103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3424

 

Introduced 2/8/2024, by Sen. Christopher Belt

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Hospital Licensing Act. Provides that "hospital worker" means any person who receives an hourly wage directly or indirectly via a subcontractor by a hospital licensed under the Act. Replaces references to "nurse" with "hospital worker". Provides for additional staffing transparency and reporting requirements. Provides that hospitals licensed under the Act must employ and schedule enough hospital workers to provide quality patient care and ensure patient safety. Provides that hospitals must make available, at the beginning of each calendar year and upon request, all staffing matrices and other staffing metrics, if any, used to assess and maintain safe staffing levels for hospital workers in each unit. Provides that the Department of Public Health shall produce an annual report based on staffing disclosures. Provides that the Department shall make recommendations for minimum staffing standards for hospital workers in each hospital unit. Provides that hospitals licensed under the Act shall conduct, within the first month of employment and at no cost, a competency validation for each hospital worker hired. Provides that a hospital must submit documentation of each hospital worker's competency validation to the Department within 4 weeks after the worker's start date. Provides that hospitals shall conduct ongoing verification for each hospital worker employed during a given calendar year to determine each worker's continued competency to perform the worker's job and shall submit documentation of each worker's ongoing verification to the Department within 2 weeks of completion. Provides that hospitals shall submit a list of all competent employees currently employed at the end of each calendar year. Provides for a public registry of all competent employees to be maintained by the Department. Provides for the imposition of civil penalties for specified violations of the Act. Describes an assignment despite objection resolution process to be implemented by each hospital that is licensed under the Act. Provides for a Hospital Safety Advocate role to be created within the Department.


LRB103 37533 CES 67656 b

 

 

A BILL FOR

 

SB3424LRB103 37533 CES 67656 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Hospital Licensing Act is amended by
5changing Section 10.9 and by adding Sections 10.15 and 10.20
6as follows:
 
7    (210 ILCS 85/10.9)
8    Sec. 10.9. Hospital worker Nurse mandated overtime
9prohibited.
10    (a) Definitions. As used in this Section:
11    "Mandated overtime" means work that is required by the
12hospital in excess of an agreed-to, predetermined work shift.
13Time spent by nurses required to be available as a condition of
14employment in specialized units, such as surgical nursing
15services, shall not be counted or considered in calculating
16the amount of time worked for the purpose of applying the
17prohibition against mandated overtime under subsection (b).
18    "Hospital worker" means any person who receives an hourly
19wage, directly or indirectly, via a subcontractor by a
20hospital licensed under this Act.
21    "Nurse" means any advanced practice registered nurse,
22registered professional nurse, or licensed practical nurse, as
23defined in the Nurse Practice Act, who receives an hourly wage

 

 

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1and has direct responsibility to oversee or carry out nursing
2care. For the purposes of this Section, "advanced practice
3registered nurse" does not include a certified registered
4nurse anesthetist who is primarily engaged in performing the
5duties of a nurse anesthetist.
6    "Related to the subcontractor" means that the
7subcontractor is, to a significant extent, associated or
8affiliated with, owns, or is owned by, or has control of or is
9controlled by, the organization furnishing services to a
10hospital licensed under this Act.
11    "Subcontractor" means any entity, including an individual
12or individuals, that contracts with a hospital licensed under
13this Act to supply a service. "Subcontractor" includes
14organizations related to the subcontractor that have a
15contract with the subcontractor.
16    "Unforeseen emergent circumstance" means (i) any declared
17national, State, or municipal disaster or other catastrophic
18event, or any implementation of a hospital's disaster plan,
19that will substantially affect or increase the need for health
20care services or (ii) any circumstance in which patient care
21needs require specialized nursing skills through the
22completion of a procedure. An "unforeseen emergent
23circumstance" does not include situations in which the
24hospital fails to have enough nursing staff to meet the usual
25and reasonably predictable patient care nursing needs of its
26patients.

 

 

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1    (b) Mandated overtime prohibited. No hospital worker nurse
2may be required to work mandated overtime except in the case of
3an unforeseen emergent circumstance when such overtime is
4required only as a last resort. Such mandated overtime shall
5not exceed 4 hours beyond an agreed-to, predetermined work
6shift.
7    (c) Rest period required Off-duty period. When a hospital
8worker nurse is mandated to work up to 12 consecutive hours,
9the worker nurse must be allowed at least 8 consecutive hours
10of off-duty time off immediately following the completion of a
11shift.
12    (d) Retaliation prohibited. No hospital may discipline,
13discharge, or take any other adverse employment action against
14a hospital worker nurse solely because the worker nurse
15refused to work mandated overtime as prohibited under
16subsection (b).
17    (e) Violations. Any employee of a hospital that is subject
18to this Act may file a complaint with the Department of Public
19Health regarding an alleged violation of this Section. The
20complaint must be filed within 45 days following the
21occurrence of the incident giving rise to the alleged
22violation. The Department must forward notification of the
23alleged violation to the hospital in question within 3
24business days after the complaint is filed. Upon receiving a
25complaint of a violation of this Section, the Department may
26take any action authorized under Section 7 or 9 of this Act.

 

 

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1    (f) Proof of violation. Any violation of this Section must
2be proved by clear and convincing evidence that a hospital
3worker nurse was required to work overtime against the
4worker's his or her will. The hospital may defeat the claim of
5a violation by presenting clear and convincing evidence that
6an unforeseen emergent circumstance, which required overtime
7work, existed at the time the employee was required or
8compelled to work.
9(Source: P.A. 100-513, eff. 1-1-18.)
 
10    (210 ILCS 85/10.15 new)
11    Sec. 10.15. Additional staffing transparency and reporting
12requirements.
13    (a) As used in this Section:
14    "Hospital worker" means any person who receives an hourly
15wage, directly or indirectly, via a subcontractor by a
16hospital licensed under this Act.
17    "Related to the subcontractor" means that the
18subcontractor is, to a significant extent, associated or
19affiliated with, owns, or is owned by, or has control of or is
20controlled by, the organization furnishing services to a
21hospital licensed under this Act.
22    "Staffing metric" means any tool used by hospital
23management to determine safe staffing levels in a patient care
24or support services unit.
25    "Subcontractor" means any entity, including an individual

 

 

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1or individuals, that contracts with a hospital licensed under
2this Act to supply a service. This includes organizations
3related to the subcontractor that have a contract with the
4subcontractor.
5    "Unit" means a functional division of a hospital that
6provides patient care or support services.
7    (b) Hospitals licensed under this Act must employ and
8schedule enough hospital workers to provide quality patient
9care and ensure patient safety.
10    (c) In order to ensure compliance with safe staffing
11practices, hospitals licensed under this Act shall make
12available, upon request, all the staffing matrices and other
13staffing metrics, if any, used to assess and maintain safe
14staffing levels for hospital workers in each unit.
15    (d) Hospitals shall share any and all staffing matrices,
16staffing metrics, and underlying materials used to determine
17staffing levels with the Department at the beginning of each
18calendar year.
19    (e) The Department shall produce an annual report based on
20staffing disclosures required under this Section beginning the
21first year after implementation.
22    (f) The Department shall make recommendations for minimum
23staffing standards for hospital workers in each hospital unit
24based on the information collected under this Section.
 
25    (210 ILCS 85/10.20 new)

 

 

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1    Sec. 10.20. Hospital worker competency validation and
2assignment despite objection process.
3    (a) Findings. The Legislature finds and declares all of
4the following:
5        (1) The State of Illinois has an obligation to ensure
6    hospitals provide quality patient care.
7        (2) Numerous studies have linked patient outcomes,
8    including in-hospital mortality rates, to hospital worker
9    staffing.
10        (3) In spite of the preponderance of evidence that
11    adequate staffing improves patient outcomes, hospitals in
12    Illinois and elsewhere too often systemically and
13    intentionally understaff to maximize profit even at the
14    expense of quality patient care.
15        (4) The COVID-19 pandemic both exposed and exacerbated
16    these unsafe staffing practices.
17        (5) The State asserts that based on their demonstrated
18    competencies and training, hospital workers themselves are
19    best positioned to identify unsafe conditions that
20    jeopardize quality patient care, including, especially,
21    short staffing.
22        (6) Hospitals perform competency validations and
23    ongoing verifications to ensure workers know how to
24    perform their jobs safely and to identify unsafe practices
25    including short staffing.
26        (7) The State should require hospitals to affirm that

 

 

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1    hospital workers have received the necessary training to
2    safely perform their work via competency validations and
3    ongoing verification and empower these workers to identify
4    and formally object to unsafe working conditions,
5    including short staffing.
6        (8) To facilitate this, the State should create a
7    dispute resolution process for hospital workers to
8    formally object to unsafe working conditions.
9    (b) Definitions. As used in this Section:
10    "Assignment despite objection" means a formal process by
11which hospital workers notify management when they receive an
12assignment that, based on their training, is potentially
13unsafe.
14    "Competent employee" means a hospital worker whose
15employer has received a competency validation or ongoing
16verification during a given calendar year.
17    "Competency validation" means a determination based on a
18hospital worker's satisfactory performance of each specific
19element of the employee's job description and of specific
20requirements of the unit in which they are employed in a safe
21and ethical manner.
22    "Hospital worker" means any person who receives an hourly
23wage, directly or indirectly, via a subcontractor by a
24hospital licensed under this Act.
25    "Ongoing verification" means annual redetermination based
26on a hospital worker's satisfactory performance of each

 

 

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1specific element of the hospital worker's job description and
2the specific requirements of the unit in which the worker is
3employed in a safe and ethical manner.
4    "Related to the subcontractor" means that the
5subcontractor is, to a significant extent, associated or
6affiliated with, owns, or is owned by, or has control of or is
7controlled by, the organization furnishing services to a
8hospital licensed under this Act.
9    "Subcontractor" means any entity, including an individual
10or individuals, that contracts with a hospital licensed under
11this Act to supply a service. "Subcontractor" includes
12organizations related to the subcontractor that have a
13contract with the subcontractor.
14    (c) Competency Validation Credential.
15        (1) Hospitals licensed under this Act shall conduct a
16    competency validation for each hospital worker hired as a
17    condition of employment within the first month after
18    employment and at no cost to the new hire.
19        (2) The competency validation formally affirms the
20    hospital has adequately trained a hospital worker to
21    perform all aspects of the hospital worker's job safely
22    and to identify unsafe conditions, including inadequate
23    staffing.
24        (3) Hospitals must submit documentation of each
25    hospital worker's competency validation to the Department
26    of Public Health within 4 weeks after the worker's start

 

 

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1    date.
2        (4) Hospitals licensed under this Act shall also
3    conduct an ongoing verification for each hospital worker
4    employed during a given calendar year to determine the
5    continued competency of each hospital worker to perform
6    the worker's job and shall submit documentation of ongoing
7    verification of each hospital worker to the Department of
8    Public Health within 2 weeks after completion.
9        (5) Hospitals licensed under this Act shall submit a
10    list of all competent employees currently employed at the
11    end of each calendar year.
12        (6) The Department shall maintain a registry of all
13    competent employees that includes the name, address,
14    contact information and current employer of the worker and
15    make this registry available to the public.
16        (7) Following notice and an opportunity to be heard,
17    the Department shall impose, for each day that a hospital
18    licensed under this Act is in violation of this subsection
19    (c), a civil penalty against the hospital in an amount
20    equal to 0.1% of the hospital's annual revenue during the
21    most recently completed fiscal year.
22    (d) Assignment despite objection.
23        (1) A hospital licensed under this Act must create an
24    assignment despite objection form that is applicable and
25    accessible to all of its hospital workers that enables the
26    hospital workers to formally object to unsafe working

 

 

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1    conditions, including unsafe staffing levels, and that
2    assigns to the hospital liability for requiring a hospital
3    worker to work in an unsafe manner.
4        (2) The assignment despite objection form must include
5    the following language: "This is to confirm that I
6    notified you that, in my professional judgment derived
7    from my competency validation, today's assignment is
8    unsafe and places patients at risk. As a result, the
9    facility is responsible for any adverse effects on patient
10    care."
11        (3) The hospital must retain a copy of each assignment
12    despite objection form and provide a copy to the hospital
13    worker's union, if any, and the Department. Hospitals must
14    provide, at the end of each calendar year, a report of all
15    assignment despite objection forms filed during the
16    calendar year and must maintain these records for a
17    minimum of 5 years.
18        (4) Hospitals must not retaliate against hospital
19    workers for filing an assignment despite objection form or
20    otherwise reporting or objecting to unsafe conditions.
21    (e) Resolution Process.
22        (1) Hospitals must develop a transparent, fair, and
23    expedient assignment despite objection resolution process
24    for all hospital workers either via collective bargaining
25    or in accordance with Department process articulated
26    below.

 

 

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1        (2) Hospital workers currently covered by a collective
2    bargaining agreement that includes an assignment despite
3    objection resolution process shall abide by the process
4    included in the collective bargaining agreement.
5        (3) Hospital workers not covered by a collective
6    bargaining agreement that includes an assignment despite
7    objection resolution process may access the following
8    Department mandated assignment despite objection
9    resolution process:
10            (A) The objecting hospital worker shall make a
11        good faith effort to inform the hospital worker's
12        manager or supervisor at the time of the objection to
13        assignment.
14            (B) If the manager or supervisor fails to resolve
15        the unsafe situation to the reporting hospital
16        worker's satisfaction, the hospital worker shall then
17        complete an assignment despite objection form, shall
18        submit a copy to that person's manager or supervisor
19        and that person's representative organization, if
20        covered by a collective bargaining agreement, and
21        shall keep a copy for their records.
22            (C) Hospital management must respond in writing to
23        the assignment despite objection form within one week
24        after its receipt and shall provide a copy of the
25        response to the hospital worker's representative
26        organization, if the hospital worker is covered by a

 

 

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1        collective bargaining agreement.
2            (D) In any instance in which the affected hospital
3        worker(s) is unsatisfied with management's response,
4        the hospital must convene a Safety Review Panel
5        composed of 3 representatives selected by the hospital
6        and 3 representatives selected by hospital workers via
7        a transparent democratic process. The representatives
8        selected by hospital workers are not required to be
9        hospital employees. The panel shall attempt to resolve
10        the dispute within 15 days of referral, unless
11        extended by mutual consent.
12            (E) If the Safety Review Panel cannot resolve the
13        dispute within 15 days after referral, the Department
14        shall appoint a mutually agreed upon neutral
15        third-party to assist in resolving the dispute. The
16        neutral third-party shall make a binding decision to
17        resolve the dispute.
18        (4) Following notice and an opportunity to be heard,
19    the Department shall impose, for each day that a hospital
20    licensed under this Act is in violation of subsection (d)
21    or this subsection, a civil penalty against the hospital
22    in an amount equal to 0.1% of the hospital's annual
23    revenue during the most recently completed fiscal year.
24        (5) The Department shall create a Hospital Safety
25    Advocate position responsible for enforcing the new
26    competency credentialing and assignment despite objection

 

 

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1    requirements and developing additional rules, as needed.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    210 ILCS 85/10.9
4    210 ILCS 85/10.15 new
5    210 ILCS 85/10.20 new