HB4245 93RD GENERAL ASSEMBLY

LRB093 16079 DRJ 45097 b

93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB4245

Introduced 1/28/2004, by Angelo Saviano

SYNOPSIS AS INTRODUCED:

New Act

Creates the Patient Safety Act. Requires hospitals to implement a written staffing plan for nursing services, and sets forth requirements for the plan. Requires a hospital to establish a committee to develop and monitor implementation of the plan. Restricts a hospital's authority to require nurses to work overtime, making exceptions for emergencies. Provides for civil penalties for violations of the Act. Effective immediately.

A BILL FOR

AN ACT concerning health facilities.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Patient Safety Act.

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

(1) Health care services are becoming complex and it is increasingly difficult for patients to access integrated services.

(2) Quality of patient care could be impacted by staffing changes implemented in response to managed care.

(3) 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.

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

Section 10. Definitions. In this Act:

"Hospital" means an entity licensed under the Hospital Licensing Act or a University of Illinois hospital as defined in the University of Illinois Hospital Act.

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

"Overtime" means work in excess of an agreed-to, predetermined scheduled work shift not to exceed 12 hours, or work in excess of 40 hours in one work week, except in the case of an unforeseen emergent circumstance when overtime is used only as a last resort.

"Patient classification system" means a mechanism used by a health care facility to determine and differentiate health care needs of all patients receiving care within the facility.

"Unforeseen emergent circumstance" means a circumstance in which the employer has no foreseeable control, as in the instance of war, a national disaster, or a declared state of emergency. The term does not mean a situation in which the employer has reasonable knowledge of a decreased facility staffing plan, for reasons including, but not limited to, scheduled vacations, employee illness, or increased patient census.

"Workplace design to prevent and mitigate errors" means a nursing work environment and care process to reduce errors and enhance patient safety.

"Written staffing plan for nursing services" means a written plan of direct care personnel staffing requirements that are appropriate to ensure that all patients receive quality health care based on the patient classification system under normal and emergent circumstances.

Section 15. Written staffing plan for nursing services.

(a) Every hospital is responsible for the development and implementation of a hospital-wide written staffing plan for nursing services. The hospital shall appoint a patient classification committee as provided in Section 20 to develop and implement its written staffing plan for nursing services by creating a patient classification system. The staffing plan shall be an integral part of the overall hospital organizational plan and shall be available to all nursing personnel. The staffing plan shall be developed in a manner that enables the patient care unit to meet or exceed the nurse staffing requirements that are derived from the computation used in the patient classification system. The staffing plan developed for each patient care unit for each work shift must be consistent with acceptable and prevailing standards of safe nursing care and with the American Nurses Association's Principles for Nurse Staffing. After developing the staffing plan, the committee shall monitor the implementation of the plan, with no less than an annual evaluation and requisite modification.

(b) The staffing plan must be developed for each patient care unit for each work shift and must be consistent with acceptable and prevailing standards of safe nursing care and with the American Nurses Association's Principles for Nurse Staffing. The staffing plan must take into account, but need not be limited to, all of the following:

(1) The plan must be based on the nursing care required by the aggregate and individual needs of patients in each nursing unit. This nursing care shall be the major consideration in determining the number and categories of nursing staff needed.

(2) The plan must establish minimum numbers of nursing staff, including licensed nurses and nursing assistants, on specified shifts. The number of nursing staff on duty shall be sufficient (as determined by the committee established under Section 20) to ensure that the nursing care needs of each patient are met

(3) The plan must be based on the specialized qualifications and competencies of the nursing staff. The skill mix and the competency of the staff shall ensure that the nursing care needs of the patients are met and shall ensure patient safety.

(4) The plan must be consistent with the scopes of practice for registered professional nurses and licensed practical nurses and with the authorized duties of nursing assistants as delegated by the registered professional nursing staff.

(5) The plan must provide that registered professional nurses must be present whenever patient care is delivered.

(6) The plan must require that the hospital administration make provisions for replacement staff in the event of sickness, vacations, vacancies, breaks, and other absences of nursing staff, with the exception of unforeseen emergent circumstances, and that provides a sufficient number of replacement staff (as determined by the committee established under Section 20) for the hospital on a regular basis.

(c) The patient classification committee established under Section 20 shall develop an internal review mechanism for use in evaluating whether the hospital's staffing plan results in sufficient staffing requirements to meet the health care needs of the hospital's patients. The committee shall develop a review mechanism that takes into account changes in the characteristics of the hospital or the environment, as well as changes that may have occurred in the overall acuity level of the patients being treated in the hospital. Evaluation tools that may be used in the review mechanism shall include, but need not be limited to, the following:

(1) Patient outcome indicators that have been shown to correlate with nurse staffing, as those indicators are developed by nationally recognized nursing organizations.

(2) Acceptable and prevailing standards of safe nursing care.

(3) Hospital reports and analysis of incidents and injuries to patients, nursing staff, and other nursing personnel.

(4) Available reports and surveys of patient satisfaction and nurse satisfaction that correlate to the quality of nursing care provided in the hospital.

(5) Criteria required by State or federal law for assessing the quality of patient care provided by a hospital.

(6) American Nurse Credentialing Center Magnet Hospital elements and American Nurses Association Principles for Nurse Staffing.

(7) Any other criteria the committee considers appropriate.

(d) Not later than 6 months after the effective date of this Act, the committee shall complete its development of the internal review mechanism and conduct an internal review of the staffing plan it has selected. Thereafter, the committee shall conduct an internal review of the plan at least once each year and shall report to the hospital leaders on the data analysis regarding staffing effectiveness and any actions taken to improve staffing.

(e) Whenever the committee determines that the staffing plan that the committee has selected for the hospital no longer meets the staffing requirements necessary to meet the health care needs of the hospital's patients, the committee shall select a different written staffing plan pursuant to this Section.

(f) Staff nurses shall collect unit-level-specific data for analysis of the patient classification committee on a routine basis.

(g) The hospital shall provide training to support all staff nurses in their roles in analyzing data and to provide training on data elements and their relevance to staffing to best support the development and ongoing review of the written staffing plan.

(h) A hospital's staffing plan is subject to inspection by the Department of Public Health.

Section 20. Patient classification committee. Every hospital shall establish a patient classification committee for the purpose of selecting the patient classification system to be used in establishing staffing requirements pursuant to Section 15. A hospital shall appoint members of the committee in accordance with the following:

(1) At least 50% of the members of the committee shall be comprised of registered professional nurses who are staff nurses providing direct patient care.

(2) If the hospital has entered into a collective bargaining agreement with its nursing staff, the leadership of the collective bargaining unit shall appoint their own committee members.

Section 25. Patient classification system. The patient classification committee of a hospital shall select a patient classification system that does all of the following:

(1) Computes staffing requirements that are appropriate to ensure that all patients in the hospital receive quality health care according to an analysis of their individual and aggregate needs.

(2) Specifies staffing requirements to be filled by licensed nurses and other personnel utilized in the provision of direct patient care or the support of other unit activities.

(3) Includes methods to ensure the validity and reliability of its projection of staffing requirements.

(4) Incorporates standards that are consistent with acceptable and prevailing standards of safe nursing care and with the American Nurses Association's Principles for Nurse Staffing.

Section 30. Workplace design to prevent and mitigate errors.

(a) To reduce error-producing fatigue, a hospital may not require nursing staff to provide patient care in any combination of scheduled shifts, mandatory overtime in excess of 12 hours in any 24-hour period, and mandatory overtime in excess of 60 hours in any 7-day period.

(b) The hospital administration is responsible for implementing the staffing plan for nursing developed under Section 15 to obtain registered professional nurses for the unfilled hours or shifts.

(c) A hospital may not require a nurse to work:

(1) more than 12 hours in any 24-hour period; or

(2) more than 60 hours in any 7-day period.

(d) A hospital must dedicate budgetary resources equal to a defined percentage of nursing payroll to support nursing staff in their ongoing acquisition and maintenance of knowledge and skills. These resources should be sufficient for and used to implement policies and practices that:

(1) assign experienced nursing staff to precept nurses newly practicing in a clinical area to address knowledge and skill gaps; and

(2) provide education and training of staff as new technology or changes in the workplace are introduced.

Section 35. Compliance with staffing requirements.

(a) A hospital must do all of the following:

(1) The hospital must comply with the staffing requirements established under subsection (b) of Section 15.

(2) The hospital must comply with the working scheduling limitations by employing a sufficient number of employees to perform duties that are non-nursing such as housekeeping, clerical duties, and administrative duties.

(3) The hospital may not require an employee to accept overtime work except in the case of an unforeseen emergent circumstance when overtime is required only as a last resort. The acceptance by any employee of overtime work must be strictly voluntary, and the refusal to accept such overtime work may not be grounds for discrimination, dismissal, discharge, or retaliation, or any other employment decision adverse to the employee.

(b) If subdivisions (1) and (2) of subsection (a) are both violated in the same work shift, each violation is a separate violation for purposes of Section 40. If subdivisions (1) and (2) of subsection (a) are violated in different patient care units at the same time, each violation is a separate violation for purposes of Section 40.

(c) The provisions of this Section do not apply to nursing staff needs in the event of a national or State emergency or circumstances requiring the implementation of a hospital disaster plan.

Section 40. Violations; penalties.

(a) If the Department of Public Health determines, after an investigation, that a hospital has violated subdivision (1) or (2) of subsection (a) of Section 35, the Department shall impose a civil penalty against the hospital in accordance with subsection (b) of this Section. In determining the amount of the civil penalty to be imposed, the Department shall consider the severity of this violation, the hospital's efforts to correct the violation, whether the violation has been corrected, and whether the hospital's failure to correct the violation is the result of a willful disregard of the requirements of this Act.

(b) In the case of a first violation of subdivision (1) or (2) of subsection (a) of Section 35, the Department of Public Health shall impose a civil penalty in an amount that is not less than $2,000 for each week in which the violation occurs. In the case of a subsequent violation, for each day of the first week in which the violation occurs, the Department shall impose a civil penalty in an amount that is not less than $8,000 and not more than $15,000. During each week thereafter, the Department shall impose a civil penalty for each day of the violation in an amount that is 3 times the amount imposed per day in the immediately preceding week.

(c) The Department of Public Health may impose a civil penalty under this Section only after notice to the hospital and an opportunity for the hospital to be heard on the matter.

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

(e) Notice of a hospital's violation of this Act shall be posted in a public area of the hospital's premises. Violations must also be included in a hospital's quarterly reports to the Department of Public Health under Section 25 of the Hospital Report Card Act.

(f) Amounts collected under this Section shall be allocated to the Department of Public Health for nursing scholarships awarded pursuant to the Nursing Education Scholarship Law.

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