HB1083sam001 93RD GENERAL ASSEMBLY

Sen. Don Harmon

Filed: 4/28/2004

09300HB1083sam001 LRB093 05459 DRJ 50226 a

AMENDMENT TO HOUSE BILL 1083

AMENDMENT NO. ______. Amend House Bill 1083 by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Responsible Hospital Staffing Act.

Section 5. Findings. The Legislature finds and declares all of the following:

(1) Adequate staffing in hospitals contributes to high quality patient care and the prevention of medical errors.

(2) To ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses be accessible and available to meet the needs of patients.

(3) The basic principles of staffing in the acute care setting should be based on the patient's care needs, the severity of the condition, services needed, and the complexities surrounding those services, as well as the experience level, clinical competencies, and education of the licensed nurses providing patient care services.

Section 10. Definitions. As used in this Act:

"Critical care unit" means a unit that is established to safeguard and protect patients whose medical conditions are severe enough to require continuous monitoring and complex interventions by registered nurses.

"Department" means the Department of Public Health.

"Director" means the Director of Public Health.

"Employee" means any individual permitted to work by an employer in an occupation, including both individuals hired directly by the company and those hired pursuant to a contract with an outside entity, such as a staffing agency.

"Employer" means any person or entity licensed under the Hospital Licensing Act, or the parent or holding company of any such person or entity, who directly or indirectly, or through an agent or any other person, employs or exercises control over the wages, hours, or working conditions of any person.

"Health system" means a company (i) that is non-profit or for-profit, religious or non-religious, and (ii) that owns, operates, or controls more than 2 hospitals.

"Hospital" means an entity licensed under the Hospital Licensing Act.

"Hospital unit" means a critical care unit, burn unit, labor and delivery room, postanesthesia service area, emergency department, operating room, pediatric unit, step-down or intermediate care unit, specialty care unit, telemetry unit, general medical care unit, sub-acute care unit, or transitional inpatient care unit.

"Nurse" or "registered nurse" means a person licensed as a registered professional nurse or licensed practical nurse under the Nursing and Advanced Practice Nursing Act.

"Violation" means a finding by a court, governmental commission, or neutral arbiter that wage-and-hour laws or regulations were violated.

"Wage-and-hour laws or regulations" means any State or federal law that regulates the hours worked by and wages paid to registered nurses.

"Organizational plan of nursing services" means a written plan of direct care nursing personnel staffing requirements that are appropriate to ensure that all patients receive health care under normal and emergent circumstances.

Section 15. Registered nurse staff planning. Each hospital shall develop and implement an organizational plan of nursing services. It shall be an integral part of the overall hospital organizational plan and shall be available to all nursing personnel. Each hospital shall have a process that ensures the consideration of input from direct care clinical staff in the development, implementation, monitoring, evaluation, and modification of the organizational plan of nursing services. At least one-third the members of the committee charged with developing, monitoring, evaluating, and modifying the plan shall be nurses who provide direct patient care. The organizational plan of nursing services shall include:

(1) Competency validation for registered nurses based on the statutorily recognized duties and responsibilities of the registered nurse and the standards that are specific to each patient care unit.

(2) A patient classification system that establishes staffing requirements by unit, patient, and shift; determines staff resource allocation based on nursing care requirements for each shift and each unit; establishes a method by which the hospital validates the reliability of the patient classification system; and incorporates a method by which the hospital improves patient outcomes based on clinical data.

(3) Written nursing service policies and procedures based on current standards of nursing practice and consistent with the nursing process, which includes assessment, nursing diagnosis, planning, intervention, evaluation, and patient advocacy.

The hospital administration and the governing body shall review and approve all policies and procedures that relate to nursing service at least once every 3 years. The organizational plan of nursing services may include a schedule for meal periods and rest periods different from those required by Section 20 of this Act, provided that the schedule has been approved by (and cannot be altered, suspended, or terminated without the consent of) the committee charged with developing, monitoring, evaluating, and modifying the organizational plan.

The Department of Public Health may establish by rule additional criteria for organizational plans of nursing services.

Section 20. Rest periods. Every hospital shall permit each employee to take a 30-minute meal period and 2 10-minute rest periods during the first 7.5 hours of work, and an additional 15 minutes of meal or break period time for each additional 2 hours worked beyond the first 7.5 hours of work. If circumstances require an employee to work during or through a meal period or break period for which the employee would have received no compensation, then the employer shall pay the employee for the time worked without compensation at 1.5 times the employee's regular rate of compensation.

This Section 20 does not apply to employees for whom meal and break periods are established through a collective bargaining plan or pursuant to an organizational plan of nursing services schedule prepared in accordance with Section 15 of this Act. This Section does not apply to employees who monitor patients with developmental disabilities or mental illness, or both, and who, in the course of those duties, are required to be on-call during the entire work period; provided, however, that such employees shall be permitted to eat a meal or meals during the work period while continuing to monitor those patients.

Section 25. Violation of Act; license. The Director, after notice and opportunity for hearing, may deny, suspend, revoke, or place conditional provisions upon a license of a hospital in any case in which the Director finds that there has been a substantial failure to comply with the provisions of this Act.

Section 30. Wage-and-hour provisions for registered nurses.

(a) An employer that is a health system as defined in this Act and commits more than 500 violations of wage-and-hour laws or regulations for registered nurses within a 3-year period shall be subject to a civil monetary penalty of up to 5% of the employer's gross hospital patient revenues.

(b) The Attorney General shall determine whether 500 violations were committed and shall set the penalty based on the severity of the violations.

(c) The Department may impose a civil penalty under this Section only after it provides the following to the employer:

(1) Written notice of the alleged violation.

(2) Written notice of the employer's right to request an administrative hearing on the question of the alleged violation.

(3) An opportunity to present evidence, orally or in writing or both, on the question of the alleged violation before an impartial hearing examiner appointed by the Director.

(4) A written decision from the Director, based on the evidence introduced at the hearing and the hearing examiner's recommendations, finding that the employer violated this Act and imposing the civil penalty.

(d) The Attorney General may bring an action in the circuit court to enforce the collection of a monetary penalty imposed under this Section.

(e) The moneys collected under this Section shall be allocated to the Department for nursing scholarships awarded pursuant to the Nursing Education Scholarship Law in addition to any other funds set aside and appropriated for that purpose.

Section 99. Effective date. This Act takes effect upon becoming law.".