Public Act 103-0211
 
HB3890 EnrolledLRB103 30120 CPF 56544 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Hospital Licensing Act is amended by
changing Section 10.10 as follows:
 
    (210 ILCS 85/10.10)
    Sec. 10.10. Nurse Staffing by Patient Acuity.
    (a) Findings. The Legislature finds and declares all of
the following:
        (1) The State of Illinois has a substantial interest
    in promoting quality care and improving the delivery of
    health care services.
        (2) Evidence-based studies have shown that the basic
    principles of staffing in the acute care setting should be
    based on the complexity of patients' care needs aligned
    with available nursing skills to promote quality patient
    care consistent with professional nursing standards.
        (3) Compliance with this Section promotes an
    organizational climate that values registered nurses'
    input in meeting the health care needs of hospital
    patients.
    (b) Definitions. As used in this Section:
    "Acuity model" means an assessment tool selected and
implemented by a hospital, as recommended by a nursing care
committee, that assesses the complexity of patient care needs
requiring professional nursing care and skills and aligns
patient care needs and nursing skills consistent with
professional nursing standards.
    "Department" means the Department of Public Health.
    "Direct patient care" means care provided by a registered
professional nurse with direct responsibility to oversee or
carry out medical regimens or nursing care for one or more
patients.
    "Nursing care committee" means a hospital-wide committee
or committees of nurses whose functions, in part or in whole,
contribute to the development, recommendation, and review of
the hospital's nurse staffing plan established pursuant to
subsection (d).
    "Registered professional nurse" means a person licensed as
a Registered Nurse under the Nurse Practice Act.
    "Written staffing plan for nursing care services" means a
written plan for the assignment of patient care nursing staff
based on multiple nurse and patient considerations that yield
minimum staffing levels for inpatient care units and the
adopted acuity model aligning patient care needs with nursing
skills required for quality patient care consistent with
professional nursing standards.
    (c) Written staffing plan.
        (1) Every hospital shall implement a written
    hospital-wide staffing plan, prepared by a nursing care
    committee or committees, that provides for minimum direct
    care professional registered nurse-to-patient staffing
    needs for each inpatient care unit, including inpatient
    emergency departments. If the staffing plan prepared by
    the nursing care committee is not adopted by the hospital,
    or if substantial changes are proposed to it, the chief
    nursing officer shall either: (i) provide a written
    explanation to the committee of the reasons the plan was
    not adopted; or (ii) provide a written explanation of any
    substantial changes made to the proposed plan prior to it
    being adopted by the hospital. The written hospital-wide
    staffing plan shall include, but need not be limited to,
    the following considerations:
            (A) The complexity of complete care, assessment on
        patient admission, volume of patient admissions,
        discharges and transfers, evaluation of the progress
        of a patient's problems, ongoing physical assessments,
        planning for a patient's discharge, assessment after a
        change in patient condition, and assessment of the
        need for patient referrals.
            (B) The complexity of clinical professional
        nursing judgment needed to design and implement a
        patient's nursing care plan, the need for specialized
        equipment and technology, the skill mix of other
        personnel providing or supporting direct patient care,
        and involvement in quality improvement activities,
        professional preparation, and experience.
            (C) Patient acuity and the number of patients for
        whom care is being provided.
            (D) The ongoing assessments of a unit's patient
        acuity levels and nursing staff needed shall be
        routinely made by the unit nurse manager or his or her
        designee.
            (E) The identification of additional registered
        nurses available for direct patient care when
        patients' unexpected needs exceed the planned workload
        for direct care staff.
        (2) In order to provide staffing flexibility to meet
    patient needs, every hospital shall identify an acuity
    model for adjusting the staffing plan for each inpatient
    care unit.
        (2.5) Each hospital shall implement the staffing plan
    and assign nursing personnel to each inpatient care unit,
    including inpatient emergency departments, in accordance
    with the staffing plan.
            (A) A registered nurse may report to the nursing
        care committee any variations where the nurse
        personnel assignment in an inpatient care unit is not
        in accordance with the adopted staffing plan and may
        make a written report to the nursing care committee
        based on the variations.
            (B) Shift-to-shift adjustments in staffing levels
        required by the staffing plan may be made by the
        appropriate hospital personnel overseeing inpatient
        care operations. If a registered nurse in an inpatient
        care unit objects to a shift-to-shift adjustment, the
        registered nurse may submit a written report to the
        nursing care committee.
            (C) The nursing care committee shall develop a
        process to examine and respond to written reports
        submitted under subparagraphs (A) and (B) of this
        paragraph (2.5), including the ability to determine if
        a specific written report is resolved or should be
        dismissed.
        (3) The written staffing plan shall be posted, either
    by physical or electronic means, in a conspicuous and
    accessible location for both patients and direct care
    staff, as required under the Hospital Report Card Act. A
    copy of the written staffing plan shall be provided to any
    member of the general public upon request.
    (d) Nursing care committee.
        (1) Every hospital shall have a nursing care committee
    that meets at least 6 times per year. A hospital shall
    appoint members of a committee whereby at least 55% of the
    members are registered professional nurses providing
    direct inpatient care, one of whom shall be selected
    annually by the direct inpatient care nurses to serve as
    co-chair of the committee.
        (2) (Blank).
        (2.5) A nursing care committee shall prepare and
    recommend to hospital administration the hospital's
    written hospital-wide staffing plan. If the staffing plan
    is not adopted by the hospital, the chief nursing officer
    shall provide a written statement to the committee prior
    to a staffing plan being adopted by the hospital that: (A)
    explains the reasons the committee's proposed staffing
    plan was not adopted; and (B) describes the changes to the
    committee's proposed staffing or any alternative to the
    committee's proposed staffing plan.
        (3) A nursing care committee's or committees' written
    staffing plan for the hospital shall be based on the
    principles from the staffing components set forth in
    subsection (c). In particular, a committee or committees
    shall provide input and feedback on the following:
            (A) Selection, implementation, and evaluation of
        minimum staffing levels for inpatient care units.
            (B) Selection, implementation, and evaluation of
        an acuity model to provide staffing flexibility that
        aligns changing patient acuity with nursing skills
        required.
            (C) Selection, implementation, and evaluation of a
        written staffing plan incorporating the items
        described in subdivisions (c)(1) and (c)(2) of this
        Section.
            (D) Review the nurse staffing plans for all
        inpatient areas and current acuity tools and measures
        in use. The nursing care committee's review shall
        consider:
                (i) patient outcomes;
                (ii) complaints regarding staffing, including
            complaints about a delay in direct care nursing or
            an absence of direct care nursing;
                (iii) the number of hours of nursing care
            provided through an inpatient hospital unit
            compared with the number of inpatients served by
            the hospital unit during a 24-hour period;
                (iv) the aggregate hours of overtime worked by
            the nursing staff;
                (v) the extent to which actual nurse staffing
            for each hospital inpatient unit differs from the
            staffing specified by the staffing plan; and
                (vi) any other matter or change to the
            staffing plan determined by the committee to
            ensure that the hospital is staffed to meet the
            health care needs of patients.
        (4) A nursing care committee must issue a written
    report addressing the items described in subparagraphs (A)
    through (D) of paragraph (3) semi-annually. A written copy
    of this report shall be made available to direct inpatient
    care nurses by making available a paper copy of the
    report, distributing it electronically, or posting it on
    the hospital's website.
        (5) A nursing care committee must issue a written
    report at least annually to the hospital governing board
    that addresses items including, but not limited to: the
    items described in paragraph (3); changes made based on
    committee recommendations and the impact of such changes;
    and recommendations for future changes related to nurse
    staffing.
        (6) A nursing care committee must annually notify the
    hospital nursing staff of the staff's rights under this
    Section. The annual notice must provide a phone number and
    an email address for staff to report noncompliance with
    the nursing staff's rights as described in this Section.
    The notice must be provided by email or by regular mail in
    a manner that effectively facilitates receipt of the
    notice. The Department shall monitor and enforce the
    requirements of this paragraph (6).
    (e) Nothing in this Section 10.10 shall be construed to
limit, alter, or modify any of the terms, conditions, or
provisions of a collective bargaining agreement entered into
by the hospital.
    (f) No hospital may discipline, discharge, or take any
other adverse employment action against an employee solely
because the employee expresses a concern or complaint
regarding an alleged violation of this Section or concerns
related to nurse staffing.
    (g) Any employee of a hospital may file a complaint with
the Department regarding an alleged violation of this Section.
The Department must forward notification of the alleged
violation to the hospital in question within 10 business days
after the complaint is filed. Upon receiving a complaint of a
violation of this Section, the Department may take any action
authorized under Sections 7 or 9 of this Act.
(Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
102-813, eff. 5-13-22.)