders prohibited. A rapid response team's registered
22nurse shall not be given direct care patient assignments while
23assigned as a registered nurse who is responsible for
24responding to a rapid response team request.



SB2314- 8 -LRB103 30711 CPF 57186 b

1    Section 20. Implementation by a facility.
2    (a) A facility shall implement the patient limits
3established under Section 10 without diminishing the staffing
4levels of the facility's health care workforce. A facility may
5not lay off licensed practical nurses, licensed psychiatric
6technicians, certified nursing assistants, or other ancillary
7support staff to meet the patient limits under Section 10.
8    (b) Each patient shall be assigned to a direct care
9registered professional nurse who shall directly provide the
10comprehensive patient assessment, development of a plan of
11care, and supervision, implementation, and evaluation of the
12nursing care provided to the patient at least every shift and
13who has the responsibility for the provision of care to a
14particular patient within the registered nurse's scope of
16    (c) There shall be no averaging of the number of patients
17and the total number of registered nurses in each clinical
18unit or patient care area in order to meet the patient limits
19under Section 10.
20    (d) Only registered nurses providing direct patient care
21shall be considered when evaluating compliance with the
22patient limits under Section 10. Ancillary staff and
23unlicensed personnel shall not be considered when evaluating
24compliance with the patient limits under Section 10.
25    (e) The hours in which a nurse administrator, nurse
26supervisor, nurse manager, charge nurse, and other licensed



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1nurse provides patient care shall not be considered when
2evaluating compliance with the patient limits under Section 10
3and with the patient assignment requirement under subsection
4(b) unless the registered nurse:
5        (1) has a current and active direct patient care
6    assignment;
7        (2) provides direct patient care in compliance with
8    this Act;
9        (3) has demonstrated the registered nurse's competence
10    in providing care in the registered nurse's assigned unit
11    to the facility; and
12        (4) has the principal responsibility of providing
13    direct patient care and has no additional job duties
14    during the time period during which the nurse has a
15    patient assignment.
16    (f) The hours in which a nurse administrator, nurse
17supervisor, nurse manager, charge nurse, or other licensed
18nurse provides direct patient care may be considered when
19evaluating compliance with the patient limits under Section 10
20and with the patient assignment requirement under subsection
21(b) only if he or she is providing relief for a direct care
22registered professional nurse during breaks, meals, and other
23routine and expected absences from that unit.
24    (g) At all times during each shift within a facility unit,
25clinical unit, or patient care area of a facility, and with the
26full complement of ancillary support staff, at least 2 direct



SB2314- 10 -LRB103 30711 CPF 57186 b

1care registered nurses shall be physically present in each
2facility unit, clinical unit, or patient care area where a
3patient is present.
4    (h) Identifying a clinical unit or patient care area by a
5name or term other than those listed in this Act does not
6affect a facility's requirement to staff the unit consistent
7with the patient limits identified for the level of intensity
8or type of care described in this Act.
9    (i) A registered nurse providing direct care to a patient
10has the authority to determine if a change in the patient's
11status places the patient in a different category requiring a
12different patient limit under Section 10.
13    (j) A facility shall assign direct care professional
14registered nurses in a patient care unit in accordance with
15Section 10 in order to meet the highest level of intensity and
16type of care provided in the patient care unit. If multiple
17assignments described under Section 10 apply to a patient, the
18facility shall assign a direct care professional registered
19nurse in accordance with the lowest numerical patient
20assignment under that Section.
21    (k) A facility shall provide staffing of direct care
22registered professional nurses above the number of direct care
23registered professional nurses required to comply with the
24patient levels under Section 10, or additional staffing of
25licensed practical nurses, certified nursing assistants, or
26other licensed or unlicensed ancillary support staff, based on



SB2314- 11 -LRB103 30711 CPF 57186 b

1the direct care registered professional nurse's assessment of
2each assigned individual patient, the individual patient's
3nursing care requirements, and the individual patient's
4nursing care plan.
5    (l) A facility shall not employ video monitors, remote
6patient monitoring, or any form of electronic visualization of
7a patient as a substitute for the direct in-person observation
8required for patient assessment by a registered nurse or for
9patient protection. Video monitors or any form of electronic
10visualization of a patient shall not constitute compliance
11with the patient limits under Section 10.
12    (m) A facility must provide relief by a direct care
13registered professional nurse with unit-specific education,
14training, and competence during another direct care registered
15professional nurse's meal periods, breaks, and routine
16absences as part of the facility's obligation to meet the
17patient limits under Section 10 at all times.
18    Section 25. Changes in patient census.
19    (a) A facility shall plan for routine fluctuations in its
20patient census, including, but not limited to, admissions,
21discharges, and transfers.
22    (b) If a health care emergency causes a change in the
23number of patients in a clinical care unit or patient care
24area, the facility must be able to demonstrate that immediate
25and diligent efforts were made to maintain required staffing



SB2314- 12 -LRB103 30711 CPF 57186 b

1levels under this Act.
2    (c) A facility shall immediately notify the Department if
3a health care emergency described under subsection (b) causes
4a change in the number of patients in a clinical care unit or
5patient care area and shall report to the Department efforts
6made to maintain staffing levels required under this Act.
7    Section 30. Record of staff assignments.
8    (a) A facility shall keep a record of the actual direct
9care registered professional nurse, licensed practical nurse,
10certified nursing assistant, and other ancillary staff
11assignments to individual patients documented on a day-to-day,
12shift-by-shift basis, shall submit copies of its records to
13the Department quarterly, and shall keep copies of its staff
14assignments on file for a period of 7 years.
15    (b) The documentation required under subsection (a) shall
16be submitted to the Department as a mandatory condition of
17licensure. The documentation shall be submitted with a
18certification by the chief nursing officer of the facility
19that the documentation completely and accurately reflects
20registered nurse staffing levels by the facility for each
21shift in each facility unit, clinical unit, and patient care
22area in which patients receive care. The chief nursing officer
23shall execute the certification under penalty of perjury and
24the certification must contain an expressed acknowledgment
25that any false statement constitutes fraud and is subject to



SB2314- 13 -LRB103 30711 CPF 57186 b

1criminal and civil prosecution and penalties.
2    Section 35. Implementation by the Department. The
3Department shall adopt rules governing the implementation and
4administration of this Act, including methods for facility
5staff, facility staff's collective bargaining representatives,
6and the public to file complaints regarding violations of this
7Act with the Department. The Department shall conduct periodic
8audits to ensure compliance with this Act.
9    Section 40. Nursing staff education, training, and
11    (a) A facility shall adopt written policies that include,
12but are not limited to:
13        (1) procedures for the education, training, and
14    orientation of nursing staff to each clinical area where
15    the nursing staff will work; and
16        (2) criteria for the facility to use in determining
17    whether a registered nurse has demonstrated current
18    competence in providing care in a clinical area.
19    (b) A registered nurse shall not be assigned to a facility
20unit, clinical unit, or patient care area unless the
21registered nurse has first received education, training, and
22orientation in that clinical area that is sufficient to
23provide safe, therapeutic, and competent care to patients in
24that clinical area and has demonstrated competence in



SB2314- 14 -LRB103 30711 CPF 57186 b

1providing care in that clinical area.
2    (c) A registered nurse shall not be assigned to relieve a
3direct care professional registered nurse during breaks,
4meals, and routine absences from a facility unit, clinical
5unit, or patient care area unless that registered nurse has
6first received education, training, and orientation in that
7clinical area that is sufficient to provide safe, therapeutic,
8and competent care to patients in that clinical area and has
9demonstrated competence in providing care in that clinical
11    (d) A health care facility may not assign any nursing
12personnel from a temporary nursing agency to the facility's
13unit, clinical unit, or patient care area unless the nursing
14personnel have first received education, training, and
15orientation in that clinical area that is sufficient to
16provide safe, therapeutic, and competent care to patients in
17that clinical area and have demonstrated competence in
18providing care in that clinical area.
19    Section 45. Enforcement.
20    (a) In addition to any other penalty prescribed by law,
21the Department may impose a civil penalty against a facility
22that violates this Act of up to $25,000 for each violation,
23except that the Department shall impose a civil penalty of at
24least $25,000 for each violation if the Department determines
25that the health care facility has a pattern of violation. A



SB2314- 15 -LRB103 30711 CPF 57186 b

1separate and distinct violation shall be deemed to have been
2committed on each day during which any violation continues
3after receipt of written notice of the violation from the
4Department by the facility.
5    (b) The Department shall post on its website the names of
6facilities against which civil penalties have been imposed
7under this Act, the violation for which the penalty was
8imposed, and additional information as the Department deems
10    (c) A facility's failure to adhere to the patient
11assignment limits under Section 10, any other violation of
12this Act, or any violation of Section 10.10 of the Hospital
13Licensing Act shall be reported by the Department to the
14Attorney General for enforcement, for which the Attorney
15General may bring action in a court of competent jurisdiction
16seeking injunctive relief and civil penalties.
17    (d) It is a defense to an enforcement action under this Act
18if the facility demonstrates that a health care emergency was
19in force at the time of the alleged violation and that the
20facility made immediate and diligent efforts to maintain
21staffing levels required under this Act.
22    Section 50. Nurse rights and protections.
23    (a) A registered professional nurse may object to or
24refuse to participate in any activity, practice, assignment,
25or task if:



SB2314- 16 -LRB103 30711 CPF 57186 b

1        (1) in good faith, the registered nurse reasonably
2    believes it to be a violation of the direct care
3    registered professional nurse maximum patient assignments
4    or any other provision established under this Act or a
5    rule adopted by the Department under this Act;
6        (2) the registered nurse, based on the registered
7    nurse's nursing judgment, reasonably believes the
8    registered nurse is not prepared by education, training,
9    or experience to fulfill the assignment without
10    compromising the safety of any patient or jeopardizing the
11    license of the registered nurse; or
12        (3) in the registered nurse's nursing judgment, the
13    activity, policy, practice, assignment or task would be
14    outside the registered nurse's scope of practice or would
15    otherwise compromise the safety of any patient or the
16    registered nurse.
17    (b) A facility shall not retaliate, discriminate, or
18otherwise take adverse action in any manner with respect to
19any aspect of a nurse's employment, including discharge,
20promotion, compensation, or terms, conditions, or privileges
21of employment, based on the nurse's refusal to complete an
22assignment under subsection (a).
23    (c) A facility shall not file a complaint against a
24registered professional nurse with the Board of Nursing based
25on the nurse's refusal to complete an assignment under
26subsection (a).



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1    (d) A facility shall not retaliate, discriminate, or
2otherwise take adverse action in any manner against any person
3or with respect to any aspect of a nurse's employment,
4including discharge, promotion, compensation, or terms,
5conditions, or privileges of employment, based on that nurse's
6or that person's opposition to any facility policy, practice,
7or action that the nurse in good faith believes violates this
9    (e) A facility shall not retaliate, discriminate, or
10otherwise take adverse action against any patient or employee
11of the facility or any other individual on the basis that the
12patient, employee, or individual, in good faith, individually
13or in conjunction with another person or persons, has
14presented a grievance or complaint, initiated or cooperated in
15any investigation or proceeding of any governmental entity,
16regulatory agency, or private accreditation body, made a civil
17claim or demand, or filed an action relating to the care,
18services, or conditions of the facility or of any affiliated
19or related facility.
20    (f) A facility shall not:
21        (1) interfere with, restrain, or deny the exercise of,
22    or attempt to deny the exercise of, a right conferred
23    under this Act; or
24        (2) coerce or intimidate any individual regarding the
25    exercise of, or an attempt to exercise, a right conferred
26    under this Act.



SB2314- 18 -LRB103 30711 CPF 57186 b

1    Section 97. Severability. The provisions of this Act are
2severable under Section 1.31 of the Statute on Statutes.
3    Section 110. The Hospital Licensing Act is amended by
4changing Section 10.10 as follows:
5    (210 ILCS 85/10.10)
6    Sec. 10.10. Nurse Staffing by Patient Acuity.
7    (a) Findings. The Legislature finds and declares all of
8the following:
9        (1) The State of Illinois has a substantial interest
10    in promoting quality care and improving the delivery of
11    health care services.
12        (2) Evidence-based studies have shown that the basic
13    principles of staffing in the acute care setting should be
14    based on the complexity of patients' care needs aligned
15    with available nursing skills to promote quality patient
16    care consistent with professional nursing standards.
17        (3) Compliance with this Section promotes an
18    organizational climate that values registered nurses'
19    input in meeting the health care needs of hospital
20    patients.
21    (b) Definitions. As used in this Section:
22    "Acuity model" means an assessment tool selected and
23implemented by a hospital, as recommended by a nursing care



SB2314- 19 -LRB103 30711 CPF 57186 b

1committee, that assesses the complexity of patient care needs
2requiring professional nursing care and skills and aligns
3patient care needs and nursing skills consistent with
4professional nursing standards.
5    "Department" means the Department of Public Health.
6    "Direct patient care" means care provided in person by a
7registered professional nurse with direct responsibility to
8oversee or carry out medical regimens or nursing care for one
9or more patients.
10    "Nursing care committee" means a hospital-wide committee
11or committees of nurses whose functions, in part or in whole,
12contribute to the development, recommendation, and review of
13the hospital's nurse staffing plan established pursuant to
14subsection (d).
15    "Registered professional nurse" means a person licensed as
16a Registered Nurse under the Nurse Practice Act.
17    "Written staffing plan for nursing care services" means a
18written plan for the assignment of patient care nursing staff
19based on multiple nurse and patient considerations that
20ensures the facility meets the maximum patient assignment
21limits under Section 10 of the Safe Patient Limits Act and the
22adopted method to adjust the staffing plan for each inpatient
23care unit when additional staff are needed to fulfill the care
24needs of each individual patient as determined by the
25patient's assigned direct care registered professional nurse
26yield minimum staffing levels for inpatient care units and the



SB2314- 20 -LRB103 30711 CPF 57186 b

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



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1            (B) The complexity of clinical professional
2        nursing judgment needed to design and implement a
3        patient's nursing care plan, the need for specialized
4        equipment and technology, the skill mix of other
5        personnel providing or supporting direct patient care,
6        and involvement in quality improvement activities,
7        professional preparation, and experience.
8            (C) Patient acuity and the number of patients for
9        whom care is being provided.
10            (D) The ongoing assessments of a unit's patient
11        acuity levels, as determined by the direct care
12        registered professional nurse responsible for each
13        patient's care, and nursing staff needed shall be
14        routinely made by the unit nurse manager or the unit
15        nurse manager's his or her designee.
16            (E) The identification of additional registered
17        nurses available for direct patient care when
18        patients' unexpected needs exceed the planned workload
19        for direct care staff.
20            (F) Ensuring that patient limits under Section 10
21        of the Safe Patient Limits Act to a registered nurse
22        are not exceeded.
23        (2) In order to provide staffing flexibility to meet
24    patient needs, every hospital shall include in its
25    staffing plan a method to adjust the staffing plan for
26    each inpatient care unit when the maximum patient



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1    assignment under Section 10 of the Safe Patient Limits Act
2    should be reduced or additional staff are needed to
3    fulfill the care needs of each individual patient as
4    determined by the patient's assigned direct care
5    registered professional nurse identify an acuity model for
6    adjusting the staffing plan for each inpatient care unit.
7        (2.5) Each hospital shall implement the staffing plan
8    and assign nursing personnel to each inpatient care unit
9    and emergency department , including inpatient emergency
10    departments, in accordance with the staffing plan.
11            (A) A registered nurse may report to the nursing
12        care committee any variations where the nurse
13        personnel assignment in an inpatient care unit is not
14        in accordance with the adopted staffing plan and may
15        make a written report to the nursing care committee
16        based on the variations.
17            (B) Shift-to-shift adjustments in staffing levels
18        required by the staffing plan may be made by the
19        appropriate hospital personnel overseeing inpatient
20        care operations. If a registered nurse in an inpatient
21        care unit objects to a shift-to-shift adjustment, the
22        registered nurse may submit a written report to the
23        nursing care committee.
24            (C) The nursing care committee shall develop a
25        process to examine and respond to written reports
26        submitted under subparagraphs (A) and (B) of this



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1        paragraph (2.5), including the ability to determine if
2        a specific written report is resolved or should be
3        dismissed.
4        (3) The written staffing plan shall be posted, either
5    by physical or electronic means, in a conspicuous and
6    accessible location for both patients and direct care
7    staff, as required under the Hospital Report Card Act. A
8    copy of the written staffing plan shall be provided to any
9    member of the general public upon request.
10        (4) The written staffing plan shall be updated on an
11    annual basis and submitted to the Department.
12        (5) Any acuity model, or other method, software, or
13    tool used to create or evaluate a staffing plan adopted by
14    a facility, shall be transparent in all respects,
15    including disclosure of detailed documentation of the
16    methodology used to determine nurse staffing and
17    identifying each factor, assumption, and value used in
18    applying the methodology. This documentation shall be
19    submitted to the Department and made available to facility
20    staff, facility staff's collective bargaining
21    representatives, and the public upon request. The patient
22    limits under Section 10 of the Safe Patient Limits Act
23    shall not be exceeded regardless of the use and
24    application of any acuity model.
25    (d) Nursing care committee.
26        (1) Every hospital shall have a nursing care committee



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1    that meets at least 6 times per year. A hospital shall
2    appoint members of a committee whereby at least 55% of the
3    members are registered professional nurses providing
4    direct inpatient care, one of whom shall be selected
5    annually by the direct inpatient care nurses to serve as
6    co-chair of the committee.
7        (2) (Blank).
8        (2.5) A nursing care committee shall prepare and
9    recommend to hospital administration the hospital's
10    written hospital-wide staffing plan. If the staffing plan
11    is not adopted by the hospital, the chief nursing officer
12    shall provide a written statement to the committee prior
13    to a staffing plan being adopted by the hospital that: (A)
14    explains the reasons the committee's proposed staffing
15    plan was not adopted; and (B) describes the changes to the
16    committee's proposed staffing or any alternative to the
17    committee's proposed staffing plan.
18        (3) A nursing care committee's or committees' written
19    staffing plan for the hospital shall be based on the
20    principles from the staffing components set forth in
21    subsection (c). In particular, a committee or committees
22    shall provide input and feedback on the following:
23            (A) Selection, implementation, and evaluation of
24        minimum staffing levels consistent with the maximum
25        patient limits under the Safe Patient Limits Act for
26        inpatient care units.



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1            (B) Selection, implementation, and evaluation of a
2        method to increase staffing as needed to meet patient
3        care needs an acuity model to provide staffing
4        flexibility that aligns changing patient acuity with
5        nursing skills required.
6            (C) Selection, implementation, and evaluation of a
7        written staffing plan incorporating the items
8        described in subdivisions (c)(1) and (c)(2) of this
9        Section.
10            (D) Review the nurse staffing plans for all
11        inpatient areas and current acuity tools and measures
12        in use. The nursing care committee's review shall
13        consider:
14                (i) patient outcomes;
15                (ii) complaints regarding staffing, including
16            complaints about a delay in direct care nursing or
17            an absence of direct care nursing;
18                (iii) the number of hours of nursing care
19            provided through an inpatient hospital unit
20            compared with the number of inpatients served by
21            the hospital unit during a 24-hour period;
22                (iv) the aggregate hours of overtime worked by
23            the nursing staff;
24                (v) the extent to which actual nurse staffing
25            for each hospital inpatient unit differs from the
26            staffing specified by the staffing plan; and



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1                (vi) any other matter or change to the
2            staffing plan determined by the committee to
3            ensure that the hospital is staffed to meet the
4            health care needs of patients.
5        (4) A nursing care committee must issue a written
6    report addressing the items described in subparagraphs (A)
7    through (D) of paragraph (3) semi-annually. A written copy
8    of this report shall be made available to direct inpatient
9    care nurses by making available a paper copy of the
10    report, distributing it electronically, or posting it on
11    the hospital's website.
12        (5) A nursing care committee must issue a written
13    report at least annually to the hospital governing board
14    that addresses items including, but not limited to: the
15    items described in paragraph (3); changes made based on
16    committee recommendations and the impact of such changes;
17    and recommendations for future changes related to nurse
18    staffing.
19    (e) Nothing in this Section 10.10 shall be construed to
20limit, alter, or modify any of the terms, conditions, or
21provisions of a collective bargaining agreement entered into
22by the hospital.
23    (f) No hospital may discipline, discharge, or take any
24other adverse employment action against an employee solely
25because the employee expresses a concern or complaint
26regarding an alleged violation of this Section or concerns



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1related to nurse staffing.
2    (g) Any employee of a hospital may file a complaint with
3the Department regarding an alleged violation of this Section.
4The Department must forward notification of the alleged
5violation to the hospital in question within 10 business days
6after the complaint is filed. Upon receiving a complaint of a
7violation of this Section, the Department may take any action
8authorized under Sections 7 or 9 of this Act.
9    (h) Delegation of nursing interventions by a registered
10professional nurse must be in accordance with the Nurse
11Practice Act.
12    (i) A hospital shall not mandate that a registered
13professional nurse delegate any element of the nursing
14process, including, but not limited to, nursing interventions,
15medication administration, nursing judgment, comprehensive
16patient assessment, development of the plan of care, or
17evaluation of care. A delegation of a nursing intervention by
18a registered professional nurse shall not be delegated again
19to another person.
20    (j) The Department shall establish procedures to ensure
21that the documentation submitted under this Section is
22available for public inspection in its entirety.
23    (k) Nothing in this Section shall be construed to limit,
24alter, or modify the requirements of the Safe Patient Limits
26(Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;



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1102-813, eff. 5-13-22.)
2    Section 115. The Nurse Practice Act is amended by adding
3Section 50-15.15 as follows:
4    (225 ILCS 65/50-15.15 new)
5    Sec. 50-15.15. Nursing judgment.
6    (a) The General Assembly finds that:
7        (1) Performance of the scope of practice of a direct
8    care registered professional nurse requires the exercise
9    of nursing judgment in the exclusive interests of the
10    patient.
11        (2) The exercise of nursing judgment, unencumbered by
12    the commercial or revenue-generation priorities of a
13    hospital, long-term acute care hospital, ambulatory
14    surgical treatment center, or other employing entity of a
15    direct care registered professional nurse is necessary to
16    ensure safe, therapeutic, effective, and competent
17    treatment of patients and is essential to protect the
18    health and safety of the people of Illinois.
19    (b) The exercise of nursing judgment by a direct care
20registered professional nurse in the performance of the scope
21of practice of the registered professional nurse under Section
2260-35 or the scope of practice of the advanced practice
23registered nurse under Section 65-30 shall be provided in the
24exclusive interests of the patient and shall not, for any



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1purpose, be considered, relied upon, or represented as a job
2function, authority, responsibility, or activity undertaken in
3any respect for the purpose of serving the business,
4commercial, operational, or other institutional interests of
5the employer.
6    (c) A hospital, long-term acute care hospital, ambulatory
7surgical treatment center, or other health care facility shall
8not adopt a policy that:
9        (1) limits a direct care registered professional nurse
10    in performing duties that are part of the nursing process,
11    including, but not limited to, full exercise of nursing
12    judgment in assessing, planning, implementing, and
13    evaluating care;
14        (2) substitutes recommendations, decisions, or outputs
15    of health information technology, algorithms used to
16    achieve a medical or nursing care objective at a facility,
17    systems based on artificial intelligence or machine
18    learning, or clinical practice guidelines for the
19    independent nursing judgment of a direct care registered
20    professional nurse or penalize a direct care registered
21    professional nurse for overriding the technology or
22    guidelines if, in that registered nurse's judgment, and in
23    accordance with that registered nurse's scope of practice,
24    it is in the best interest of the patient to do so; or
25        (3) limits a direct care registered professional nurse
26    in acting as a patient advocate in the exclusive interests



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1    of the patient.