96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
SB0224


 
Introduced 2/3/2009, by Sen. Kimberly A. Lightford
 
SYNOPSIS AS INTRODUCED:














New Act










 Creates the Nursing Care and Quality Improvement Act. Provides that each hospital shall implement a staffing plan that (i) provides adequate, appropriate, and quality delivery of health care services, (ii) protects patient safety, and (iii) is consistent with the requirements of the Act. Sets forth the minimum direct care registered nurse-to-patient ratios required in a unit of a hospital during each shift in that unit. Sets forth development and reevaluation requirements for the staffing plan. Prohibits a hospital from discharging, discriminating against, or retaliating against (i) a nurse in any manner with respect to any aspect of employment based on the nurse's refusal of a work assignment under certain conditions or (ii) a nurse or any individual, who, in good faith, reports a violation of the Act, initiates, cooperates, or otherwise participates in an investigation or proceeding under the Act, or informs or discusses with other individuals or with representatives of hospital employees a violation or suspected violation of the Act. Sets forth penalties for violation of the Act.
















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FISCAL NOTE ACT MAY APPLY
















 


 


A BILL FOR









 











SB0224

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1
 AN ACT concerning healthcare.


2
 Be it enacted by the People of the State of Illinois,

3
represented in the General Assembly:



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
 quality measures in order to protect patient care and 
16
 reduce the incidence of medical errors.
17
  (3) Inadequate and poorly monitored registered nurse 
18
 staffing practices that result in too few registered nurses 
19
 providing direct care jeopardize the delivery of quality 
20
 health care.
21
  (4) Numerous studies have shown that patient outcomes 
22
 are directly correlated to direct care registered nurse 
23
 staffing levels.
 


 






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  (5) Requirements for direct care registered nurse 
2
 staffing ratios will help address the registered nurse 
3
 shortage in Illinois by aiding in recruitment of new 
4
 registered nurses and improving retention of registered 
5
 nurses who are considering leaving direct patient care 
6
 because of the demands created by inadequate staffing.
7
  (6) Establishing adequate minimum direct care 
8
 registered nurse-to-patient ratios that take into account 
9
 patient acuity measures will improve the delivery of 
10
 quality health care services and patient safety.
11
  (7) Establishing safe staffing standards for direct 
12
 care registered nurses is a critical component of assuring 
13
 that there is adequate hospital staffing at all levels to 
14
 improve the delivery of quality care and protect patient 
15
 safety.

16
 Section 10. Definitions. In this Act:
17
 
"Acuity system" means an established measurement tool that 
18
does all of the following:
19
  (1) predicts nursing care requirements for individual 
20
 patients based on the severity of patient illness, the need 
21
 for specialized equipment and technology, the intensity of 
22
 nursing interventions required, and the complexity of 
23
 clinical nursing judgment that is needed to design, 
24
 implement, and evaluate the patient's nursing care plan;
25
  (2) details the amount of nursing care needed, both in 
 


 






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 the number of nurses and in the skill mix of nursing 
2
 personnel required, on a daily basis for each patient in a 
3
 nursing department or unit;
4
  (3) takes into consideration the patient care services 
5
 provided not only by registered nurses but also by direct 
6
 care licensed practical nurses and other health care 
7
 personnel; and
8
  (4) is stated in terms that can be readily used and 
9
 understood by nurses.
10
 "Nurse" and "registered nurse" means any person licensed as 
11
a registered nurse or a registered professional nurse under the 
12
Nursing and Advanced Practice Nursing Act.
13
 "Direct care registered nurse" means an individual who has 
14
been granted a license to practice as a registered nurse and 
15
who provides bedside care for one or more patients.
16
 "Director" means the Director of Public Health.

17
 "Department" means the Department of Public Health.

18
 "Employment" includes the provision of services under a 
19
contract or other arrangement.
20
 "Hospital" means an entity licensed under the Hospital 
21
Licensing Act.
22
 "Staffing plan" means a staffing plan required under 
23
Section 15 of this Act.


24
 Section 15. Staffing plan required. 
25
 (a) Each hospital shall implement a staffing plan that (i) 
 


 






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provides adequate, appropriate, and quality delivery of health 
2
care services, (ii) protects patient safety, and (iii) is 
3
consistent with the requirements of this Act.
4
 (b) Subject to Section 20 of this Act, the requirements of 
5
subsection (a) shall take effect not later than one year after 
6
the effective date of this Act.


7
 Section 20. Minimum direct care registered 
8
nurse-to-patient ratios. 

9
 (a) For the purposes of this Section:
10
 "Assigned" means the registered nurse has responsibility 
11
for the provision of care to a particular patient within his or 
12
her scope of practice.
13
 "Assist" means that licensed nurses may provide patient 
14
care beyond their patient assignments if the tasks performed 
15
are specific and time-limited.
16
 "Declared state-of-emergency" means a state-of-emergency 
17
that has been declared by the federal government or the head of 
18
the appropriate State or local governmental agency having 
19
authority to declare that the State, county, municipality, or 
20
locality is in a state-of-emergency, but does not include 
21
consistent understaffing.
22
 (b) A hospital's staffing plan shall provide that, during 
23
each shift within a unit of the hospital, a direct care 
24
registered nurse may be assigned to not more than the following 
25
number of patients in that unit:
 


 






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  (1) One patient in operating room units and trauma 
2
 emergency units.
3
  (2) 2 patients in critical care units, including 
4
 emergency critical care and intensive care units, labor and 
5
 delivery units, and post anesthesia units.
6
  (3) 3 patients in ante partum units, emergency room 
7
 units, pediatrics units, step-down units, and telemetry 
8
 units.
9
  (4) 4 patients in intermediate care nursery units, 
10
 specialty care units, medical or surgical units, and acute 
11
 care psychiatric units.
12
  (5) 5 patients in rehabilitation units.

13
  (6) 6 patients in postpartum (3 couplets) units and 
14
 well-baby nursery units.
15
 Registered nurse-to-patient ratios represent the maximum 
16
number of patients who may be assigned to one registered nurse 
17
at any one time. There shall be no averaging of the number of 
18
patients and the total number of registered nurses on the unit 
19
during any one shift nor over any period of time. The 
20
registered nurse-to-patient ratio must be maintained at all 
21
times throughout each shift. Only nurses providing direct 
22
patient care shall be included in the ratios.

23
 Staffing for care not requiring a registered nurse is not 
24
included within these ratios. Additional staff in excess of 
25
these prescribed ratios, including non-licensed staff, shall 
26
be assigned in accordance with the hospital's documented 
 


 






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patient acuity system for determining nursing care 
2
requirements, considering factors that include the severity of 
3
the illness, the need for specialized equipment and technology, 
4
the complexity of clinical judgment needed to design, 
5
implement, and evaluate the patient care plan, the ability for 
6
self-care, and the licensure of the personnel required for 
7
care.
8
 Nurse administrators, nurse supervisors, nurse managers, 
9
charge nurses, and other licensed nurses shall be included in 
10
the calculation of the licensed nurse-to-patient ratio only 
11
when those licensed nurses are engaged in providing direct 
12
patient care. When a nurse administrator, nurse supervisor, 
13
nurse manager, charge nurse, or other licensed nurse is engaged 
14
in activities other than direct patient care, that nurse shall 
15
not be included in the ratio. Nurse administrators, nurse 
16
supervisors, nurse managers, and charge nurses who have 
17
demonstrated current competence to the hospital in providing 
18
care on a particular unit may relieve nurses during breaks, 
19
meals, and other routine, expected absences from the unit.
20
 (c) Nothing in this Section shall prohibit a nurse from 
21
assisting with specific tasks within the scope of his or her 
22
practice for a patient assigned to another nurse.
23
 (d) Within one year after the effective date of this Act, 
24
the Department shall adopt rules providing specific guidance on 
25
the implementation of the minimum direct care registered 
26
nurse-to-patient ratios. The Department shall adopt these 
 


 






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rules in accordance with the Department's licensing and 
2
certification rules and other professional and vocational 
3
rules under Illinois law.
4
 (e) The Director may apply the minimum direct care 
5
registered nurse-to-patient ratios established in subsection 
6
(b) of this Section to a type of hospital unit not referred to 
7
in that subsection (b) if that other unit performs a function 
8
similar to the function performed by a unit referred to in 
9
subsection (b).
10
 (f) If necessary to protect patient safety, the Director 
11
may prescribe regulations that (i) increase minimum direct care 
12
registered nurse-to-patient ratios under this Section to 
13
further limit the number of patients that may be assigned to 
14
each direct care nurse or (ii) add minimum direct care 
15
registered nurse-to-patient ratios for units not referred to in 
16
subsections (b) and (d). These regulations shall be prescribed 
17
after consultation with affected hospitals and registered 
18
nurses.
19
 (g) The requirements established under this Section shall 
20
not apply during a declared state-of-emergency, if a hospital 
21
is requested or expected to provide an exceptional level of 
22
emergency or other medical services.

23
 (h) Nursing personnel from temporary nursing agencies 
24
shall not be responsible for a patient care unit without having 
25
demonstrated clinical and supervisory competence.
26
 (i) The requirements of this Section shall take effect as 
 


 






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soon as practicable, as determined by the Director, but not 
2
later than 2 years after the effective date of this Act.


3
 Section 25. Development and reevaluation of staffing plan. 

4
 (a) In developing a staffing plan, a hospital shall provide 
5
for direct care registered nurse-to-patient ratios above the 
6
minimum direct care registered nurse-to-patient ratios 
7
required under Section 20 of this Act, if appropriate, based 
8
upon consideration of all of the following factors:
9
  (1) the number of patients and acuity level of patients 
10
 as determined by the application of an acuity system, on a 
11
 shift-by-shift basis;
12
  (2) the anticipated admissions, discharges, and 
13
 transfers of patients during each shift that impacts direct 
14
 patient care;
15
  (3) specialized experience required of direct care 
16
 registered nurses on a particular unit;
17
  (4) staffing levels and services provided by other 
18
 health care personnel in meeting direct patient care needs 
19
 not required by a direct care registered nurse;
20
  (5) the level of technology available that affects the 
21
 delivery of direct patient care;
22
  (6) the level of familiarity with hospital practices, 
23
 policies, and procedures by temporary agency direct care 
24
 registered nurses used during a shift; and
25
  (7) obstacles to efficiency in the delivery of patient 
 


 






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 care presented by physical layout.
2
 (b) A hospital shall specify the system used to document 
3
actual staffing in each unit for each shift.
4
 (c) A hospital shall annually evaluate (i) its staffing 
5
plan in each unit in relation to actual patient care 
6
requirements and (ii) the accuracy of its acuity system and 
7
update its staffing plan and acuity system to the extent 
8
appropriate based on the evaluation.
9
 (d) A staffing plan of a hospital shall be developed and 
10
subsequent reevaluations shall be conducted under this Section 
11
on the basis of input from direct care registered nurses at the 
12
hospital or, if the nurses are represented through collective 
13
bargaining, from the applicable recognized or certified 
14
collective bargaining representative of the nurses.
15
 (e) A hospital shall submit to the Director its staffing 
16
plan and any annual updates under subsection (c).
17
 (f) Nothing in this Act shall be construed to permit 
18
conduct prohibited under the National Labor Relations Act or 
19
under the Federal Labor Relations Act of 1978.

20
 Section 30. Protection of nurses and other individuals. 

21
 (a) A nurse may refuse to accept an assignment as a nurse 
22
in a hospital if either of the following conditions apply:
23
  (1) the assignment would violate the provisions of 
24
 Sections 15, 20, or 25; or
25
  (2) the nurse is not prepared by education, training, 
 


 






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 or experience to fulfill the assignment without 
2
 compromising the safety of any patient or jeopardizing his 
3
 or her license.
4
 The requirements of this subsection (a) shall apply to 
5
refusals occurring on or after the effective date of this Act, 
6
except that the requirements of paragraph (2) of this 
7
subsection (a) shall not apply to refusals in any hospital 
8
before the requirements of Section 15 of this Act apply to that 
9
hospital.
10
 (b) No hospital shall discharge, discriminate against, or 
11
retaliate against a nurse in any manner with respect to any 
12
aspect of employment, including discharge, promotion, 
13
compensation, or terms, conditions, or privileges of 
14
employment, based on the nurse's refusal of a work assignment 
15
under subsection (a). The requirements of this subsection (b) 
16
shall apply to refusals occurring on or after the effective 
17
date of this Act.
18
 (c) No hospital shall file a complaint or a report against 
19
a nurse with the appropriate State professional disciplinary 
20
agency because of the nurse's refusal of a work assignment 
21
under subsection (a). The requirements of this subsection (c) 
22
shall apply to refusals occurring on or after the effective 
23
date of this Act.
24
 (d) Any nurse who has been discharged, discriminated 
25
against, or retaliated against or against whom a complaint has 
26
been filed in violation of this Section may bring a cause of 
 


 






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action in a State court. A nurse who prevails in the cause of 
2
action shall be entitled to one or more of the following:
3
  (1) Reinstatement.
4
  (2) Reimbursement of lost wages, compensation, and 
5
 benefits.
6
  (3) Attorneys' fees.
7
  (4) Court costs.
8
  (5) Other damages.
9
 The requirements of this subsection (d) shall apply to 
10
refusals occurring on or after the effective date of this Act.
11
 (e) A nurse or other individual may file a complaint with 
12
the Director against a hospital that violates any provision of 
13
this Act. For any complaint filed, the Director shall do all of 
14
the following:
15
  (1) receive and investigate the complaint;
16
  (2) determine whether a violation of this Act as 
17
 alleged in the complaint has occurred; and
18
  (3) if such a violation has occurred, issue an order 
19
 that the complaining nurse or individual shall not suffer 
20
 any retaliation under subsections (b), (c) or (f).
21
 (f) A hospital shall not discriminate or retaliate in any 
22
manner with respect to any aspect of employment, including 
23
hiring, discharge, promotion, compensation, or terms, 
24
conditions, or privileges of employment, against any 
25
individual who in good faith, individually or in conjunction 
26
with another person or persons, does any of the following:
 


 






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  (1) reports a violation or a suspected violation of 
2
 this Act to the Director, a public regulatory agency, a 
3
 private accreditation body, or the management personnel of 
4
 the hospital;
5
  (2) initiates, cooperates, or otherwise participates 
6
 in an investigation or proceeding brought by the Director, 
7
 a public regulatory agency, or a private accreditation body 
8
 concerning matters covered by this Act; or
9
  (3) informs or discusses with other individuals or with 
10
 representatives of hospital employees a violation or 
11
 suspected violation of this Act.
12
 For the purposes of this subsection (f), an individual 
13
shall be deemed to be acting in good faith if the individual 
14
reasonably believes that the information reported or disclosed 
15
is true and that a violation of this Act has occurred or may 
16
occur.
17
 The requirements of this subsection (f) shall apply to 
18
those actions set forth in paragraphs (1) and (3) of this 
19
subsection (f) and occurring on or after the effective date 
20
this Act. The requirements of this subsection (f) shall apply 
21
to initiation, cooperation, or participation in an 
22
investigation or proceeding on or after the effective date of 
23
this Act.
24
 (g) Beginning 18 months after the effective date of this 
25
Act, a hospital shall post in an appropriate location in each 
26
unit a conspicuous notice in a form specified by the Director 
 


 






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that shall do each of the following:

2
  (1) explain the rights of nurses and other individuals 
3
 under this Section; and
4
  (2) include a statement that a nurse or other 
5
 individual may file a complaint with the Director against a 
6
 hospital that violates the provisions of this Act and 
7
 provide instructions on how to file this complaint.


8
 Section 35. Penalties. The Director may impose civil 
9
penalties or suspend, revoke, or place conditional provisions 
10
upon a license of a hospital for a violation of any provision 
11
of this Act. The Department shall adopt by rule a schedule 
12
establishing the amount of civil penalty that may be imposed 
13
for any violation of Sections 15, 20, 25, or 30 of this Act 
14
when there is a reasonable belief that safe patient care has 
15
been or may be negatively impacted. Each violation of a 
16
staffing plan shall be considered a separate violation.
17
 In addition to any other monies set aside and appropriated 
18
to the Department for nursing scholarships awarded pursuant to 
19
the Nursing Education Scholarship Law, revenues collected from 
20
fines incurred under this Act shall be allocated to the 
21
Department for that same purpose.