SB0867sam001 95TH GENERAL ASSEMBLY

Sen. Carol Ronen

Filed: 3/21/2007

09500SB0867sam001 LRB095 05612 DRJ 34011 a

AMENDMENT TO SENATE BILL 867

AMENDMENT NO. ______. Amend Senate Bill 867 by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Patient Acuity Nursing Staffing Act.

Section 5. 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 in health care facilities in the State.

(2) Numerous studies have shown that improved patient outcomes are directly correlated to direct care registered nurse staffing levels.

(3) 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 matched to nursing skills required for optimal outcomes and improved quality of care within the system's environment.

Section 10. Definitions. In this Act:

"Acuity model" means an acuity tool developed and implemented by a hospital, as determined by that hospital's nursing care committee, that matches patient care needs and nurse competency required for optimal outcomes into the staffing plan.

"Department" means the Department of Public Health.

"Direct patient care" means a registered professional nurse with direct responsibility to carry out medical regimens or nursing care for one or more patients.

"Hospital" means an entity licensed under the Hospital Licensing Act or organized under the University of Illinois Hospital Act.

"Nursing care committee" means a committee to develop and review a hospital's staffing plan, established pursuant to Section 20.

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

"Written staffing plan for nursing care services" means a written plan for assignment of nursing staff based on minimum staffing levels for each patient care unit and the adopted acuity model linking patient care needs with nursing skills required for optimal outcomes.

Section 15. Written staffing plan.

(a) Every hospital shall implement a written hospital-wide staffing plan, adopted by the hospital's nursing care committee, that includes a matrix for staffing decision-making that provides for minimum direct care professional registered nurse-to-patient staffing needs for each unit of care. The written hospital-wide staffing plan shall include, but need not be limited to, the following considerations:

(1) The complexity of complete care, assessment on patient admission, patient admissions, discharges and transfers, and volume; individual patient intensity; and evaluation of the progress of the patient problems, ongoing physical assessments, planning for patient discharge, assessment after a change in patient condition, or assessment of the need for patient referrals.

(2) The complexity of clinical professional nursing judgment needed to design and implement the patient's nursing care plan, the need for specialized equipment and technology, and the skill mix of other personnel providing or supporting direct patient care not required by direct care registered professional nurse; the learning curve for individuals and groups of nurses; staffing consistency, continuity, and cohesion; cross-training; control of practice; and involvement in quality improvement activities, professional expectations, preparation, and experience.

(3) Patient characteristics and the number of patients for whom care is being provided.

(4) Architecture (geographical dispersion of patients, size and layout of individual patient rooms, arrangement of entire patient care units, and so forth); technology; same unit or cluster of patients.

Ongoing patient assessments of a unit's patient acuity level and nursing staff required shall be routinely made by the patient care coordinator or charge nurse.

The charge nurse shall not be routinely assigned for direct patient care in order to provide and accommodate changing patient care needs and nurse availability.

As nurse and non-nurse staffing needs are identified from the staffing-decision matrix, organizational policy should reflect an organizational climate that values registered nurses and other employees as strategic assets and exhibits a true commitment to filling budgeted positions in a timely manner.

(b) In addition to the written staffing plan, every hospital shall adopt an acuity plan to adjust the staffing plan for each patient care unit to provide staffing flexibility to meet patient care needs.

Section 20. Nursing care committee.

(a) Every hospital shall establish a nursing care committee. A hospital shall appoint members of the committee such that at least 50% of the members of the committee must be registered professional nurses providing direct patient care.

(b) The nursing care committee shall determine a written staffing plan for the hospital based on the principles from the staffing decision matrix components set forth in subsection (a) of Section 15. In particular, the committee shall do the following:

(1) Develop, adopt, and implement minimum staffing levels for each patient care unit.

(2) Develop, adopt, and implement an acuity model to provide staffing flexibility that links changing patient acuity with nursing with nursing skills required.

(3) Develop and implement a written staffing plan incorporating the items described in subsections (a) and (b) of Section 15.

(4) Post the written staffing plan in a conspicuous and accessible location for both patients and direct care staff, as required under the Hospital Report Card Act.

(5) Analyze and recommend changes to improve patient care.

(6) Meet no less than monthly.

(7) Review annually the following: budgeting of nursing care hours for each inpatient unit; nurse-to-patient staffing guidelines for all inpatient areas; and current acuity measures in use.

Section 25. Violation; complaint; penalty. Any nurse who is an employee of a hospital that is subject to this Act may file a complaint with the Department of Public Health regarding an alleged violation of this Act without fear of retaliation, discipline, or discharge. Upon receiving a complaint of a violation of this Act, the Department may take any action authorized under Section 7 or 9 of the Hospital Licensing Act.

Section 90. The Hospital Licensing Act is amended by changing Sections 7 and 9 as follows:

(210 ILCS 85/7) (from Ch. 111 1/2, par. 148)

Sec. 7. (a) The Director after notice and opportunity for hearing to the applicant or licensee may deny, suspend, or revoke a permit to establish a hospital or deny, suspend, or revoke a license to open, conduct, operate, and maintain a hospital in any case in which he finds that there has been a substantial failure to comply with the provisions of this Act, the Hospital Report Card Act, the Patient Acuity Nursing Staffing Act, or the Illinois Adverse Health Care Events Reporting Law of 2005 or the standards, rules, and regulations established by virtue of any of those Acts.

(b) Such notice shall be effected by registered mail or by personal service setting forth the particular reasons for the proposed action and fixing a date, not less than 15 days from the date of such mailing or service, at which time the applicant or licensee shall be given an opportunity for a hearing. Such hearing shall be conducted by the Director or by an employee of the Department designated in writing by the Director as Hearing Officer to conduct the hearing. On the basis of any such hearing, or upon default of the applicant or licensee, the Director shall make a determination specifying his findings and conclusions. In case of a denial to an applicant of a permit to establish a hospital, such determination shall specify the subsection of Section 6 under which the permit was denied and shall contain findings of fact forming the basis of such denial. A copy of such determination shall be sent by registered mail or served personally upon the applicant or licensee. The decision denying, suspending, or revoking a permit or a license shall become final 35 days after it is so mailed or served, unless the applicant or licensee, within such 35 day period, petitions for review pursuant to Section 13.

(c) The procedure governing hearings authorized by this Section shall be in accordance with rules promulgated by the Department and approved by the Hospital Licensing Board. A full and complete record shall be kept of all proceedings, including the notice of hearing, complaint, and all other documents in the nature of pleadings, written motions filed in the proceedings, and the report and orders of the Director and Hearing Officer. All testimony shall be reported but need not be transcribed unless the decision is appealed pursuant to Section 13. A copy or copies of the transcript may be obtained by any interested party on payment of the cost of preparing such copy or copies.

(d) The Director or Hearing Officer shall upon his own motion, or on the written request of any party to the proceeding, issue subpoenas requiring the attendance and the giving of testimony by witnesses, and subpoenas duces tecum requiring the production of books, papers, records, or memoranda. All subpoenas and subpoenas duces tecum issued under the terms of this Act may be served by any person of full age. The fees of witnesses for attendance and travel shall be the same as the fees of witnesses before the Circuit Court of this State, such fees to be paid when the witness is excused from further attendance. When the witness is subpoenaed at the instance of the Director, or Hearing Officer, such fees shall be paid in the same manner as other expenses of the Department, and when the witness is subpoenaed at the instance of any other party to any such proceeding the Department may require that the cost of service of the subpoena or subpoena duces tecum and the fee of the witness be borne by the party at whose instance the witness is summoned. In such case, the Department in its discretion, may require a deposit to cover the cost of such service and witness fees. A subpoena or subpoena duces tecum issued as aforesaid shall be served in the same manner as a subpoena issued out of a court.

(e) Any Circuit Court of this State upon the application of the Director, or upon the application of any other party to the proceeding, may, in its discretion, compel the attendance of witnesses, the production of books, papers, records, or memoranda and the giving of testimony before the Director or Hearing Officer conducting an investigation or holding a hearing authorized by this Act, by an attachment for contempt, or otherwise, in the same manner as production of evidence may be compelled before the court.

(f) The Director or Hearing Officer, or any party in an investigation or hearing before the Department, may cause the depositions of witnesses within the State to be taken in the manner prescribed by law for like depositions in civil actions in courts of this State, and to that end compel the attendance of witnesses and the production of books, papers, records, or memoranda.

(Source: P.A. 93-563, eff. 1-1-04; 94-242, eff. 7-18-05.)

(210 ILCS 85/9) (from Ch. 111 1/2, par. 150)

Sec. 9. Inspections and investigations. The Department shall make or cause to be made such inspections and investigations as it deems necessary. Information received by the Department through filed reports, inspection, or as otherwise authorized under this Act or under the Patient Acuity Nursing Staffing Act shall not be disclosed publicly in such manner as to identify individuals or hospitals, except (i) in a proceeding involving the denial, suspension, or revocation of a permit to establish a hospital or a proceeding involving the denial, suspension, or revocation of a license to open, conduct, operate, and maintain a hospital, (ii) to the Department of Children and Family Services in the course of a child abuse or neglect investigation conducted by that Department or by the Department of Public Health, (iii) in accordance with Section 6.14a of this Act, or (iv) in other circumstances as may be approved by the Hospital Licensing Board.

(Source: P.A. 90-608, eff. 6-30-98; 91-242, eff. 1-1-00.)

Section 99. Effective date. This Act takes effect January 1, 2008.".