Full Text of SB0936 95th General Assembly
SB0936sam001 95TH GENERAL ASSEMBLY
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Sen. Iris Y. Martinez
Filed: 3/21/2007
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| AMENDMENT TO SENATE BILL 936
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| AMENDMENT NO. ______. Amend Senate Bill 936 by replacing | 3 |
| everything after the enacting clause with the following:
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| "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 |
| quality measures in order to protect patient care and | 16 |
| reduce the incidence of medical errors. |
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| (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 |
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"Acuity system" means an established measurement tool that | 25 |
| does all of the following: |
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| (1) predicts nursing care requirements for individual | 2 |
| patients based on the severity of patient illness, the need | 3 |
| for specialized equipment and technology, the intensity of | 4 |
| nursing interventions required, and the complexity of | 5 |
| clinical nursing judgment that is needed to design, | 6 |
| implement, and evaluate the patient's nursing care plan; | 7 |
| (2) details the amount of nursing care needed, both in | 8 |
| the number of nurses and in the skill mix of nursing | 9 |
| personnel required, on a daily basis for each patient in a | 10 |
| nursing department or unit; | 11 |
| (3) takes into consideration the patient care services | 12 |
| provided not only by registered nurses but also by direct | 13 |
| care licensed practical nurses and other health care | 14 |
| personnel; and | 15 |
| (4) is stated in terms that can be readily used and | 16 |
| understood by nurses. | 17 |
| "Nurse" and "registered nurse" means any person licensed as | 18 |
| a registered nurse or a registered professional nurse under the | 19 |
| Nursing and Advanced Practice Nursing Act. | 20 |
| "Direct care registered nurse" means an individual who has | 21 |
| been granted a license to practice as a registered nurse and | 22 |
| who provides bedside care for one or more patients. | 23 |
| "Director" means the Director of Public Health.
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| "Department" means the Department of Public Health.
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| "Employment" includes the provision of services under a | 26 |
| contract or other arrangement. |
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| "Hospital" means an entity licensed under the Hospital | 2 |
| Licensing Act. | 3 |
| "Staffing plan" means a staffing plan required under | 4 |
| Section 15 of this Act.
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| Section 15. Staffing plan required. | 6 |
| (a) Each hospital shall implement a staffing plan that (i) | 7 |
| provides adequate, appropriate, and quality delivery of health | 8 |
| care services, (ii) protects patient safety, and (iii) is | 9 |
| consistent with the requirements of this Act. | 10 |
| (b) Subject to Section 20 of this Act, the requirements of | 11 |
| subsection (a) shall take effect not later than one year after | 12 |
| the effective date of this Act.
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| Section 20. Minimum direct care registered | 14 |
| nurse-to-patient ratios.
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| (a) For the purposes of this Section: | 16 |
| "Assigned" means the registered nurse has responsibility | 17 |
| for the provision of care to a particular patient within his or | 18 |
| her scope of practice. | 19 |
| "Assist" means that licensed nurses may provide patient | 20 |
| care beyond their patient assignments if the tasks performed | 21 |
| are specific and time-limited. | 22 |
| "Declared state-of-emergency" means a state-of-emergency | 23 |
| that has been declared by the federal government or the head of | 24 |
| the appropriate State or local governmental agency having |
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| authority to declare that the State, county, municipality, or | 2 |
| locality is in a state-of-emergency, but does not include | 3 |
| consistent understaffing. | 4 |
| (b) A hospital's staffing plan shall provide that, during | 5 |
| each shift within a unit of the hospital, a direct care | 6 |
| registered nurse may be assigned to not more than the following | 7 |
| number of patients in that unit: | 8 |
| (1) One patient in operating room units and trauma | 9 |
| emergency units. | 10 |
| (2) 2 patients in critical care units, including | 11 |
| emergency critical care and intensive care units, labor and | 12 |
| delivery units, and post anesthesia units. | 13 |
| (3) 3 patients in ante partum units, emergency room | 14 |
| units, pediatrics units, step-down units, and telemetry | 15 |
| units. | 16 |
| (4) 4 patients in intermediate care nursery units, | 17 |
| specialty care units, medical or surgical units, and acute | 18 |
| care psychiatric units. | 19 |
| (5) 5 patients in rehabilitation units.
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| (6) 6 patients in postpartum (3 couplets) units and | 21 |
| well-baby nursery units. | 22 |
| Registered nurse-to-patient ratios represent the maximum | 23 |
| number of patients who may be assigned to one registered nurse | 24 |
| at any one time. There shall be no averaging of the number of | 25 |
| patients and the total number of registered nurses on the unit | 26 |
| during any one shift nor over any period of time. The |
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| registered nurse-to-patient ratio must be maintained at all | 2 |
| times throughout each shift. Only nurses providing direct | 3 |
| patient care shall be included in the ratios.
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| Staffing for care not requiring a registered nurse is not | 5 |
| included within these ratios. Additional staff in excess of | 6 |
| these prescribed ratios, including non-licensed staff, shall | 7 |
| be assigned in accordance with the hospital's documented | 8 |
| patient acuity system for determining nursing care | 9 |
| requirements, considering factors that include the severity of | 10 |
| the illness, the need for specialized equipment and technology, | 11 |
| the complexity of clinical judgment needed to design, | 12 |
| implement, and evaluate the patient care plan, the ability for | 13 |
| self-care, and the licensure of the personnel required for | 14 |
| care. | 15 |
| Nurse administrators, nurse supervisors, nurse managers, | 16 |
| charge nurses, and other licensed nurses shall be included in | 17 |
| the calculation of the licensed nurse-to-patient ratio only | 18 |
| when those licensed nurses are engaged in providing direct | 19 |
| patient care. When a nurse administrator, nurse supervisor, | 20 |
| nurse manager, charge nurse, or other licensed nurse is engaged | 21 |
| in activities other than direct patient care, that nurse shall | 22 |
| not be included in the ratio. Nurse administrators, nurse | 23 |
| supervisors, nurse managers, and charge nurses who have | 24 |
| demonstrated current competence to the hospital in providing | 25 |
| care on a particular unit may relieve nurses during breaks, | 26 |
| meals, and other routine, expected absences from the unit. |
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| (c) Nothing in this Section shall prohibit a nurse from | 2 |
| assisting with specific tasks within the scope of his or her | 3 |
| practice for a patient assigned to another nurse. | 4 |
| (d) Within one year after the effective date of this Act, | 5 |
| the Department shall adopt rules providing specific guidance on | 6 |
| the implementation of the minimum direct care registered | 7 |
| nurse-to-patient ratios. The Department shall adopt these | 8 |
| rules in accordance with the Department's licensing and | 9 |
| certification rules and other professional and vocational | 10 |
| rules under Illinois law. | 11 |
| (e) The Director may apply the minimum direct care | 12 |
| registered nurse-to-patient ratios established in subsection | 13 |
| (b) of this Section to a type of hospital unit not referred to | 14 |
| in that subsection (b) if that other unit performs a function | 15 |
| similar to the function performed by a unit referred to in | 16 |
| subsection (b) of this Section. | 17 |
| (f) If necessary to protect patient safety, the Director | 18 |
| may prescribe regulations that (i) increase minimum direct care | 19 |
| registered nurse-to-patient ratios under this Section to | 20 |
| further limit the number of patients that may be assigned to | 21 |
| each direct care nurse or (ii) add minimum direct care | 22 |
| registered nurse-to-patient ratios for units not referred to in | 23 |
| subsections (b) and (d). These regulations shall be prescribed | 24 |
| after consultation with affected hospitals and registered | 25 |
| nurses. | 26 |
| (g) The requirements established under this Section shall |
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| not apply during a declared state-of-emergency, if a hospital | 2 |
| is requested or expected to provide an exceptional level of | 3 |
| emergency or other medical services.
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| (h) Nursing personnel from temporary nursing agencies | 5 |
| shall not be responsible for a patient care unit without having | 6 |
| demonstrated clinical and supervisory competence. | 7 |
| (i) The requirements of this Section shall take effect as | 8 |
| soon as practicable, as determined by the Director, but not | 9 |
| later than 2 years after the effective date of this Act.
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| Section 25. Development and reevaluation of staffing plan.
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| (a) In developing a staffing plan, a hospital shall provide | 12 |
| for direct care registered nurse-to-patient ratios above the | 13 |
| minimum direct care registered nurse-to-patient ratios | 14 |
| required under Section 20 of this Act, if appropriate, based | 15 |
| upon consideration of all of the following factors: | 16 |
| (1) the number of patients and acuity level of patients | 17 |
| as determined by the application of an acuity system, on a | 18 |
| shift-by-shift basis; | 19 |
| (2) the anticipated admissions, discharges, and | 20 |
| transfers of patients during each shift that impacts direct | 21 |
| patient care; | 22 |
| (3) specialized experience required of direct care | 23 |
| registered nurses on a particular unit; | 24 |
| (4) staffing levels and services provided by other | 25 |
| health care personnel in meeting direct patient care needs |
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| not required by a direct care registered nurse; | 2 |
| (5) the level of technology available that affects the | 3 |
| delivery of direct patient care; | 4 |
| (6) the level of familiarity with hospital practices, | 5 |
| policies, and procedures by temporary agency direct care | 6 |
| registered nurses used during a shift; and | 7 |
| (7) obstacles to efficiency in the delivery of patient | 8 |
| care presented by physical layout. | 9 |
| (b) A hospital shall specify the system used to document | 10 |
| actual staffing in each unit for each shift. | 11 |
| (c) A hospital shall annually evaluate (i) its staffing | 12 |
| plan in each unit in relation to actual patient care | 13 |
| requirements and (ii) the accuracy of its acuity system and | 14 |
| update its staffing plan and acuity system to the extent | 15 |
| appropriate based on the evaluation. | 16 |
| (d) A staffing plan of a hospital shall be developed and | 17 |
| subsequent reevaluations shall be conducted under this Section | 18 |
| on the basis of input from direct care registered nurses at the | 19 |
| hospital or, if the nurses are represented through collective | 20 |
| bargaining, from the applicable recognized or certified | 21 |
| collective bargaining representative of the nurses. | 22 |
| (e) A hospital shall submit to the Director its staffing | 23 |
| plan and any annual updates under subsection (c). | 24 |
| (f) Nothing in this Act shall be construed to permit | 25 |
| conduct prohibited under the National Labor Relations Act or | 26 |
| under the Federal Labor Relations Act of 1978. |
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| Section 30. Protection of nurses and other individuals.
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| (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 |
| Sections 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) No hospital shall discharge, discriminate against, or | 17 |
| retaliate against a nurse in any manner with respect to any | 18 |
| aspect of employment, including discharge, promotion, | 19 |
| compensation, or terms, conditions, or privileges of | 20 |
| employment, based on the nurse's refusal of a work assignment | 21 |
| under subsection (a). The requirements of this subsection (b) | 22 |
| shall apply to refusals occurring on or after the effective | 23 |
| date of this Act. | 24 |
| (c) No hospital shall file a complaint or a report against | 25 |
| a nurse with the appropriate State professional disciplinary |
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| agency because of the nurse's refusal of a work assignment | 2 |
| under subsection (a). The requirements of this subsection (c) | 3 |
| shall apply to refusals occurring on or after the effective | 4 |
| date of this Act. | 5 |
| (d) Any nurse who has been discharged, discriminated | 6 |
| against, or retaliated against or against whom a complaint has | 7 |
| been filed in violation of this Section may bring a cause of | 8 |
| action in a State court. A nurse who prevails in the cause of | 9 |
| action shall be entitled to one or more of the following: | 10 |
| (1) Reinstatement. | 11 |
| (2) Reimbursement of lost wages, compensation, and | 12 |
| benefits. | 13 |
| (3) Attorneys' 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 any provision of | 20 |
| this Act. For any complaint filed, the Director shall do all of | 21 |
| 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; and | 25 |
| (3) if such a violation has occurred, issue an order | 26 |
| that the complaining nurse or individual shall not suffer |
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| any retaliation under subsections (b), (c), or (f). | 2 |
| (f) A hospital shall not discriminate or retaliate in any | 3 |
| manner with respect to any aspect of employment, including | 4 |
| hiring, discharge, promotion, compensation, or terms, | 5 |
| conditions, or privileges of employment, against any | 6 |
| individual who in good faith, individually or in conjunction | 7 |
| with another person or persons, does any of the following: | 8 |
| (1) reports a violation or a suspected violation of | 9 |
| this Act to the Director, a public regulatory agency, a | 10 |
| private accreditation body, or the management personnel of | 11 |
| the hospital; | 12 |
| (2) initiates, cooperates, or otherwise participates | 13 |
| in an investigation or proceeding brought by the Director, | 14 |
| a public regulatory agency, or a private accreditation body | 15 |
| concerning matters covered by this Act; or | 16 |
| (3) informs or discusses with other individuals or with | 17 |
| representatives of hospital employees a violation or | 18 |
| suspected violation of this Act. | 19 |
| For the purposes of this subsection (f), an individual | 20 |
| shall be deemed to be acting in good faith if the individual | 21 |
| reasonably believes that the information reported or disclosed | 22 |
| is true and that a violation of this Act has occurred or may | 23 |
| occur. | 24 |
| The requirements of this subsection (f) shall apply to | 25 |
| those actions set forth in paragraphs (1) and (3) of this | 26 |
| subsection (f) and occurring on or after the effective date |
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| this Act. The requirements of this subsection (f) shall apply | 2 |
| to initiation, cooperation, or participation in an | 3 |
| investigation or proceeding on or after the effective date of | 4 |
| this Act. | 5 |
| (g) Beginning 18 months after the effective date of this | 6 |
| Act, a hospital shall post in an appropriate location in each | 7 |
| unit a conspicuous notice in a form specified by the Director | 8 |
| that shall do each of the following:
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| (1) explain the rights of nurses and other individuals | 10 |
| under this Section; and | 11 |
| (2) include a statement that a nurse or other | 12 |
| individual may file a complaint with the Director against a | 13 |
| hospital that violates the provisions of this Act and | 14 |
| provide instructions on how to file this complaint.
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| Section 35. Penalties. The Director may impose civil | 16 |
| penalties or suspend, revoke, or place conditional provisions | 17 |
| upon a license of a hospital for a violation of any provision | 18 |
| of this Act. The Department shall adopt by rule a schedule | 19 |
| establishing the amount of civil penalty that may be imposed | 20 |
| for any violation of Sections 15, 20, 25, or 30 of this Act | 21 |
| when there is a reasonable belief that safe patient care has | 22 |
| been or may be negatively impacted. Each violation of a | 23 |
| staffing plan shall be considered a separate violation. | 24 |
| In addition to any other monies set aside and appropriated | 25 |
| to the Department for nursing scholarships awarded pursuant to |
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| the Nursing Education Scholarship Law, revenues collected from | 2 |
| fines incurred under this Act shall be allocated to the | 3 |
| Department for that same purpose.".
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