Full Text of HB0392 95th General Assembly
HB0392ham001 95TH GENERAL ASSEMBLY
|
Health Care Availability and Access Committee
Adopted in House Comm. on Mar 06, 2007
|
|
09500HB0392ham001 |
|
LRB095 05277 DRJ 32282 a |
|
| 1 |
| AMENDMENT TO HOUSE BILL 392
| 2 |
| AMENDMENT NO. ______. Amend House Bill 392 by replacing | 3 |
| everything after the enacting clause with the following:
| 4 |
| "Section 1. Short title. This Act may be cited as the | 5 |
| Nursing Care and Quality Improvement Act. | 6 |
| Section 5. Findings. The Legislature finds and declares all | 7 |
| of the following:
| 8 |
| (1) The State of Illinois has a substantial interest in | 9 |
| promoting quality care and improving the delivery of health | 10 |
| care services to patients in health care facilities in the | 11 |
| State.
| 12 |
| (2) Recent changes in the health care delivery systems | 13 |
| that have resulted in higher acuity levels among patients | 14 |
| in health care facilities increase the need for improved | 15 |
| safety measures in order to protect patient care and reduce | 16 |
| adverse events.
|
|
|
|
09500HB0392ham001 |
- 2 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| (3) Inadequate and poorly monitored registered nurse | 2 |
| staffing practices that result in too few registered nurses | 3 |
| providing direct care jeopardize the delivery of quality | 4 |
| health care.
| 5 |
| (4) Numerous studies have shown that patient outcomes | 6 |
| are directly correlated to direct care registered nurse | 7 |
| staffing levels.
| 8 |
| (5) Requirements for direct care registered nurse | 9 |
| staffing ratios will help address the registered nurse | 10 |
| shortage in Illinois by aiding in recruitment of new | 11 |
| registered nurses and improving retention of registered | 12 |
| nurses who are considering leaving direct patient care | 13 |
| because of the demands created by inadequate staffing.
| 14 |
| (6) Establishing adequate minimum direct care | 15 |
| registered nurse-to-patient ratios that take into account | 16 |
| patient acuity measures will improve the delivery of | 17 |
| quality health care services and patient safety.
| 18 |
| (7) Establishing safe staffing standards for direct | 19 |
| care registered nurses is a critical component of assuring | 20 |
| that there is adequate hospital staffing at all levels to | 21 |
| improve the delivery of quality care and protect patient | 22 |
| safety.
| 23 |
| Section 10. Definitions. In this Act:
| 24 |
| "Acuity system" means an established measurement tool that | 25 |
| does all of the following:
|
|
|
|
09500HB0392ham001 |
- 3 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| (1) Predicts nursing care requirements for individual | 2 |
| patients based on: the severity of the patient's illness; | 3 |
| the need for specialized equipment and technology; the | 4 |
| intensity and complexity of nursing interventions | 5 |
| required; the complexity of clinical nursing judgment | 6 |
| needed to design, implement, and evaluate the patient's | 7 |
| nursing care plan; the ability for self-care, including | 8 |
| motor, sensory, and cognitive deficits; and the licensure | 9 |
| required for care.
| 10 |
| (2) Details the amount and complexity of nursing care | 11 |
| needed, both in number of nurses and in skill mix of | 12 |
| nursing personnel required, on a daily basis for each | 13 |
| patient in a nursing department or unit.
| 14 |
| (3) Takes into consideration the patient care services | 15 |
| provided not only by registered nurses but also by direct | 16 |
| care licensed practical nurses and other health care | 17 |
| personnel.
| 18 |
| (4) Is stated in terms that can be readily used and | 19 |
| understood by nurses.
| 20 |
| "Department" means the Department of Public Health.
| 21 |
| "Direct care registered nurse" means an individual who has | 22 |
| been granted a license to practice as a registered nurse and | 23 |
| who provides bedside care for one or more patients.
| 24 |
| "Director" means the Director of Public Health.
| 25 |
| "Employment" includes the provision of services under a | 26 |
| contract or other arrangement.
|
|
|
|
09500HB0392ham001 |
- 4 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| "Hospital" means an entity licensed under the Hospital | 2 |
| Licensing Act.
| 3 |
| "Nurse" and "registered nurse" mean any person licensed as | 4 |
| a registered nurse or a registered professional nurse under the | 5 |
| Nursing and Advanced Practice Nursing Act.
| 6 |
| "Staffing plan" means a staffing plan required under | 7 |
| Section 15 of this Act.
| 8 |
| Section 15. Staffing plan required. Not later than one year | 9 |
| after the effective date of this Act, each hospital shall | 10 |
| implement a written staffing plan that (i) provides for safe, | 11 |
| therapeutic, and competent care services, (ii) protects | 12 |
| patient safety, and (iii) is consistent with the requirements | 13 |
| of this Act. | 14 |
| Section 20. Minimum direct care registered | 15 |
| nurse-to-patient ratios. | 16 |
| (a) For the purposes of this Section:
| 17 |
| "Assigned" means that the registered nurse has | 18 |
| responsibility for the provision of care to a particular | 19 |
| patient within his or her scope of practice.
| 20 |
| "Declared state of emergency" means a state of emergency | 21 |
| that has been declared by the federal government or the head of | 22 |
| the appropriate State or local governmental agency having | 23 |
| authority to declare that the State, county, municipality, or | 24 |
| locality is in a state of emergency, but does not include |
|
|
|
09500HB0392ham001 |
- 5 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| consistent understaffing.
| 2 |
| (b) A hospital's staffing plan shall provide that, during | 3 |
| each shift within a unit of the hospital, a direct care | 4 |
| registered nurse shall not be assigned to more than the | 5 |
| following number of patients in that unit:
| 6 |
| (1) One patient in operating room units, trauma | 7 |
| emergency units, and for patients receiving conscious | 8 |
| sedation, at all times.
| 9 |
| (2) Two patients in critical care units, including | 10 |
| emergency critical care and intensive care units, newborn | 11 |
| intensive care units, labor and delivery units, and | 12 |
| post-anesthesia units at all times.
| 13 |
| (3) Three patients in ante-partum units, emergency | 14 |
| room units, pediatrics units, step-down units, and | 15 |
| telemetry units at all times.
| 16 |
| (4) Four patients in intermediate care nursery units, | 17 |
| specialty care units, medical/surgical units, postpartum | 18 |
| (mothers only) units, and acute care psychiatric units at | 19 |
| all times.
| 20 |
| (5) Five patients in rehabilitation units, skilled | 21 |
| nursing units, and well-baby nursery units at all times.
| 22 |
| (6) Six patients in postpartum (3 couplets) units and | 23 |
| well-baby nursery units at all times.
| 24 |
| Registered nurse-to-patient ratios represent the maximum | 25 |
| number of patients who may be assigned to one registered nurse | 26 |
| at any one time. There shall be no averaging of the number of |
|
|
|
09500HB0392ham001 |
- 6 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| patients and the total number of registered nurses on the unit | 2 |
| during any one shift nor over any period of time. The | 3 |
| registered nurse-to-patient ratio must be maintained at all | 4 |
| times throughout each shift. Only nurses providing direct | 5 |
| patient care shall be included in the ratios.
| 6 |
| Staffing for care not requiring a registered nurse is not | 7 |
| included within these ratios. Additional staff in excess of | 8 |
| these prescribed ratios, including non-licensed staff, shall | 9 |
| be assigned in accordance with the hospital's documented | 10 |
| patient acuity system for determining nursing care | 11 |
| requirements, considering factors that include the severity of | 12 |
| the illness, the need for specialized equipment and technology, | 13 |
| the complexity of clinical judgment needed to design, | 14 |
| implement, and evaluate the patient care plan, the ability for | 15 |
| self-care, and the licensure of the personnel required for | 16 |
| care.
| 17 |
| Nurse administrators, nurse supervisors, nurse managers, | 18 |
| charge nurses, and other licensed nurses shall be included in | 19 |
| the calculation of the licensed nurse-to-patient ratio only | 20 |
| when those licensed nurses are engaged in providing direct | 21 |
| patient care. When a nurse administrator, nurse supervisor, | 22 |
| nurse manager, charge nurse, or other licensed nurse is engaged | 23 |
| in activities other than direct patient care, that nurse shall | 24 |
| not be included in the calculation of the ratio. Nurse | 25 |
| administrators, nurse supervisors, nurse managers, and charge | 26 |
| nurses who have demonstrated current competence to the hospital |
|
|
|
09500HB0392ham001 |
- 7 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| in providing care on a particular unit may relieve nurses | 2 |
| during breaks, meals, and other routine, expected absences from | 3 |
| the unit.
| 4 |
| (c) The names used to identify clinical units in subsection | 5 |
| (b) reflect common usage and understanding. Each identified | 6 |
| unit provides care to distinct patient types and conditions; | 7 |
| each unit provides nursing care in accordance with general | 8 |
| direct care registered nursing practice standards and | 9 |
| unit-specific standards and competency requirements; and | 10 |
| direct care registered nurse staffing levels for each shift in | 11 |
| each unit are determined on the basis of patient assessments | 12 |
| performed by direct care registered nurses with demonstrated | 13 |
| competency on the unit and in accordance with unit-specific | 14 |
| standards regarding nursing care requirements for patients | 15 |
| served by the unit. These unit-specific characteristics | 16 |
| determine the applicable minimum direct care registered | 17 |
| nurse-to-patient staffing ratio for each unit.
| 18 |
| (d) Identifying a unit by a name or term other than those | 19 |
| used in subsection (b) does not affect the requirement to staff | 20 |
| at the direct care registered nurse-to-patient ratios | 21 |
| identified for the level of intensity or type of care described | 22 |
| in this Section.
| 23 |
| (e) Patients shall be cared for only on units where the | 24 |
| level of intensity, type of care, and direct care registered | 25 |
| nurse-to-patients ratios meet the individual requirements and | 26 |
| needs of each patient.
|
|
|
|
09500HB0392ham001 |
- 8 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| (f) Within one year after the effective date of this Act, | 2 |
| the Department shall adopt rules providing specific guidance on | 3 |
| the implementation of the minimum direct care registered | 4 |
| nurse-to-patient ratios. The Department shall adopt these | 5 |
| rules in accordance with the Department's licensing and | 6 |
| certification rules and other professional and vocational | 7 |
| rules under Illinois law.
| 8 |
| (g) The Director may apply minimum direct care registered | 9 |
| nurse-to-patient ratios established in subsection (b) of this | 10 |
| Section to a type of hospital unit not referred to in that | 11 |
| subsection (b) if that other unit performs a function similar | 12 |
| to the function performed by the unit referred to in subsection | 13 |
| (b).
| 14 |
| (h) If necessary to protect patient safety, the Director | 15 |
| may prescribe regulations that (i) increase minimum direct care | 16 |
| registered nurse-to-patient ratios under this Section to | 17 |
| further limit the number of patients that may be assigned to | 18 |
| each direct care nurse or (ii) add minimum direct care | 19 |
| registered nurse-to-patient ratios for units not referred to in | 20 |
| subsections (b) and (d).
| 21 |
| (i) The requirements established under this Section do not | 22 |
| apply during a declared state of emergency if a hospital is | 23 |
| requested or expected to provide an exceptional level of | 24 |
| emergency or other medical services.
| 25 |
| (j) Nursing personnel from temporary nursing agencies | 26 |
| shall not be assigned to a patient care unit without having |
|
|
|
09500HB0392ham001 |
- 9 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| demonstrated clinical and supervisory competence.
| 2 |
| (k) The Department shall adopt rules prescribing the time | 3 |
| by which the requirements of this Section must be implemented. | 4 |
| That time shall be as soon as practicable after the effective | 5 |
| date of this Act, but in no event later that 2 years after the | 6 |
| effective date of this Act.
| 7 |
| Section 25. Development and reevaluation of staffing plan. | 8 |
| (a) In developing the staffing plan, a hospital shall | 9 |
| provide for direct care registered nurse-to-patient ratios | 10 |
| above the minimum direct care registered nurse-to-patient | 11 |
| ratios required under Section 20 of this Act if appropriate, | 12 |
| based upon consideration of the following factors:
| 13 |
| (1) The number and individualized needs of patients and | 14 |
| the acuity level of patients as determined by the | 15 |
| application of an acuity system on a shift-by-shift basis.
| 16 |
| (2) The anticipated admissions, discharges, and | 17 |
| transfers of patients during each shift that impacts direct | 18 |
| patient care.
| 19 |
| (3) Specialized experience required of direct care | 20 |
| registered nurses on a particular unit.
| 21 |
| (4) Staffing levels and services provided by other | 22 |
| health care personnel in meeting direct patient care needs | 23 |
| not required by a direct care registered nurse.
| 24 |
| (5) The level of technology available that affects the | 25 |
| delivery of direct patient care.
|
|
|
|
09500HB0392ham001 |
- 10 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| (6) The level of familiarity with hospital practices, | 2 |
| policies, and procedures by temporary agency direct care | 3 |
| registered nurses used during a shift. | 4 |
| (7) Obstacles to efficiency in the delivery of patient | 5 |
| care presented by physical layout.
| 6 |
| (b) A hospital shall specify the system used to document | 7 |
| actual staffing in each unit for each shift.
| 8 |
| (c) A hospital shall annually evaluate (i) its staffing | 9 |
| plan in each unit in relation to actual patient care | 10 |
| requirements and (ii) the accuracy of its acuity system and | 11 |
| shall update its staffing plan and acuity system to the extent | 12 |
| appropriate based on that evaluation.
| 13 |
| (d) A hospital's staffing plan shall be developed, and | 14 |
| subsequent reevaluations shall be conducted, under this | 15 |
| Section by a review committee. At least half the members of the | 16 |
| review committee shall be unit-specific direct care registered | 17 |
| nurses who provide direct patient care. If direct care | 18 |
| registered nurses are represented under a collective | 19 |
| bargaining agreement, the appointment of those nurse members | 20 |
| shall be made by the authorized collective bargaining agent.
| 21 |
| (e) A hospital shall submit to the Director its staffing | 22 |
| plan and any annual updates under subsection (c).
| 23 |
| (f) Nothing in this Act shall be construed to permit | 24 |
| conduct prohibited under the National Labor Relations Act or | 25 |
| under the Federal Labor Relations Act.
|
|
|
|
09500HB0392ham001 |
- 11 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| Section 30. Protection of nurses and other individuals. | 2 |
| (a) A nurse may refuse to accept an assignment as a nurse | 3 |
| in a hospital if either of the following conditions apply:
| 4 |
| (1) the assignment would violate the provisions of | 5 |
| Section 15, 20, or 25; or
| 6 |
| (2) the nurse is not prepared by education, training, | 7 |
| or experience to fulfill the assignment without | 8 |
| compromising the safety of any patient or jeopardizing his | 9 |
| or her license.
| 10 |
| The requirements of this subsection (a) shall apply to | 11 |
| refusals occurring on or after the effective date of this Act, | 12 |
| except that the requirements of paragraph (2) of this | 13 |
| subsection (a) shall not apply to refusals in any hospital | 14 |
| before the requirements of Section 15 of this Act apply to that | 15 |
| hospital.
| 16 |
| (b) A hospital may not discharge, discriminate, or | 17 |
| retaliate in any manner with respect to any aspect of | 18 |
| employment, including discharge, promotion, compensation, or | 19 |
| terms, conditions, or privileges of employment, against a nurse | 20 |
| based on the nurse's refusal of a work assignment under | 21 |
| subsection (a). The requirements of this subsection (b) shall | 22 |
| apply to refusals occurring on or after the effective date of | 23 |
| the Act.
| 24 |
| (c) A hospital may not file a complaint or a report against | 25 |
| a nurse with the appropriate State professional disciplinary | 26 |
| agency because of the nurse's refusal of a work assignment |
|
|
|
09500HB0392ham001 |
- 12 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| under subsection (a). The requirements of this subsection (c) | 2 |
| shall apply to refusals occurring on or after the effective | 3 |
| date of this Act.
| 4 |
| (d) Any nurse who has been discharged, discriminated | 5 |
| against, or retaliated against in violation of this Section may | 6 |
| bring an action in the circuit court seeking relief as | 7 |
| authorized in items (1) through (5) of this subsection. A nurse | 8 |
| who prevails in such an action shall be entitled to one or more | 9 |
| of the following:
| 10 |
| (1) Reinstatement.
| 11 |
| (2) Reimbursement of lost wages, compensation, and | 12 |
| benefits.
| 13 |
| (3) Attorney's fees.
| 14 |
| (4) Court costs.
| 15 |
| (5) Other damages.
| 16 |
| The requirements of this subsection (d) shall apply to | 17 |
| refusals occurring on or after the effective date of this Act.
| 18 |
| (e) A nurse or other individual may file a complaint with | 19 |
| the Director against a hospital that violates the provisions of | 20 |
| this Act. For any complaint filed under this subsection, the | 21 |
| Director shall do all of the following:
| 22 |
| (1) Receive and investigate the complaint.
| 23 |
| (2) Determine whether a violation of this Act as | 24 |
| alleged in the complaint has occurred.
| 25 |
| (3) If such a violation has occurred, issue an order | 26 |
| that the complaining nurse or individual shall not suffer |
|
|
|
09500HB0392ham001 |
- 13 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| any retaliation in accordance with subsection (b), (c), or | 2 |
| (f).
| 3 |
| (f) A hospital may not discriminate or retaliate in any | 4 |
| manner with respect to any aspect of employment, including | 5 |
| hiring, discharge, promotion, compensation, or terms, | 6 |
| conditions, or privileges of employment, against any | 7 |
| individual who, individually or in conjunction with another | 8 |
| person or persons, does any of the following:
| 9 |
| (1) Reports a violation or a suspected violation of | 10 |
| this Act to the Director, a public regulatory agency, a | 11 |
| private accreditation body, or the management personnel of | 12 |
| the hospital.
| 13 |
| (2) Initiates, cooperates, or otherwise participates | 14 |
| in an investigation or proceeding brought by the Director, | 15 |
| a public regulatory agency, or a private accreditation body | 16 |
| concerning matters covered by this Act. | 17 |
| (3) Informs or discusses with other individuals or with | 18 |
| representatives of hospital employees a violation or | 19 |
| suspected violation of this Act.
| 20 |
| The requirements of this subsection (f) shall apply to | 21 |
| those actions set forth in paragraphs (1) through (3) of this | 22 |
| subsection (f) and occurring on or after the effective date of | 23 |
| this Act. The requirements of this subsection (f) shall apply | 24 |
| to initiation, cooperation, or participation in an | 25 |
| investigation or proceeding on or after the effective date of | 26 |
| this Act.
|
|
|
|
09500HB0392ham001 |
- 14 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| (g) Beginning 18 months after the effective date of this | 2 |
| Act, a hospital shall post in an appropriate location in each | 3 |
| unit a conspicuous notice in a form specified by the Director | 4 |
| that does each of the following:
| 5 |
| (1) Explains the rights of nurses and other individuals | 6 |
| under this Section. | 7 |
| (2) Includes a statement that a nurse or other | 8 |
| individual may file a complaint with the Director against a | 9 |
| hospital that violates the provisions of this Act, and | 10 |
| provides instructions on how to file such a complaint.
| 11 |
| Section 35. Penalties. The Director may impose | 12 |
| administrative penalties or suspend, revoke, or place | 13 |
| conditional provisions upon a license of a hospital for a | 14 |
| violation of any provision of this Act. The Department shall | 15 |
| adopt by rule a schedule establishing the amount of an | 16 |
| administrative penalty that may be imposed for any violation of | 17 |
| Section 15, 20, 25, or 30 of this Act when there is a | 18 |
| reasonable belief that safe patient care has been or may be | 19 |
| negatively impacted. Each violation of a staffing plan shall be | 20 |
| considered a separate violation of this Act.
Before imposing a | 21 |
| penalty under this Section, the Director shall afford the | 22 |
| hospital an opportunity to request a hearing and present | 23 |
| evidence on the matter. | 24 |
| In addition to other moneys set aside and appropriated to | 25 |
| the Department for nursing scholarships awarded pursuant to the |
|
|
|
09500HB0392ham001 |
- 15 - |
LRB095 05277 DRJ 32282 a |
|
| 1 |
| Nursing Education Scholarship Law, revenues collected from | 2 |
| administrative penalties imposed under this Act shall be | 3 |
| allocated to the Department for that same purpose.".
|
|