Illinois General Assembly - Full Text of HB3890
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Full Text of HB3890  103rd General Assembly

HB3890ham001 103RD GENERAL ASSEMBLY

Rep. Fred Crespo

Filed: 3/20/2023

 

 


 

 


 
10300HB3890ham001LRB103 30120 BMS 59180 a

1
AMENDMENT TO HOUSE BILL 3890

2    AMENDMENT NO. ______. Amend House Bill 3890 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Hospital Licensing Act is amended by
5changing Section 10.10 as follows:
 
6    (210 ILCS 85/10.10)
7    Sec. 10.10. Nurse Staffing by Patient Acuity.
8    (a) Findings. The Legislature finds and declares all of
9the following:
10        (1) The State of Illinois has a substantial interest
11    in promoting quality care and improving the delivery of
12    health care services.
13        (2) Evidence-based studies have shown that the basic
14    principles of staffing in the acute care setting should be
15    based on the complexity of patients' care needs aligned
16    with available nursing skills to promote quality patient

 

 

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1    care consistent with professional nursing standards.
2        (3) Compliance with this Section promotes an
3    organizational climate that values registered nurses'
4    input in meeting the health care needs of hospital
5    patients.
6    (b) Definitions. As used in this Section:
7    "Acuity model" means an assessment tool selected and
8implemented by a hospital, as recommended by a nursing care
9committee, that assesses the complexity of patient care needs
10requiring professional nursing care and skills and aligns
11patient care needs and nursing skills consistent with
12professional nursing standards.
13    "Department" means the Department of Public Health.
14    "Direct patient care" means care provided by a registered
15professional nurse with direct responsibility to oversee or
16carry out medical regimens or nursing care for one or more
17patients.
18    "Nursing care committee" means a hospital-wide committee
19or committees of nurses whose functions, in part or in whole,
20contribute to the development, recommendation, and review of
21the hospital's nurse staffing plan established pursuant to
22subsection (d).
23    "Registered professional nurse" means a person licensed as
24a Registered Nurse under the Nurse Practice Act.
25    "Written staffing plan for nursing care services" means a
26written plan for the assignment of patient care nursing staff

 

 

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1based on multiple nurse and patient considerations that yield
2minimum staffing levels for inpatient care units and the
3adopted acuity model aligning patient care needs with nursing
4skills required for quality patient care consistent with
5professional nursing standards.
6    (c) Written staffing plan.
7        (1) Every hospital shall implement a written
8    hospital-wide staffing plan, prepared by a nursing care
9    committee or committees, that provides for minimum direct
10    care professional registered nurse-to-patient staffing
11    needs for each inpatient care unit, including inpatient
12    emergency departments. If the staffing plan prepared by
13    the nursing care committee is not adopted by the hospital,
14    or if substantial changes are proposed to it, the chief
15    nursing officer shall either: (i) provide a written
16    explanation to the committee of the reasons the plan was
17    not adopted; or (ii) provide a written explanation of any
18    substantial changes made to the proposed plan prior to it
19    being adopted by the hospital. The written hospital-wide
20    staffing plan shall include, but need not be limited to,
21    the following considerations:
22            (A) The complexity of complete care, assessment on
23        patient admission, volume of patient admissions,
24        discharges and transfers, evaluation of the progress
25        of a patient's problems, ongoing physical assessments,
26        planning for a patient's discharge, assessment after a

 

 

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1        change in patient condition, and assessment of the
2        need for patient referrals.
3            (B) The complexity of clinical professional
4        nursing judgment needed to design and implement a
5        patient's nursing care plan, the need for specialized
6        equipment and technology, the skill mix of other
7        personnel providing or supporting direct patient care,
8        and involvement in quality improvement activities,
9        professional preparation, and experience.
10            (C) Patient acuity and the number of patients for
11        whom care is being provided.
12            (D) The ongoing assessments of a unit's patient
13        acuity levels and nursing staff needed shall be
14        routinely made by the unit nurse manager or his or her
15        designee.
16            (E) The identification of additional registered
17        nurses available for direct patient care when
18        patients' unexpected needs exceed the planned workload
19        for direct care staff.
20        (2) In order to provide staffing flexibility to meet
21    patient needs, every hospital shall identify an acuity
22    model for adjusting the staffing plan for each inpatient
23    care unit.
24        (2.5) Each hospital shall implement the staffing plan
25    and assign nursing personnel to each inpatient care unit,
26    including inpatient emergency departments, in accordance

 

 

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1    with the staffing plan.
2            (A) A registered nurse may report to the nursing
3        care committee any variations where the nurse
4        personnel assignment in an inpatient care unit is not
5        in accordance with the adopted staffing plan and may
6        make a written report to the nursing care committee
7        based on the variations.
8            (B) Shift-to-shift adjustments in staffing levels
9        required by the staffing plan may be made by the
10        appropriate hospital personnel overseeing inpatient
11        care operations. If a registered nurse in an inpatient
12        care unit objects to a shift-to-shift adjustment, the
13        registered nurse may submit a written report to the
14        nursing care committee.
15            (C) The nursing care committee shall develop a
16        process to examine and respond to written reports
17        submitted under subparagraphs (A) and (B) of this
18        paragraph (2.5), including the ability to determine if
19        a specific written report is resolved or should be
20        dismissed.
21        (3) The written staffing plan shall be posted, either
22    by physical or electronic means, in a conspicuous and
23    accessible location for both patients and direct care
24    staff, as required under the Hospital Report Card Act. A
25    copy of the written staffing plan shall be provided to any
26    member of the general public upon request.

 

 

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1    (d) Nursing care committee.
2        (1) Every hospital shall have a nursing care committee
3    that meets at least 6 times per year. A hospital shall
4    appoint members of a committee whereby at least 55% of the
5    members are registered professional nurses providing
6    direct inpatient care, one of whom shall be selected
7    annually by the direct inpatient care nurses to serve as
8    co-chair of the committee.
9        (2) (Blank).
10        (2.5) A nursing care committee shall prepare and
11    recommend to hospital administration the hospital's
12    written hospital-wide staffing plan. If the staffing plan
13    is not adopted by the hospital, the chief nursing officer
14    shall provide a written statement to the committee prior
15    to a staffing plan being adopted by the hospital that: (A)
16    explains the reasons the committee's proposed staffing
17    plan was not adopted; and (B) describes the changes to the
18    committee's proposed staffing or any alternative to the
19    committee's proposed staffing plan.
20        (3) A nursing care committee's or committees' written
21    staffing plan for the hospital shall be based on the
22    principles from the staffing components set forth in
23    subsection (c). In particular, a committee or committees
24    shall provide input and feedback on the following:
25            (A) Selection, implementation, and evaluation of
26        minimum staffing levels for inpatient care units.

 

 

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1            (B) Selection, implementation, and evaluation of
2        an acuity model to provide staffing flexibility that
3        aligns changing patient acuity with nursing skills
4        required.
5            (C) Selection, implementation, and evaluation of a
6        written staffing plan incorporating the items
7        described in subdivisions (c)(1) and (c)(2) of this
8        Section.
9            (D) Review the nurse staffing plans for all
10        inpatient areas and current acuity tools and measures
11        in use. The nursing care committee's review shall
12        consider:
13                (i) patient outcomes;
14                (ii) complaints regarding staffing, including
15            complaints about a delay in direct care nursing or
16            an absence of direct care nursing;
17                (iii) the number of hours of nursing care
18            provided through an inpatient hospital unit
19            compared with the number of inpatients served by
20            the hospital unit during a 24-hour period;
21                (iv) the aggregate hours of overtime worked by
22            the nursing staff;
23                (v) the extent to which actual nurse staffing
24            for each hospital inpatient unit differs from the
25            staffing specified by the staffing plan; and
26                (vi) any other matter or change to the

 

 

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1            staffing plan determined by the committee to
2            ensure that the hospital is staffed to meet the
3            health care needs of patients.
4        (4) A nursing care committee must issue a written
5    report addressing the items described in subparagraphs (A)
6    through (D) of paragraph (3) semi-annually. A written copy
7    of this report shall be made available to direct inpatient
8    care nurses by making available a paper copy of the
9    report, distributing it electronically, or posting it on
10    the hospital's website.
11        (5) A nursing care committee must issue a written
12    report at least annually to the hospital governing board
13    that addresses items including, but not limited to: the
14    items described in paragraph (3); changes made based on
15    committee recommendations and the impact of such changes;
16    and recommendations for future changes related to nurse
17    staffing.
18        (6) A nursing care committee must annually notify the
19    hospital nursing staff of the staff's rights under this
20    Section. The annual notice must provide a phone number and
21    an email address for staff to report noncompliance with
22    the nursing staff's rights as described in this Section.
23    The notice must be provided by email or by regular mail in
24    a manner that effectively facilitates receipt of the
25    notice. The Department shall monitor and enforce the
26    requirements of this paragraph (6).

 

 

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1    (e) Nothing in this Section 10.10 shall be construed to
2limit, alter, or modify any of the terms, conditions, or
3provisions of a collective bargaining agreement entered into
4by the hospital.
5    (f) No hospital may discipline, discharge, or take any
6other adverse employment action against an employee solely
7because the employee expresses a concern or complaint
8regarding an alleged violation of this Section or concerns
9related to nurse staffing.
10    (g) Any employee of a hospital may file a complaint with
11the Department regarding an alleged violation of this Section.
12The Department must forward notification of the alleged
13violation to the hospital in question within 10 business days
14after the complaint is filed. Upon receiving a complaint of a
15violation of this Section, the Department may take any action
16authorized under Sections 7 or 9 of this Act.
17(Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
18102-813, eff. 5-13-22.)".