Full Text of HB2604 101st General Assembly
HB2604ham001 101ST GENERAL ASSEMBLY | Rep. Fred Crespo Filed: 3/19/2019
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| 1 | | AMENDMENT TO HOUSE BILL 2604
| 2 | | AMENDMENT NO. ______. Amend House Bill 2604 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the Safe | 5 | | Patient Limits Act. | 6 | | Section 5. Definitions. In this Act:
| 7 | | "Couplet" means one mother and one baby.
| 8 | | "Critical trauma patient" means a patient who has an injury | 9 | | to an anatomic area that (i) requires life-saving | 10 | | interventions, or (ii) in conjunction with unstable vital | 11 | | signs, poses an immediate threat to life or limb. | 12 | | "Department" means the Department of Public Health. | 13 | | "Facility" means a hospital licensed under the Hospital | 14 | | Licensing Act or organized under the University of Illinois | 15 | | Hospital Act, a private or State-owned and State-operated | 16 | | general acute care hospital, an acute psychiatric hospital, an |
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| 1 | | acute care specialty hospital, or an acute care unit within a | 2 | | health care facility.
| 3 | | "Health care workforce" means personnel employed by or | 4 | | contracted to work at a facility that have an effect upon the | 5 | | delivery of quality care to patients, including, but not | 6 | | limited to, registered nurses, licensed practical nurses, | 7 | | unlicensed assistive personnel, service, maintenance, | 8 | | clerical, professional, and technical workers, and other | 9 | | health care workers.
| 10 | | "Immediate postpartum patients" means those patients who | 11 | | have given birth within the previous 2 hours.
| 12 | | "Nursing care" means care that falls within the scope of | 13 | | practice as defined in the Nurse Practice Act or is otherwise | 14 | | encompassed within recognized standards of nursing practice, | 15 | | including assessment, nursing diagnosis, planning, | 16 | | intervention, evaluation, and patient advocacy. | 17 | | "Registered nurse" means a competent registered nurse who | 18 | | has accepted a direct, hands-on patient care assignment to | 19 | | implement the nursing care plan for that patient and the | 20 | | nursing process while, at all times, exercising independent | 21 | | professional judgment in the exclusive interest of the patient. | 22 | | "Specialty care unit" means a unit which is organized, | 23 | | operated, and maintained to provide care for a specific medical | 24 | | condition or a specific patient population. | 25 | | For the purposes of this Act, a patient is considered | 26 | | assigned to a registered nurse if the registered nurse accepts |
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| 1 | | responsibility for the patient's nursing care. | 2 | | Section 10. Maximum patient assignments for registered | 3 | | nurses.
| 4 | | (a) The maximum number of patients assigned to a registered | 5 | | nurse in a facility shall not exceed the limits provided in | 6 | | this Section. However, nothing shall preclude a facility from | 7 | | assigning fewer patients to a registered nurse than the limits | 8 | | provided in this Section.
| 9 | | (b) In all units with critical care or intensive care | 10 | | patients, including, but not limited to, coronary care, acute | 11 | | respiratory, burn, or neonatal intensive care patients, the | 12 | | maximum patient assignment of critical care patients to a | 13 | | registered nurse is 2. | 14 | | (c) In all units with step-down or intermediate care | 15 | | patients, the maximum patient assignment of step-down or | 16 | | intermediate care patients to a registered nurse is 3.
| 17 | | (d) In all units with postanesthesia care patients, the | 18 | | maximum patient assignment of postanesthesia care patients | 19 | | under the age of 18 to a registered nurse is one. The maximum | 20 | | patient assignment of postanesthesia care patients 18 years of | 21 | | age or older to a registered nurse is 2.
| 22 | | (e) In all units with operating room patients, the maximum | 23 | | patient assignment of operating room patients to a registered | 24 | | nurse is one, provided that a minimum of one additional person | 25 | | serves as a scrub assistant for each patient.
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| 1 | | (f) In the emergency department:
| 2 | | (1) In a unit providing basic emergency medical | 3 | | services or comprehensive emergency medical services, the | 4 | | maximum patient assignment at any time to a registered | 5 | | nurse is 3.
| 6 | | (2) The maximum assignment of critical care emergency | 7 | | patients to a registered nurse is 2. A patient in the | 8 | | emergency department shall be considered a critical care | 9 | | patient when the patient meets the criteria for admission | 10 | | to a critical care service area within the hospital.
| 11 | | (3) The maximum assignment of critical trauma patients | 12 | | in an emergency unit to a registered nurse is one. | 13 | | (4) At least one direct care registered professional | 14 | | nurse shall be assigned to triage patients. The direct care | 15 | | registered professional nurse assigned to triage patients | 16 | | shall be immediately available at all times to triage | 17 | | patients when they arrive in the emergency department. The | 18 | | direct care registered professional nurse assigned to | 19 | | triage patients shall perform triage functions only. | 20 | | (g) In all units with maternal child care patients:
| 21 | | (1) The maximum patient assignment to a registered | 22 | | nurse of antepartum patients requiring continuous fetal | 23 | | monitoring is 2.
| 24 | | (2) The maximum patient assignment of other antepartum | 25 | | patients to a registered nurse is 3.
| 26 | | (3) The maximum patient assignment of active labor |
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| 1 | | patients to a registered nurse is one.
| 2 | | (4) The maximum patient assignment during birth is one | 3 | | registered nurse responsible for the mother and, for each | 4 | | baby born, one registered nurse whose sole responsibility | 5 | | is that baby.
| 6 | | (5) The maximum patient assignment of immediate | 7 | | postpartum patients is one couplet, and in the case of | 8 | | multiple births, one nurse for each additional baby. | 9 | | (6) The maximum patient assignment of postpartum | 10 | | patients to a registered nurse is 6 patients or 3 couplets.
| 11 | | (h) In all units with pediatric patients, the maximum | 12 | | patient assignment of pediatric patients to a registered nurse | 13 | | is 4.
| 14 | | (i) In all units with psychiatric patients, the maximum | 15 | | patient assignment of psychiatric patients to a registered | 16 | | nurse is 4.
| 17 | | (j) In all units with medical and surgical patients, the | 18 | | maximum patient assignment of medical or surgical patients to a | 19 | | registered nurse is 4.
| 20 | | (k) In all units with telemetry patients, the maximum | 21 | | patient assignment of telemetry patients to a registered nurse | 22 | | is 3.
| 23 | | (l) In all units with observational patients, the maximum | 24 | | patient assignment of observational patients to a registered | 25 | | nurse is 4.
| 26 | | (m) In all units with acute rehabilitation patients, the |
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| 1 | | maximum patient assignment of acute rehabilitation patients to | 2 | | a registered nurse is 4.
| 3 | | (n) In all specialty care units, the maximum patient | 4 | | assignment to a registered nurse is 4. | 5 | | (o) In all units with conscious sedation patients, the | 6 | | maximum patient assignment of conscious sedation patients to a | 7 | | registered nurse is one. | 8 | | (p) In any unit not otherwise listed in this Section, the | 9 | | maximum patient assignment to a registered nurse is 4.
| 10 | | Section 15. Use of rapid response teams as first responders | 11 | | prohibited. A rapid response team nurse shall not be given | 12 | | direct care patient assignments while assigned as a nurse | 13 | | responsible for responding to a rapid response team request. | 14 | | Section 20. Implementation by a facility. | 15 | | (a) A facility shall implement the patient limits | 16 | | established by Section 10 without diminishing the staffing | 17 | | levels of the facility's health care workforce. | 18 | | (b) There shall be no averaging of the number of patients | 19 | | and the total number of registered nurses in each clinical unit | 20 | | or patient care area in order to meet the limits established | 21 | | under this Act. | 22 | | (c) Only registered nurses providing direct patient care | 23 | | must comply with the patient limits under Section 10. Nurse | 24 | | administrators, nurse supervisors, nurse managers, charge |
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| 1 | | nurses, case managers, ancillary staff, unlicensed personnel, | 2 | | or any other hospital administrator or supervisor shall not be | 3 | | required to comply with the patient limits under Section 10. | 4 | | (d) Identifying a clinical unit or patient care area by a | 5 | | name or term other than those listed in this Act does not | 6 | | affect a facility's requirement to staff the unit consistent | 7 | | with the patient limits identified for the level of intensity | 8 | | or type of care described in this Act. | 9 | | (e) A registered nurse providing direct care to a patient | 10 | | has the authority to determine if a change in the patient's | 11 | | status places the patient in a different category requiring a | 12 | | different patient limit under Section 10. | 13 | | (f) A registered nurse may determine that additional | 14 | | ancillary staff, such as licensed practical nurses, certified | 15 | | nursing assistants, or other ancillary staff, excluding | 16 | | medical assistants, are needed in order to provide safe care. | 17 | | (g) A facility shall not employ video monitors or any form | 18 | | of electronic visualization of a patient as a substitute for | 19 | | the direct observation required for patient assessment by the | 20 | | registered nurse or for patient protection. Video monitors or | 21 | | any form of electronic visualization of a patient shall not | 22 | | constitute compliance with the patient limits under Section 10. | 23 | | Section 25. Changes in patient census. | 24 | | (a) A facility shall plan for routine fluctuations in its | 25 | | patient
census, including, but not limited to, admissions, |
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| 1 | | discharges, and transfers. | 2 | | (b) If a health care emergency causes a change in the
| 3 | | number of patients in a clinical care unit or patient care
| 4 | | area, a facility must be able to demonstrate that immediate and | 5 | | diligent efforts were made to maintain required staffing levels | 6 | | under this Act. For purposes of this subsection, "health care | 7 | | emergency" means an emergency declared by the federal | 8 | | government or the head of a State or local governmental entity. | 9 | | Section 30. Record of staff assignments. A facility shall | 10 | | keep a record of the actual direct care registered professional | 11 | | nurse, licensed practical nurse, certified nursing assistant, | 12 | | and other ancillary staff assignments to individual patients | 13 | | documented on a day-to-day, shift-by-shift basis and shall keep | 14 | | copies of its staff assignments on file for a period of 7 | 15 | | years. | 16 | | Section 35. Implementation by the Department. The | 17 | | Department shall adopt rules governing the implementation and | 18 | | operation of this Act. | 19 | | Section 40. Patient acuity systems. Nothing in this Act | 20 | | precludes the use of patient acuity systems consistent with | 21 | | Section 10.10 of the Hospital Licensing Act. However, the | 22 | | maximum patient assignments in Section 10 shall not be exceeded | 23 | | regardless of the use and application of any patient acuity |
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| 1 | | system. | 2 | | Any method, software, or tool used to create or evaluate a | 3 | | staffing plan adopted by a facility shall be established in | 4 | | coordination with direct care registered professional nurses | 5 | | and shall be transparent in all respects, including disclosure | 6 | | of detailed documentation of the methodology used to determine | 7 | | nurse staffing and identifying each factor, assumption, and | 8 | | value used in applying the methodology. The Department shall | 9 | | establish procedures to ensure that the documentation | 10 | | submitted under this Section is available for public inspection | 11 | | in its entirety. | 12 | | Section 45. Training. All facilities shall adopt written | 13 | | policies and procedures for the training and orientation of | 14 | | nursing staff. No registered nurse shall be assigned to a | 15 | | nursing unit or clinical area unless that nurse has first | 16 | | received training and orientation in that clinical area that is | 17 | | sufficient to provide competent care to patients in that area | 18 | | and has demonstrated competence in providing care in that area. | 19 | | The written policies and procedures for that training and | 20 | | orientation of nursing staff shall require that all temporary | 21 | | personnel receive the same amount and type of training and | 22 | | orientation that is required for permanent staff. | 23 | | Section 50. Enforcement.
A facility's failure to adhere to | 24 | | the limits set by Section 10 shall be reported by the |
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| 1 | | Department to the Attorney General for enforcement, for which | 2 | | the Attorney General may bring action in a court of competent | 3 | | jurisdiction seeking injunctive relief and civil penalties. A | 4 | | separate and distinct violation, for which the facility shall | 5 | | be subject to a civil penalty of up to $25,000, shall be deemed | 6 | | to have been committed on each day during which any violation | 7 | | continues after receipt of written notice of the violation from | 8 | | the Department by the facility. The requirements of this Act, | 9 | | and its enforcement, shall be suspended during a public health | 10 | | emergency declared by the State or federal government.
| 11 | | Section 55. Whistleblower protection. | 12 | | (a) A registered professional nurse may object to or refuse | 13 | | to participate in any activity, practice, assignment, or task | 14 | | if: | 15 | | (1) in good faith, the nurse reasonably believes it to | 16 | | be a violation of the direct care registered professional | 17 | | nurse-to-patient ratios established under this Act; or | 18 | | (2) the nurse is not prepared by education, training, | 19 | | or experience to fulfill the assignment without | 20 | | compromising the safety of any patient or jeopardizing the | 21 | | license of the nurse. | 22 | | (b) A facility shall not retaliate, discriminate, or | 23 | | otherwise take adverse action in any manner with respect to any | 24 | | aspect of a nurse's employment, including discharge, | 25 | | promotion, compensation, or terms, conditions, or privileges |
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| 1 | | of employment, based on the nurse's refusal to complete an | 2 | | assignment under subsection (a). | 3 | | (c) A facility shall not file a complaint against a | 4 | | registered professional nurse with the Board of Nursing based | 5 | | on the nurse's refusal to complete an assignment under | 6 | | subsection (a). | 7 | | (d) A facility shall not retaliate, discriminate, or | 8 | | otherwise take adverse action in any manner against any person | 9 | | or with respect to any aspect of a nurse's employment, | 10 | | including discharge, promotion, compensation, or terms, | 11 | | conditions, or privileges of employment, based on that nurse's | 12 | | or that person's opposition to any hospital policy, practice, | 13 | | or action that the nurse in good faith believes violates this | 14 | | Act. | 15 | | (e) A facility shall not retaliate, discriminate, or | 16 | | otherwise take adverse action against any patient or employee | 17 | | of the facility or any other individual on the basis that the | 18 | | patient, employee, or individual, in good faith, individually | 19 | | or in conjunction with another person or persons, has presented | 20 | | a grievance or complaint, or has initiated or cooperated in any | 21 | | investigation or proceeding of any governmental entity, | 22 | | regulatory agency, or private accreditation body, made a civil | 23 | | claim or demand, or filed an action relating to the care, | 24 | | services, or conditions of the facility or of any affiliated or | 25 | | related facilities. | 26 | | (f) A facility shall not do either of the following: |
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| 1 | | (1) Interfere with, restrain, or deny the exercise of, | 2 | | or attempt to deny the exercise of, a right conferred under | 3 | | this Act. | 4 | | (2) Coerce or intimidate any individual regarding the | 5 | | exercise of, or an attempt to exercise, a right conferred | 6 | | by this Act.
| 7 | | Section 60. Severability.
The provisions of this Act are | 8 | | severable, and if any clause, sentence, paragraph, subsection, | 9 | | or Section of this law or any application thereof shall be | 10 | | adjudged by any court of competent jurisdiction to be invalid, | 11 | | such judgment shall not affect, impair, or invalidate the | 12 | | remainder thereof but shall be confined in its operation to the | 13 | | clause, sentence, paragraph, subsection, Section, or | 14 | | application adjudged invalid and such clause, sentence, | 15 | | paragraph, subsection, Section, or application shall be | 16 | | reformed and construed so that it would be valid to the maximum | 17 | | extent permitted.
| 18 | | Section 85. The Hospital Licensing Act is amended by | 19 | | changing Section 10.10 as follows: | 20 | | (210 ILCS 85/10.10) | 21 | | Sec. 10.10. Nurse Staffing by Patient Acuity.
| 22 | | (a) Findings. The Legislature finds and declares all of the | 23 | | following: |
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| 1 | | (1) The State of Illinois has a substantial interest in | 2 | | promoting quality care and improving the delivery of health | 3 | | care services. | 4 | | (2) Evidence-based studies have shown that the basic | 5 | | principles of staffing in the acute care setting should be | 6 | | based on the complexity of patients' care needs aligned | 7 | | with available nursing skills to promote quality patient | 8 | | care consistent with professional nursing standards. | 9 | | (3) Compliance with this Section promotes an | 10 | | organizational climate that values registered nurses' | 11 | | input in meeting the health care needs of hospital | 12 | | patients. | 13 | | (b) Definitions. As used in this Section: | 14 | | "Acuity model" means an assessment tool selected and | 15 | | implemented by a hospital, as recommended by a nursing care | 16 | | committee, that assesses the complexity of patient care needs | 17 | | requiring professional nursing care and skills and aligns | 18 | | patient care needs and nursing skills consistent with | 19 | | professional nursing standards. | 20 | | "Department" means the Department of Public Health. | 21 | | "Direct patient care" means care provided by a registered | 22 | | professional nurse with direct responsibility to oversee or | 23 | | carry out medical regimens or nursing care for one or more | 24 | | patients. | 25 | | "Nursing care committee" means an existing or newly created | 26 | | hospital-wide committee or committees of nurses whose |
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| 1 | | functions, in part or in whole, contribute to the development, | 2 | | recommendation, and review of the hospital's nurse staffing | 3 | | plan established pursuant to subsection (d). | 4 | | "Registered professional nurse" means a person licensed as | 5 | | a Registered Nurse under the Nurse
Practice Act. | 6 | | "Written staffing plan for nursing care services" means a | 7 | | written plan for guiding the assignment of patient care nursing | 8 | | staff based on multiple nurse and patient considerations that | 9 | | yield minimum staffing levels for inpatient care units and the | 10 | | adopted acuity model aligning patient care needs with nursing | 11 | | skills required for quality patient care consistent with | 12 | | professional nursing standards. | 13 | | (c) Written staffing plan. | 14 | | (1) Every hospital shall implement a written | 15 | | hospital-wide staffing plan, recommended by a nursing care | 16 | | committee or committees, that provides for minimum direct | 17 | | care professional registered nurse-to-patient staffing | 18 | | needs for each inpatient care unit. The written | 19 | | hospital-wide staffing plan shall include, but need not be | 20 | | limited to, the following considerations: | 21 | | (A) The complexity of complete care, assessment on | 22 | | patient admission, volume of patient admissions, | 23 | | discharges and transfers, evaluation of the progress | 24 | | of a patient's problems, ongoing physical assessments, | 25 | | planning for a patient's discharge, assessment after a | 26 | | change in patient condition, and assessment of the need |
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| 1 | | for patient referrals. | 2 | | (B) The complexity of clinical professional | 3 | | nursing judgment needed to design and implement a | 4 | | patient's nursing care plan, the need for specialized | 5 | | equipment and technology, the skill mix of other | 6 | | personnel providing or supporting direct patient care, | 7 | | and involvement in quality improvement activities, | 8 | | professional preparation, and experience. | 9 | | (C) Patient acuity and the number of patients for | 10 | | whom care is being provided. | 11 | | (D) The ongoing assessments of a unit's patient | 12 | | acuity levels and nursing staff needed shall be | 13 | | routinely made by the unit nurse manager or his or her | 14 | | designee. | 15 | | (E) The identification of additional registered | 16 | | nurses available for direct patient care when | 17 | | patients' unexpected needs exceed the planned workload | 18 | | for direct care staff. | 19 | | (2) In order to provide staffing flexibility to meet | 20 | | patient needs, every hospital shall identify an acuity | 21 | | model for adjusting the staffing plan for each inpatient | 22 | | care unit. | 23 | | (3) The written staffing plan shall be posted in a | 24 | | conspicuous and accessible location for both patients and | 25 | | direct care staff, as required under the Hospital Report | 26 | | Card Act. A copy of the written staffing plan shall be |
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| 1 | | provided to any member of the general public upon request. | 2 | | (d) Nursing care committee. | 3 | | (1) Every hospital shall have a nursing care committee. | 4 | | A hospital shall appoint members of a committee whereby at | 5 | | least 50% of the members are registered professional nurses | 6 | | providing direct patient care. | 7 | | (2) A nursing care committee's recommendations must be | 8 | | given significant regard and weight in the hospital's | 9 | | adoption and implementation of a written staffing plan.
| 10 | | (3) A nursing care committee or committees shall | 11 | | recommend a written staffing plan for the hospital based on | 12 | | the principles from the staffing components set forth in | 13 | | subsection (c). In particular, a committee or committees | 14 | | shall provide input and feedback on the following: | 15 | | (A) Selection, implementation, and evaluation of | 16 | | minimum staffing levels for inpatient care units. | 17 | | (B) Selection, implementation, and evaluation of | 18 | | an acuity model to provide staffing flexibility that | 19 | | aligns changing patient acuity with nursing skills | 20 | | required. | 21 | | (C) Selection, implementation, and evaluation of a | 22 | | written staffing plan incorporating the items | 23 | | described in subdivisions (c)(1) and (c)(2) of this | 24 | | Section. | 25 | | (D) Review the following: nurse-to-patient | 26 | | staffing guidelines for all inpatient areas; and |
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| 1 | | current acuity tools and measures in use. | 2 | | (4) A nursing care committee must address the items | 3 | | described in subparagraphs (A) through (D) of paragraph (3) | 4 | | semi-annually. | 5 | | (e) Nothing in this Section 10.10 shall be construed to | 6 | | limit, alter, or modify any of the terms, conditions, or | 7 | | provisions of a collective bargaining agreement entered into by | 8 | | the hospital.
| 9 | | (f) A hospital shall not directly assign any unlicensed | 10 | | personnel to perform registered professional nurse functions | 11 | | in lieu of care delivered by a registered professional nurse | 12 | | and shall not assign unlicensed personnel to perform registered | 13 | | professional nurse functions under the supervision of a direct | 14 | | care registered professional nurse. | 15 | | (g) Unlicensed personnel shall not be required to perform | 16 | | tasks that require the clinical assessment, professional | 17 | | judgment, and skill of a licensed registered professional | 18 | | nurse, including, but not limited to, the following: activities | 19 | | that require a nursing assessment or nursing judgment during | 20 | | implementation; physical, psychological, and social | 21 | | assessments that require nursing judgment, intervention, | 22 | | referral, or follow-up; formulation of a plan of nursing care | 23 | | and evaluation of a patient's response to the care provided; | 24 | | and administration of medications.
| 25 | | (Source: P.A. 96-328, eff. 8-11-09; 97-423, eff. 1-1-12; | 26 | | 97-813, eff. 7-13-12.) |
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| 1 | | Section 90. The Nurse Practice Act is amended by adding | 2 | | Sections 50-15.1, 50-15.5, 50-15.10, and 50-15.15 as follows: | 3 | | (225 ILCS 65/50-15.1 new) | 4 | | Sec. 50-15.1. Functions generally. | 5 | | (a) A direct care registered professional nurse, holding a | 6 | | valid license to practice as a registered professional nurse, | 7 | | employing scientific knowledge and experience in the physical, | 8 | | social, and biological sciences, and exercising independent | 9 | | professional judgment in applying the nursing process in the | 10 | | exclusive interests of a patient, shall directly perform the | 11 | | following essential functions: | 12 | | (1) Continuous and ongoing comprehensive nursing | 13 | | assessments of a patient's condition based upon the | 14 | | independent professional judgment of the direct care | 15 | | registered professional nurse. | 16 | | (2) Planning, implementation, and evaluation of the | 17 | | nursing care provided to each patient. The implementation | 18 | | of nursing care may be assigned by the direct care | 19 | | registered professional nurse responsible for the patient | 20 | | to other licensed nursing staff or to unlicensed staff, | 21 | | subject to any limitations of the licensure, | 22 | | certification, level of validated competency, or | 23 | | applicable law concerning such staff. In any case, however: | 24 | | (A) The direct care registered professional nurse |
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| 1 | | assigned to a patient must determine in her or his | 2 | | professional judgment that nursing personnel to be | 3 | | assigned patient care tasks possess the necessary | 4 | | preparation and capability to competently perform the | 5 | | assigned tasks. | 6 | | (B) The direct care registered professional nurse | 7 | | may assign the implementation of nursing care only when | 8 | | the registered professional nurse is physically | 9 | | present and available. | 10 | | (3) Assessment, planning, implementation, and | 11 | | evaluation of patient education, including ongoing | 12 | | discharge education of each patient. | 13 | | (b) The planning and delivery of patient care shall: (i) | 14 | | reflect all elements of the nursing process, including | 15 | | comprehensive nursing assessment, nursing diagnosis, planning, | 16 | | intervention, evaluation, and, as circumstances require, | 17 | | patient advocacy; and (ii) be initiated by a direct care | 18 | | registered professional nurse at the time of a patient's | 19 | | admission to the hospital. | 20 | | (c) A nursing plan for a patient's care shall be discussed | 21 | | with and developed as a result of coordination with the | 22 | | patient, the patient's family, or other representatives of the | 23 | | patient, when appropriate, and staff of other disciplines | 24 | | involved in the care of the patient. | 25 | | (d) A direct care registered professional nurse shall | 26 | | evaluate the effectiveness of the care plan through: (i) |
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| 1 | | comprehensive nursing assessments based on direct observation | 2 | | of the patient's physical condition and behavior, signs and | 3 | | symptoms of illness, and reactions to treatment; and (ii) | 4 | | communication with the patient and other caregivers as | 5 | | applicable. The direct care registered professional nurse | 6 | | shall modify the plan as needed. | 7 | | (e) Information related to the patient's initial | 8 | | comprehensive nursing assessment and reassessments, nursing | 9 | | diagnosis, plan, intervention, evaluation, and patient | 10 | | advocacy shall be permanently recorded, as narrative | 11 | | registered professional nurse progress notes, in the patient's | 12 | | medical record. The practice of "charting by exception" is | 13 | | expressly prohibited. | 14 | | (225 ILCS 65/50-15.5 new) | 15 | | Sec. 50-15.5. Patient assessment. | 16 | | (a) Patient assessment requires: (i) direct observation of | 17 | | the patient's signs and symptoms of illness, reaction to | 18 | | treatment, behavior and physical condition; and (ii) | 19 | | interpretation of information obtained from the patient and | 20 | | others, including other caregivers, as applicable. | 21 | | (b) Only a direct care registered professional nurse who is | 22 | | physically present with the patient is authorized to perform | 23 | | patient assessments. A licensed practical nurse may assist a | 24 | | direct care registered professional nurse in data collection. |
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| 1 | | (225 ILCS 65/50-15.10 new) | 2 | | Sec. 50-15.10. Determining nursing care needs of patients. | 3 | | (a) The nursing care needs of each individual patient shall | 4 | | be determined by a direct care registered professional nurse | 5 | | through the process of ongoing comprehensive nursing | 6 | | assessments, nursing diagnosis, and formulation and adjustment | 7 | | of nursing care plans. | 8 | | (b) The prediction of individual patient nursing care needs | 9 | | for prospective assignment of direct care registered | 10 | | professional nurses shall be based on individual comprehensive | 11 | | nursing assessments by the direct care registered professional | 12 | | nurse assigned to each patient. | 13 | | (225 ILCS 65/50-15.15 new) | 14 | | Sec. 50-15.15. Independent professional judgment. | 15 | | (a) Competent performance of the essential functions of a | 16 | | direct care registered professional nurse requires the | 17 | | exercise of independent professional judgment in the exclusive | 18 | | interests of the patient. The exercise of such independent | 19 | | professional judgment, unencumbered by the commercial or | 20 | | revenue-generation priorities of a hospital, long term acute | 21 | | care hospital, or ambulatory surgical treatment center or other | 22 | | employing entity of a direct care registered professional | 23 | | nurse, is necessary to ensure safe, therapeutic, effective, and | 24 | | competent treatment of hospital patients and is essential to | 25 | | protect the health and safety of the people of Illinois. |
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| 1 | | (b) The exercise of independent professional judgment by a | 2 | | direct care registered professional nurse in the performance of | 3 | | the essential functions, as described in paragraphs (1), (2), | 4 | | and (3) of subsection (a) of Section 15-1, shall be provided in | 5 | | the exclusive interests of the patient and shall not, for any | 6 | | purpose, be considered, relied upon, or represented as a job | 7 | | function, authority, responsibility, or activity undertaken in | 8 | | any respect for the purpose of serving the business, | 9 | | commercial, operational, or other institutional interests of | 10 | | the hospital. | 11 | | (c) No hospital, long term acute care hospital, ambulatory | 12 | | surgical treatment center, or other health care institution | 13 | | shall utilize technology that: | 14 | | (1) limits a direct care registered professional nurse | 15 | | in performing functions that are part of the nursing | 16 | | process, including full exercise of independent | 17 | | professional judgment in assessment, planning, | 18 | | implementation and evaluation of care; or | 19 | | (2) limits a direct care registered professional nurse | 20 | | in acting as a patient advocate in the exclusive interests | 21 | | of the patient. | 22 | | Technology shall not be skill-degrading, interfere with a | 23 | | direct care registered professional nurse's provision of | 24 | | individualized patient care, or override a direct care | 25 | | registered professional nurse's independent professional | 26 | | judgment. ".
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