Public Act 103-0211
 
HB3890 EnrolledLRB103 30120 CPF 56544 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  


 
    Section 5. The Hospital Licensing Act is amended  by 
changing Section 10.10 as follows:
 
    (210 ILCS 85/10.10)
    Sec. 10.10. Nurse Staffing by Patient Acuity.

    (a) 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.
        (2) 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 aligned 
    with available nursing skills to promote quality patient 
    care consistent with professional nursing standards.
        (3) Compliance with this Section promotes an 
    organizational climate that values registered nurses' 
    input in meeting the health care needs of hospital 
    patients.
    (b) Definitions. As used in this Section:
    "Acuity model" means an assessment tool selected and 
implemented by a hospital, as recommended by a nursing care 
committee, that assesses the complexity of patient care needs 
requiring professional nursing care and skills and aligns 
patient care needs and nursing skills consistent with 
professional nursing standards.
    "Department" means the Department of Public Health.
    "Direct patient care" means care provided by a registered 
professional nurse with direct responsibility to oversee or 
carry out medical regimens or nursing care for one or more 
patients.
    "Nursing care committee" means a hospital-wide committee 
or committees of nurses whose functions, in part or in whole, 
contribute to the development, recommendation,  and review of 
the hospital's nurse staffing plan established pursuant to 
subsection (d).
    "Registered professional nurse" means a person licensed as 
a Registered Nurse under the Nurse
 Practice Act.
    "Written staffing plan for nursing care services" means a 
written plan for the assignment of patient care nursing staff 
based on multiple nurse and patient considerations that yield 
minimum staffing levels for inpatient care units and the 
adopted acuity model aligning patient care needs with nursing 
skills required for quality patient care consistent with 
professional nursing standards.
    (c) Written staffing plan.
        (1) Every hospital shall implement a written 
    hospital-wide staffing plan, prepared by a nursing care 
    committee or committees, that provides for minimum direct 
    care professional registered nurse-to-patient staffing 
    needs for each inpatient care unit, including inpatient 
    emergency departments. If the staffing plan prepared by 
    the nursing care committee is not adopted by the hospital, 
    or if substantial changes are proposed to it, the chief 
    nursing officer shall either: (i) provide a written 
    explanation  to the committee of the reasons the plan was 
    not adopted; or (ii) provide a written explanation of any 
    substantial changes made to the proposed plan prior to it 
    being adopted by the hospital. The written hospital-wide 
    staffing plan shall include, but need not be limited to, 
    the following considerations:
            (A) The complexity of complete care, assessment on 
        patient admission, volume of patient admissions, 
        discharges and transfers, evaluation of the progress 
        of a patient's problems, ongoing physical assessments, 
        planning for a patient's discharge, assessment after a 
        change in patient condition, and assessment of the 
        need for patient referrals.
            (B) The complexity of clinical professional 
        nursing judgment needed to design and implement a 
        patient's nursing care plan, the need for specialized 
        equipment and technology, the skill mix of other 
        personnel providing or supporting direct patient care, 
        and involvement in quality improvement activities, 
        professional preparation, and experience.
            (C) Patient acuity and the number of patients for 
        whom care is being provided.
            (D) The ongoing assessments of a unit's patient 
        acuity levels and nursing staff needed shall be 
        routinely made by the unit nurse manager or his or her 
        designee.
            (E) The identification of additional registered 
        nurses available for direct patient care when 
        patients' unexpected needs exceed the planned workload 
        for direct care staff.
        (2) In order to provide staffing flexibility to meet 
    patient needs, every hospital shall identify an acuity 
    model for adjusting the staffing plan for each inpatient 
    care unit.
        (2.5) Each hospital shall implement the staffing plan 
    and assign nursing personnel to each inpatient care unit, 
    including inpatient emergency departments, in accordance 
    with the staffing plan.
            (A) A registered nurse may report to the nursing 
        care committee any variations where the nurse 
        personnel assignment in an inpatient care unit is not 
        in accordance with the adopted staffing plan and may 
        make a written report to the nursing care committee 
        based on the variations.
            (B)  Shift-to-shift adjustments in staffing levels 
        required by the staffing plan may be made by the 
        appropriate hospital personnel overseeing inpatient 
        care operations. If a registered nurse in an inpatient 
        care unit objects to a shift-to-shift adjustment, the 
        registered nurse may submit a written report to the 
        nursing care committee.
            (C)  The nursing care committee shall develop a 
        process to examine and respond to written reports 
        submitted under subparagraphs (A) and (B) of this 
        paragraph (2.5), including the ability to determine if 
        a specific written report is resolved or should be 
        dismissed. 
        (3) The written staffing plan shall be posted, either 
    by physical or electronic means, in a conspicuous and 
    accessible location for both patients and direct care 
    staff, as required under the Hospital Report Card Act. A 
    copy of the written staffing plan shall be provided to any 
    member of the general public upon request. 
    (d) Nursing care committee.
        (1) Every hospital shall have a nursing care committee 
    that meets at least 6 times per year. A hospital shall 
    appoint members of a committee whereby at least 55% of the 
    members are registered professional nurses providing 
    direct inpatient care, one of whom shall be selected 
    annually by the direct inpatient care nurses to serve as 
    co-chair of the committee.
        (2) (Blank).

        (2.5) A nursing care committee shall prepare and 
    recommend to hospital administration the hospital's 
    written hospital-wide staffing plan. If the staffing plan 
    is not adopted by the hospital, the chief nursing officer 
    shall provide a written statement to the committee prior 
    to a staffing plan being adopted by the hospital that: (A) 
    explains the reasons the committee's proposed staffing 
    plan was not adopted; and (B) describes the changes to the 
    committee's proposed staffing or any alternative to the 
    committee's proposed staffing plan. 
        (3) A nursing care committee's or committees' written 
    staffing plan for the hospital  shall be based on the 
    principles from the staffing components set forth in 
    subsection  (c). In particular, a committee or committees 
    shall provide input and feedback on the following:
            (A) Selection, implementation, and evaluation of 
        minimum staffing levels for inpatient care units.
            (B) Selection, implementation, and evaluation of 
        an acuity model to provide staffing flexibility that 
        aligns changing patient acuity with nursing skills 
        required.
            (C) Selection, implementation, and evaluation of a 
        written staffing plan incorporating the items 
        described in subdivisions (c)(1) and (c)(2) of this 
        Section.
            (D) Review the nurse staffing plans for all 
        inpatient areas and current acuity tools and measures 
        in use. The nursing care committee's review shall 
        consider: 
                (i) patient outcomes;
                (ii) complaints regarding staffing, including 
            complaints about a delay in direct care nursing or 
            an absence of direct care nursing;
                (iii) the number of hours of nursing care 
            provided through an inpatient hospital unit 
            compared with the number of inpatients served by 
            the hospital unit during a 24-hour period;
                (iv) the aggregate hours of overtime worked by 
            the nursing staff;
                (v) the extent to which actual nurse staffing 
            for each hospital inpatient unit differs from the 
            staffing specified by the staffing plan; and
                (vi) any other matter or change to the 
            staffing plan determined by the committee to 
            ensure that the hospital is staffed to meet the 
            health care needs of patients. 
        (4) A nursing care committee must issue a written 
    report addressing the items described in subparagraphs (A) 
    through (D) of paragraph (3) semi-annually. A written copy 
    of this report shall be made available to direct inpatient 
    care nurses by making available a paper copy of the 
    report, distributing it electronically, or posting it on 
    the hospital's website. 
        (5)  A nursing care committee must issue a written 
    report at least annually to the hospital governing board 
    that addresses items including, but not limited to: the 
    items described in paragraph (3); changes made based on 
    committee recommendations and the impact of such changes; 
    and recommendations for future changes related to nurse 
    staffing.
        (6)  A nursing care committee must annually notify the 
    hospital nursing staff of the staff's rights under this 
    Section. The annual notice must provide a phone number and 
    an email address for staff to report noncompliance with 
    the nursing staff's rights as described in this Section. 
    The notice must be provided by email or by regular mail in 
    a manner that effectively facilitates receipt of the 
    notice. The Department shall monitor and enforce the 
    requirements of this paragraph (6). 
    (e) Nothing in this Section 10.10 shall be construed to 
limit, alter, or modify any of the terms, conditions, or 
provisions of a collective bargaining agreement entered into 
by the hospital.


    (f) No hospital may discipline, discharge, or take any 
other adverse employment action against an employee solely 
because the employee expresses a concern or complaint 
regarding an alleged violation of this Section or concerns 
related to nurse staffing.
    (g) Any employee of a hospital may file a complaint with 
the Department regarding an alleged violation of this Section.   
The Department must forward notification of the alleged 
violation to the hospital in question within 10 business days 
after the complaint is filed. Upon receiving a complaint of a 
violation of this Section, the Department may take any action 
authorized under Sections 7 or 9 of this Act.
(Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21; 
102-813, eff. 5-13-22.)


Effective Date:  1/1/2024