Bill Text: IL HB0282 | 2011-2012 | 97th General Assembly | Amended

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Bill Title: Creates the Nursing Care and Quality Improvement Act. Provides that each hospital shall implement a staffing plan that (i) provides adequate, appropriate, and quality delivery of health care services, (ii) protects patient safety, and (iii) is consistent with the requirements of the Act. Sets forth the minimum direct care registered nurse-to-patient ratios required in a unit of a hospital during each shift in that unit. Sets forth development and reevaluation requirements for the staffing plan. Prohibits a hospital from discharging, discriminating against, or retaliating against (i) a nurse in any manner with respect to any aspect of employment based on the nurse's refusal of a work assignment under certain conditions or (ii) a nurse or any individual, who, in good faith, reports a violation of the Act, initiates, cooperates, or otherwise participates in an investigation or proceeding under the Act, or informs or discusses with other individuals or with representatives of hospital employees a violation or suspected violation of the Act. Sets forth penalties for violation of the Act.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Failed) 2013-01-08 - Session Sine Die [HB0282 Detail]

Download: Illinois-2011-HB0282-Amended.html

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Rep. Mary E. Flowers

Filed: 3/2/2012

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AMENDMENT TO HOUSE BILL 282
AMENDMENT NO. ______. Amend House Bill 282 by replacing
everything after the enacting clause with the following:
"Article 1. General
Section 1-1. Short title. This Act may be cited as the
Hospital Patient Protection Act.
Article 5. Definitions
Section 5-1. Definitions. The definitions set forth in this
Article apply unless the context requires otherwise.
Section 5-5. Acuity-based patient classification system.
"Acuity-based patient classification system" or "system" means
a standardized set of criteria based on scientific data that
acts as a measurement instrument and that is used to predict

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registered nursing care requirements for individual patients
based on the severity of a patient's illness (including
co-morbidities), the need for specialized equipment and
technology, the intensity of required nursing interventions,
and the complexity of clinical nursing judgment required to
design, implement, and evaluate a patient's nursing care plan
consistent with professional standards, the ability for
self-care (including motor, sensory, and cognitive deficits),
the need for advocacy intervention, the licensure of the
personnel required for care, the patient care delivery system,
the unit's geographic layout, and generally accepted standards
of nursing practice, as well as elements reflective of the
unique nature of the acute-care hospital's patient population.
The system determines the additional number of direct care
registered nurses and other licensed and unlicensed nursing
staff the hospital must assign, based on the independent
professional judgment of the direct care registered nurse, to
meet the individual patient needs at all times.
Section 5-10. Clinical judgment. "Clinical judgment" means
the application of the direct care registered nurse's
knowledge, skill, and expertise and experience in making
independent decisions about patient care.
Section 5-15. Clinical supervision. "Clinical supervision"
means the assignment and direction of patient care tasks

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required in the implementation of nursing care for a patient to
other licensed nursing staff or to unlicensed staff by a direct
care registered nurse in the exclusive interests of the
patient.
Section 5-20. Competence. "Competence" means the ability
of a direct care registered nurse to act and integrate the
knowledge, skills, abilities, and independent professional
judgment that underpin safe, therapeutic, and effective
patient care.
Section 5-25. Critical access hospital. "Critical access
hospital" means a health facility designated as such pursuant
to a Medicare rural hospital flexibility program as defined in
42 U.S.C. 1395x(mm).
Section 5-30. Critical care unit or intensive care unit.
"Critical care unit" or "intensive care unit" means a hospital
unit established to safeguard and protect patients whose
severity of illness, including all co-morbidities, requires
continuous monitoring and complex interventions by a direct
care registered nurse and whose restorative measures and level
of nursing intensity requires intensive care through direct
observation by a direct care registered nurse, complex
monitoring, intensive intricate assessment, specialized rapid
intervention, evaluation, and education or teaching of the

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patient and his or her family or other representatives by a
competent and experienced direct care registered nurse. The
term includes an intensive care unit, a burn center, a coronary
care unit, or an acute respiratory unit.
Section 5-35. Department. "Department" means the
Department of Public Health.
Section 5-40. Direct care registered nurse. "Direct care
registered nurse" means a competent registered nurse who has
accepted a direct care, hands-on patient care assignment to
implement medical and nursing regimens while exercising
independent professional judgment at all times in the interest
of the patient.
Section 5-45. Hospital. "Hospital" means a general
hospital, psychiatric hospital, short-term acute-care
hospital, long-term acute-care hospital, or critical access
hospital, or any institution, place, building, or agency,
public or private, whether organized for profit or not, devoted
primarily to the maintenance and operation of facilities for
the diagnosis, prevention, and treatment of physical or mental
human illness, including convalescence and rehabilitation and
including care during and after pregnancy, or care of 2 or more
unrelated persons admitted for over night stay or longer, in
order to obtain medical, including nursing, care of illness,

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disease, injury, infirmity, or deformity.
Section 5-50. Hospital unit or clinical patient care area.
"Hospital unit" or "clinical patient care area" means an
intensive care critical care unit, burn unit, labor and
delivery room (ante-partum and post-partum), newborn nursery,
post-anesthesia service area, emergency department, operating
room, pediatric unit, step-down or intermediate care unit,
specialty care unit, telemetry unit, general medical/surgical
care unit, psychiatric unit, rehabilitation unit, or skilled
nursing unit.
Section 5-55. Long-term acute-care hospital. "Long-term
acute-care hospital" means any hospital or health care facility
that specializes in providing acute care to medically complex
patients with an anticipated length of stay of more than 25
days. The term includes both free-standing and
"hospital-within-hospital" models of long-term acute-care
facilities.
Section 5-60. Medical/surgical unit. "Medical/surgical
unit" means a unit established to safeguard and protect
patients whose severity of illness, including all
co-morbidities, requires continuous observation and complex
interventions, and whose restorative measures and level of
nursing intensity require continuous care by a competent and

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experienced direct care registered nurse. These units may
include general medical and post-surgical patients requiring
less than intensive care or step-down care and may include
mixed patient populations of diverse diagnoses and diverse age
groups excluding pediatric patients.
Section 5-65. Nursing intensity. "Nursing intensity"
means a direct observation or monitoring by a direct care
registered nurse, multiple assessments, specialized
intervention, evaluation, education or teaching of the patient
and his or her family or other representatives, and
documentation.
Section 5-70. Patient advocacy. "Patient advocacy" means
the professional obligation and right of a registered nurse or
a registered professional nurse to act as a patient advocate,
as circumstances require, by initiating action to improve
health care or change decisions or activities which in the
professional judgment of the registered nurse are against the
interests or wishes of the patient, or by giving the patient
the opportunity to make informed decisions about health care
before it is provided.
Section 5-75. Patient assessment. "Patient assessment"
means the utilization of critical thinking, which is the
intellectually disciplined process of actively and skillfully

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interpreting, applying, analyzing, synthesizing, or evaluating
data obtained through direct observation and communication
with others.
Section 5-80. Professional judgment. "Professional
judgment" means the intellectual (educated, informed, and
experienced) process that a direct care registered nurse
exercises in forming an opinion and reaching a clinical
decision, in the patient's best interest, based upon analysis
of data, information, and scientific evidence.
Section 5-85. Rehabilitation unit. "Rehabilitation unit"
means a functional clinical unit for the provision of those
rehabilitation services that restore an ill or injured patient
to the highest level of self-sufficiency in the shortest
possible time, compatible with the patient's physical,
intellectual, and emotional or psychological capabilities and
in accordance with planned goals and objectives.
Section 5-90. Skilled nursing unit. "Skilled nursing unit"
means a functional clinical unit (i) for the provision of
skilled nursing care and supportive care to patients whose
primary need is for the availability of skilled nursing care on
a long-term basis, who are admitted after at least a 48-hour
period of continuous inpatient care, and (ii) which provides at
least the following: medical, nursing, dietary, and

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pharmaceutical services and an activity program.
Section 5-95. Specialty care unit. "Specialty care unit"
means a unit (i) established to safeguard and protect patients
whose severity of illness, including all co-morbidities,
requires continuous observation and complex interventions,
(ii) whose restorative measures and level of nursing intensity
require continuous care by a competent and experienced direct
care registered nurse, (iii) that provides intensity of care
for a specific medical condition or a specific patient
population, and (iv) is more comprehensive for the specific
condition or disease process than is required on
medical/surgical units. The term includes a hospital unit that
is not a critical care or intensive care unit, medical/surgical
unit, rehabilitation unit, skilled nursing unit, step-down
unit, or telemetry unit.
Section 5-100. Step-down unit. "Step-down unit" means a
unit (i) established to safeguard and protect patients whose
severity of illness, including all co-morbidities, requires
continuous monitoring and complex interventions and (ii) whose
restorative measures and level of nursing intensity require
intermediate intensive care by a competent and experienced
direct care registered nurse for the immediate amelioration or
remediation of severe pathology for those patients requiring
less care than intensive care, but more than is required from

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medical/surgical care.
Section 5-105. Telemetry unit. "Telemetry unit" means a
unit (i) established to safeguard and protect patients whose
severity of illness, including all co-morbidities, requires
continuous monitoring and complex intervention, (ii) whose
restorative measures and level of nursing intensity require
intermediate intensive care by a competent and experienced
direct care registered nurse, and (iii) designated for the
electronic monitoring, recording, retrieval, and display of
cardiac electrical signals.
Article 10. Minimum Safe Staffing Ratios
Section 10-5. Direct care registered nurse staffing
generally.
(a) Each hospital shall provide minimum staffing by direct
care registered nurses in accordance with the clinical unit
direct care registered nurse-to-patient staffing requirements
and ratios specified in Sections 10-15, 10-20, and 10-25.
Staffing for care not requiring a direct care registered nurse
is not included within these ratios and shall be determined
pursuant to the acuity-based patient classification system
described in Section 10-40.
(b) No hospital shall assign a direct care registered nurse
to a nursing unit or clinical area unless that hospital and the

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direct care registered nurse determine that the direct care
registered nurse has demonstrated current competence in
providing care in that area and has also received orientation
to that hospital's clinical area sufficient to provide
competent safe, therapeutic, and effective nursing care to
patients in that area. The policies and procedures of the
hospital shall contain the hospital's criteria for making this
determination.
Section 10-10. Direct care registered nurse-to-patient
ratios generally.
(a) Direct care registered nurse-to-patient ratios
represent the maximum number of patients that shall be assigned
to one direct care registered nurse at any one time. For
purposes of this subsection, "assigned" means that the direct
care registered nurse has responsibility for the provision of
care to a particular patient within her or his validated
competency.
(b) There shall be no averaging of the number of patients
and the total number of direct care registered nurses on the
unit during any one shift or over any period of time.
(c) Only direct care registered nurses providing direct
patient care shall be included in the ratios. Nurse
Administrators, Nurse Supervisors, Nurse Managers, Charge
Nurses, or Case Managers shall not be included in the
calculation of the direct care registered nurse-to-patient

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ratio.
(d) Only direct care registered nurses shall relieve other
direct care registered nurses during breaks, meals, and other
routine, expected absences from the unit.
Section 10-15. Direct care registered nurse staffing;
emergency department.
(a) There shall be no fewer than 2 direct care registered
nurses physically present in the emergency department when a
patient is present. At least one direct care registered nurse
shall be assigned to triage patients. Only direct care
registered nurses shall be assigned to triage patients. The
direct care registered nurse assigned to triage patients shall
be immediately available at all times to triage patients when
they arrive in the emergency department. The direct care
registered nurse assigned to triage patients shall perform
triage functions only. Triage direct care registered nurses,
base radio responder direct care registered nurses, and
specialty/flight registered nurses do not count in the
calculation of the direct care registered nurse-to-patient
ratio.
(b) When registered nursing staff, with validated critical
care competency, are attending critical care patients in the
emergency department, the direct care registered
nurse-to-patient ratio shall be 1:2 or fewer critical care
patients at all times. A patient in the emergency department

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shall be considered a critical care patient when the patient
meets the criteria for admission to a critical care service
area within the hospital. Only direct care registered nurses
shall be assigned to critical trauma patients in the emergency
department, and a minimum direct care registered nurse to
critical trauma patient ratio of 1:1 shall be maintained at all
times. A critical trauma patient is a patient who has injuries
to an anatomic area that (i) require life saving interventions
or (ii) in conjunction with unstable vital signs, pose an
immediate threat to life or limb.
Section 10-20. Direct care registered nurse staffing;
operating room. The surgical services operating room shall have
at least one direct care registered nurse assigned to the
duties of the circulating nurse and a minimum of one additional
person serving as scrub assistant for each patient-occupied
operating room.
Section 10-25. Direct care registered nurse-to-patient
ratios; hospital clinical units or patient care areas.
(a) The direct care registered nurse-to-patient ratio
shall be 1:1 or fewer at all times when assigned to duties of
the circulating registered nurse in the operating room or
during a cesarean delivery; when assigned to an active labor
patient or a patient with medical or obstetrical complications,
or when initiating epidural anesthesia in the labor and

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delivery suite; when assigned to an unstable or in
resuscitation period newborn; when assigned to a critical
trauma patient in the emergency department; or when assigned to
a patient receiving conscious sedation.
(b) The direct care registered nurse-to-patient ratio
shall be 1:2 or fewer at all times for critical care, intensive
care, neonatal intensive care, labor and delivery units,
coronary care, acute respiratory care, post-anesthesia
recovery (regardless of the type of anesthesia the patient
received), and burn units/patient care areas; when assigned to
critical patients in the emergency department; or when assigned
to immediate post-partum patients.
(c) The direct care registered nurse-to-patient ratio
shall be 1:3 or fewer at all times for the emergency
department, a step-down or intermediate intensive care,
pediatric, telemetry, combined labor/delivery/post-partum unit
or patient care area; when assigned to ante-partum patients who
are not in active labor; or when assigned to mother-baby
couplets.
(d) The direct care registered nurse-to-patient ratio
shall be 1:4 or fewer at all times for a medical/surgical,
pre-surgical/admission, ambulatory surgical, psychiatric, or
other specialty care unit or patient care area; when assigned
to post-partum patients, post-surgical gynecological patients,
or mothers only; when assigned to recently born infants; or
when assigned to combined post-cesarean delivery mothers and

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newborns.
(e) The direct care registered nurse-to-patient ratio
shall be 1:5 or fewer at all times for the well baby nursery or
a rehabilitation unit or patient care area or for a skilled
nursing facility.
(f) In the event of multiple births, the total number of
mothers plus infants assigned to a single direct care
registered nurse shall never exceed 6.
Section 10-30. Staffing requirements in relation to
hospital units.
(a) Identifying a unit by a name or term other than
"hospital unit", "clinical patient care area", "critical care
unit", "intensive care unit", "medical/surgical unit",
"rehabilitation unit", "skilled nursing unit", "specialty care
unit", "step-down unit", or "telemetry unit", as defined in
this Act, does not affect a hospital's requirement to staff the
unit at the direct care registered nurse-to-patient ratios
identified for the level of intensity or type of care described
in this Article.
(b) Patients shall be cared for only on units where the
level of intensity, type of care, and direct care registered
nurse-to-patient ratios meet the individual requirements and
needs of each patient. The use of acuity-adjustable units or
clinical patient care areas is strictly prohibited.

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Section 10-35. Use of rapid response teams as first
responders prohibited. In no case may a hospital use rapid
response teams as first responders.
Section 10-40. Additional nursing staff. In addition to any
other direct care registered nurse-to-patient ratio
requirements of this Article 10, every hospital shall assign
additional nursing staff, such as licensed practical nurses,
certified nursing assistants, and other ancillary staff,
through the implementation of a valid acuity-based patient
classification system for determining nursing care needs of
individual patients that reflects the assessment, made by the
assigned direct care registered nurse, of patient nursing care
requirements and provides for shift-by-shift staffing based on
those requirements.
Section 10-45. Written staffing plan. A written staffing
plan shall be developed by every hospital's Chief Nursing
Officer or a designee, based on individual patient care needs
determined by the acuity-based patient classification system.
The staffing plan shall be developed and implemented for each
patient care unit and shall specify individual patient care
requirements and the staffing levels or skill mix for direct
care registered nurses and other licensed and unlicensed
personnel. In no case shall the staffing level for direct care
registered nurses on any shift fall below the requirements set

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forth in this Article 10.
Section 10-50. Record of staff assignments. Every hospital
shall keep a record of the actual direct care registered nurse,
licensed practical nurse, certified nursing assistant, and
other ancillary staff assignments to individual patients
documented on a day-to-day, shift-by-shift basis and must keep
copies of its staff assignments on file for a period of 2
years.
Section 10-55. Patient classification system review
committee. A hospital shall appoint a patient classification
system review committee. At least 60% of the members of a
hospital's patient classification system review committee
shall be unit-specific competent direct care registered nurses
who provide direct patient care. The members of the committee
shall be appointed by the hospital's Chief Nursing Officer,
except that if direct care registered nurses are represented
for collective bargaining purposes, all direct care registered
nurses on the committee shall be appointed by the authorized
collective bargaining agent.
Section 10-60. Changes in patient census. Every hospital
shall plan for routine fluctuations, such as admissions,
discharges, and transfers, in its patient census. If a health
care emergency causes a change in the number of patients on a

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unit, the hospital must demonstrate that immediate and diligent
efforts were made to maintain required staffing levels. For
purposes of this Section, "health care emergency" means an
emergency declared by the federal government or the head of a
State or local governmental entity.
Section 10-65. Department; study of nursing staff. Not
later than 2 years after the effective date of this Act, the
Department shall complete and publish a study of licensed and
unlicensed hospital nursing staff and its effects on patient
safety and care in hospitals.
Section 10-70. Prohibited activities.
(a) A hospital may not directly assign any unlicensed
personnel to perform registered-nurse functions in lieu of care
delivered by a registered nurse and may not assign unlicensed
personnel to perform registered-nurse functions under the
supervision of a direct care registered nurse.
(b) Unlicensed personnel may not perform tasks that require
the clinical assessment, judgment, and skill of a licensed
registered nurse, including, without limitation: nursing
activities that require nursing assessment and judgment during
implementation; physical, psychological, and social
assessments that require nursing judgment, intervention,
referral, or follow-up; formulation of a plan of nursing care
and evaluation of the patient's response to the care provided;

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and administration of medications.
(c) A hospital may not impose mandatory overtime
requirements to meet the staffing ratios required in this
Article 10.
(d) A hospital may not impose lay-offs of licensed or
practical nurses, certified nursing assistants, or other
ancillary staff to meet the direct care registered
nurse-to-patient ratio requirements of this Article 10.
Section 10-75. Consumer protection. Every hospital shall
post on a day-to-day, shift-by-shift basis, in a conspicuous
place visible to the patients, hospital staff, and public (i)
the ratios of direct care registered nursing staff to patients
on each unit, (ii) additional staffing requirements as
determined by the patient classification system for each unit,
(iii) the actual staff and staff mix provided, and (iv) the
variance between required and actual staffing patterns. Every
hospital shall give to each patient admitted to the hospital
for inpatient care a toll-free telephone number for the
Department of Public Health to report inadequate staffing or
care.
Article 15. Direct Care Registered Nurse
Functions Relating to Patient Care
Section 15-5. Functions generally.

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(a) A direct care professional nurse, holding a valid
license to practice as a registered nurse, employing scientific
knowledge and experience in the physical, social, and
biological sciences and exercising independent judgment in
applying the nursing process, shall directly perform the
following essential functions:
(1) Continuous and ongoing assessments of a patient's
condition based upon the independent professional judgment
of the direct care registered nurse.
(2) Planning, clinical supervision, implementation,
and evaluation of the nursing care provided to each
patient. The implementation of nursing care may be assigned
by the direct care registered nurse responsible for the
patient to other licensed nursing staff or to unlicensed
staff, subject to any limitations of the licensure,
certification, level of validated competency, or
applicable law concerning such staff. In any case, however:
(A) The direct care registered nurse assigned to a
patient must determine in her or his professional
judgment that nursing personnel to be assigned patient
care tasks possess the necessary preparation and
capability to competently perform the assigned tasks.
(B) The direct care registered nurse may assign the
implementation of nursing care only when circumstances
permit the direct care registered nurse to effectively
supervise nursing care provided pursuant to the

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assignment.
(3) Assessment, planning, implementation, and
evaluation of patient education, including ongoing
discharge teaching of each patient. Any assignment of
specific patient education tasks to patient care personnel
shall be made by the direct care registered nurse
responsible for the patient.
(b) The planning and delivery of patient care (i) shall
reflect all elements of the nursing process, including
assessment, nursing diagnosis, planning, intervention,
evaluation, and, as circumstances require, patient advocacy,
and (ii) shall be initiated by a direct care registered nurse
at the time of a patient's admission to the hospital.
(c) The nursing plan for a patient's care shall be
discussed with and developed as a result of coordination with
the patient, the patient's family, or other representatives of
the patient, when appropriate, and staff of other disciplines
involved in the care of the patient.
(d) The direct care registered nurse shall evaluate the
effectiveness of the care plan (i) through assessments based on
direct observation of the patient's physical condition and
behavior, signs and symptoms of illness, and reactions to
treatment and (ii) through communication with the patient and
the health care team members. The direct care registered nurse
shall modify the plan as needed.
(e) Information related to the patient's initial

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assessment and reassessments, nursing diagnosis, plan,
intervention, evaluation, and patient advocacy shall be
permanently recorded, as narrative registered nurse progress
notes, in the patient's medical record. The practice of
"charting by exception" is expressly prohibited.
Section 15-10. Patient assessment.
(a) Patient assessment requires (i) direct observation of
the patient's signs and symptoms of illness, reaction to
treatment, behavior and physical condition, and (ii)
interpretation of information obtained from the patient and
others, including other care givers on the health team.
Assessment requires data collection by the direct care
registered nurse and the analysis, synthesis, and evaluation of
such data.
(b) Only a direct care registered nurse is authorized to
perform patient assessments. A licensed practical nurse may
assist a direct care registered nurse in data collection.
Section 15-15. Determining nursing care needs of patients.
(a) The nursing care needs of an individual patient shall
be determined by a direct care registered nurse through the
process of ongoing patient assessments, nursing diagnosis, and
formulation and adjustment of nursing care plans.
(b) The prediction of individual patient nursing care needs
for prospective assignment of direct care registered nurses

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shall be based on individual patient assessments by the direct
care registered nurse assigned to each patient and in
accordance with a documented patient classification system as
provided in Article 10.
Section 15-20. Independent judgment.
(a) Competent performance of the essential functions of a
direct care registered nurse as described in subdivisions
(a)(1) through (a)(3) of Section 15-5, Section 15-10, and
Section 15-15 requires the exercise of independent judgment in
the interests of the patient. The exercise of such independent
judgment, unencumbered by the commercial or revenue-generation
priorities of a hospital or other employing entity of a direct
care registered nurse, is necessary to assure safe,
therapeutic, and competent treatment of hospital patients and
is essential to protect the health and safety of the people of
Illinois.
(b) The exercise of independent judgment by a direct care
registered nurse in the performance of the essential functions
described in subdivisions (a)(1) through (a)(3) of Section 15-5
and as provided in this Act and the Nurse Practice Act shall be
provided in the exclusive interests of the patient and shall
not, for any purpose, be considered, relied upon, or
represented as a job function, authority, responsibility, or
activity undertaken in any respect for the purpose of serving
the business, commercial, operational, or other institutional

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interests of the hospital.
Section 15-25. Clinical supervision.
(a) In addition to the limitations on assignments of
patient care tasks provided in subsections (a) and (b) of
Section 10-70, a direct care registered nurse responsible for a
patient may assign tasks required in the implementation of
nursing care for that patient to other licensed nurses or to
unlicensed personnel only if she or he:
(1) determines that the personnel to whom the tasks are
assigned have statutory authority to define the tasks and
possess the necessary training, experience, and capability
to competently and safely perform the tasks to be assigned;
and
(2) effectively supervises the clinical functions and
nursing care tasks performed by the assigned personnel.
(b) The exercise of clinical supervision of nursing care
personnel by a direct care registered nurse in the performance
of the essential functions described in subdivisions (a)(1)
through (a)(3) of Section 15-5 and as provided in this Act and
the Nurse Practice Act shall be in the exclusive interests of
the patient and shall not, for any purpose, be considered,
relied upon, or represented as a job function, authority,
responsibility, or activity undertaken in any respect for the
purpose of serving the business, commercial, operational, or
other institutional interests of the hospital employer, but

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constitute the exercise of professional nursing authority and
duty exclusively in the interests of the patient.
Article 20. Patient Advocacy
Section 20-5. Professional obligation. A registered nurse
has the professional obligation and therefore the right to act
as a patient's advocate, as circumstances require, by (i)
initiating action to improve the patient's health care or to
change decisions or activities which, in the professional
judgment of the registered nurse, are against the interests or
wishes of the patient and (ii) giving the patient the
opportunity to make informed decisions about his or her health
care before it is provided.
Section 20-10. Acceptance of patient care assignments. A
direct care registered nurse is always responsible for
providing safe, therapeutic, and competent nursing care to
assigned patients. Before accepting a patient assignment, a
direct care registered nurse must have the necessary knowledge,
judgment, skills, and ability to provide the required care. It
is the responsibility of the direct care registered nurse to
determine whether she or he is clinically competent to perform
the nursing care required by patients in a particular clinical
unit or with a particular diagnosis, condition, prognosis, or
other determinative characteristics of nursing care. If a

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direct care registered nurse is not clinically competent to
perform the care required for a patient to be assigned for
nursing care, she or he should not accept the patient care
assignment. Such a refusal to accept a patient care assignment
is an exercise of the direct care registered nurse's duty and
right of patient advocacy.
Section 20-15. Acceptance of orders.
(a) In the course of performing the responsibilities and
essential functions described in Article 15, a direct care
registered nurse assigned to a patient shall receive orders
initiated by physicians and other legally authorized health
care professionals within their scope of licensure regarding
patient care services to be provided to the patient, including,
without limitation, the administration of medications and
therapeutic agents necessary to implement a treatment, disease
prevention, or rehabilitative regimen.
(b) The direct care registered nurse shall assess each such
order before implementation to determine whether the order is:
(i) in the best interests of the patient; (ii) initiated by a
person legally authorized to issue the order; and (iii) in
accordance with applicable law and regulation governing
nursing care.
(c) If a direct care registered nurse determines that the
criteria described in items (i) through (iii) of subsection (b)
have not been satisfied with respect to a particular order, or

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has some doubt regarding the meaning or conformance of the
order with those criteria, she or he shall seek clarification
from the initiator of the order, the patient's physician, or
another appropriate medical officer. Clarification must be
obtained prior to implementing the order.
If, upon clarification, the direct care registered nurse
determines that the criteria for implementation of the order
have not been satisfied, she or he may refuse to implement the
order on the basis that the order is not in the best interests
of the patient.
Seeking clarification of an order or refusing an order as
described in this Section constitutes an exercise of the direct
care registered nurse's duty and right of patient advocacy.
Section 20-20. Protected speech.
(a) Every direct care registered nurse responsible for
patient care in a hospital shall enjoy the right of free speech
and shall be protected in the exercise of that right as
provided in this Section, both during working hours and during
off-duty hours. The right of free speech protected by this
Section is a necessary incident of the professional nurse's
duty of patient advocacy and is essential to protecting the
health and safety of hospital patients and of the people of
Illinois.
(b) The speech protected by this Section includes, without
limitation, any type of spoken, gestured, written, printed, or

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electronically communicated expression concerning any matter
related to or affecting safe, therapeutic, and competent direct
care registered nursing practice at a hospital facility, at
facilities within a large health delivery system or corporate
chain which includes a hospital, or more generally within the
health care industry.
The content of speech protected by this Section includes,
without limitation, the facts and circumstances of particular
events, patient care practices, institutional actions,
policies, or conditions which may facilitate or impede
competent and safe nursing practice or patient care, adverse
patient outcomes or incidents, sentinel or reportable events,
and arguments in support of or against hospital policies or
practices relating to the delivery of nursing care.
Protected speech under this Section includes the
reporting, whether internally, externally, or publicly, of
actions, conduct, events, practices, or other matters that are
believed to do any of the following:
(1) Constitute a violation of federal, State, or local
laws or regulations.
(2) Constitute a breach of applicable codes of
professional ethics, including the professional and
ethical obligations of direct care registered nurses.
(3) Concern matters which the reporting direct care
registered nurse believes are appropriate or required for
disclosure in furtherance and support of the nurse's

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exercise of patient advocacy duties to improve health care
or change decisions or activities which in the professional
judgment of the direct care registered nurse are against
the interests or wishes of a patient, or to ensure that a
patient is afforded a meaningful opportunity to make
informed decisions about health care before it is provided.
(4) Concern matters described in paragraph (3) made in
aid and support of the exercise of patient advocacy duties
of direct care registered nurse colleagues.
(c) Nothing in this Section is intended to authorize
disclosure of private and confidential patient information,
except when such disclosure is (i) required by law, (ii)
compelled by proper legal process, (iii) consented to by the
patient, or (iv) provided in confidence to a regulatory or
accreditation agency or other governmental entity for
investigatory purposes or pursuant to a formal or informal
complaint of unlawful or improper practices for purposes of
achieving corrective and remedial action.
(d) Engaging in speech activity protected under this
Section constitutes an exercise of the direct care registered
nurse's duty and right of patient advocacy. The subject matter
of protected speech activity as described in this Section is
presumed to be a matter of public concern, and the disclosures
protected under this Section are presumed to be in the public
interest.

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Section 20-25. Fiduciary duty; conflict of interest.
(a) A direct care registered nurse is in a fiduciary
relationship to an assigned patient as to matters within the
scope of practice and professional responsibility of the nurse
to provide safe, therapeutic, and competent nursing care in the
interests of the patient. As to such matters, the registered
nurse responsible for a patient shall perform the essential
functions of a direct care registered nurse exclusively in the
interests of the patient and shall not be influenced by the
interests of any third party or the directives of any such
third party or by motives other than the accomplishment of her
or his professional responsibility to provided safe,
therapeutic, and competent nursing care in the interests and
for the benefit of the patient.
(b) A direct care registered nurse shall not be influenced
by her or his own personal interests or by the interests or
demands of a third party which are in conflict with the
interests of assigned patients in performing the essential
registered nursing functions required under Article 15. The
refusal by a direct care registered nurse to engage in activity
involving such a conflict of interest with respect to nursing
care for which she or he is responsible shall constitute an
exercise of the registered nurse's duty and right of patient
advocacy.
Section 20-30. Participation in organizations.

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(a) A direct care nurse, as a necessary incident and
condition of her or his independent duty and right of patient
advocacy, shall have the right to do the following:
(1) To form, join, or participate in independent
hospital-based professional practice committees, general
and specialty registered nursing professional
associations, patient advocacy organizations, and labor
organizations.
(2) To seek representation to engage in collective
bargaining with her or his hospital employer, or to seek
other mutual aid or protection in exercising the
professional duty and public health responsibility of
patient advocacy.
(b) Engaging in activity described in subsection (a)
constitutes an exercise of the professional nurse's duty and
right of patient advocacy.
Section 20-35. Protected rights.
(a) Any person has the right to:
(1) Oppose any policy, practice, or action of any
hospital that is alleged to violate, breach, or fail to
comply with any provision of this Act.
(2) Cooperate, provide evidence, testify, or otherwise
support or participate in any investigation or complaint
proceeding conducted pursuant to Section 20-45.
(b) By virtue of her or his professional license and

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ethical obligations, a direct care registered nurse has a duty
and right to act and provide care exclusively in the interests
of patients and to act as a patient's advocate, as
circumstances require, by (i) initiating action to improve
health care or to change decisions or activities which in the
professional judgment of the direct care registered nurse are
against the interests or wishes of an assigned patient or (ii)
giving a patient the opportunity to make informed decisions
about health care before it is provided. This Act confirms and
creates statutory patient advocacy rights for direct care
registered nurses as provided in this Article 20 and made
enforceable under Article 25.
(c) A patient in a hospital who is aggrieved by the
hospital's interference with the full and free exercise of
patient advocacy duties by a direct care registered nurse has
the right to make or file a complaint and to cooperate, provide
evidence, testify, or otherwise support or participate in any
investigation or complaint proceeding conducted pursuant to
Article 25. A patient shall be considered "aggrieved" for
purposes of this subsection if the patient's health or safety
was jeopardized or the patient was exposed to additional risk
of injury, disease, pain, or suffering as a consequence of
conditions or circumstances caused in whole or in part by the
hospital's interference with patient advocacy rights of a
direct care registered nurse. Actual physical injury, disease,
pain, or suffering is not required for a patient to have

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standing to file a complaint and obtain appropriate remedies
under Article 25.
(d) A direct care registered nurse who is aggrieved by a
hospital's interference with the full and free exercise of the
nurse's patient advocacy duties has the right to make or file a
complaint cooperate, provide evidence, testify, or otherwise
support or participate in any investigation or complaint
proceeding conducted pursuant to Article 25.
Section 20-40. Interference with rights and duties
prohibited.
(a) It is unlawful for a hospital to interfere with,
restrain, coerce, intimidate, or deny the exercise or the
attempt to exercise, by any person, of any right provided or
protected under this Act.
(b) It is unlawful for a hospital to discriminate or
retaliate against any person for opposing any policy, practice,
or action of the hospital which is alleged to violate, breach,
or fail to comply with any provision of this Act.
(c) No hospital employer shall make, adopt, or enforce any
rule, regulation, policy, or practice which directly or
indirectly prohibits, impedes, discourages, intimidates,
coerces, or induces in any manner a direct care registered
nurse from engaging in protected speech activities or
disclosing information as provided in this Article 20.
(d) No hospital employer shall make, adopt, or enforce any

09700HB0282ham001 - 33 - LRB097 06642 DRJ 67048 a
rule, regulation, policy, or practice which directly or
indirectly authorizes, sanctions, permits, excuses, or
encourages any other person to engage in conduct which is
likely to prohibit, impede, discourage, intimidate, coerce, or
induce in any manner a direct care registered nurse from
engaging in protected speech activities or disclosing
information as provided in this Article 20.
(e) No hospital or other health care institution shall
engage in the deployment of technology that limits a direct
care registered nurse (i) in performing functions that are part
of the nursing process, including full exercise of independent
clinical judgment in assessment, planning, implementation and
evaluation of care or (ii) from acting as a patient advocate in
the exclusive interest of the patient. Technology shall not be
skill-degrading, interfere with a direct care registered
nurse's provision of individualized patient care, or override a
direct care registered nurse's independent professional
judgment. In addition, there shall be no interference with a
registered nurse's right to advocate in the exclusive interest
of a patient.
(f) A hospital employer, all management personnel employed
by a hospital, all personnel with management or supervisory
authority employed by a hospital, including the registered
nurse administrator, registered nurse manager, or registered
nurse supervisor, and all medical personnel who treat patients
admitted to hospital nursing unit, whether employed by the

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hospital or privileged to admit patients through an affiliated
medical group or otherwise, are strictly prohibited from
interfering with the rights and obligations of a direct care
registered nurses to perform the duties of patient advocacy as
provided in this Article 20.
Prohibited interference with patient advocacy duties of a
direct care registered nurse includes conduct, actions, or
omissions which directly or indirectly are likely to prohibit,
impede, discourage, intimidate, coerce, or induce in any manner
a direct care registered nurse from taking action indicated or
authorized by the professional obligations of patient advocacy
described in this Article 20. Any act of prohibited
interference committed by an individual within his or her
course and scope of employment as management, nursing service,
or medical personnel for a hospital as described in this
subsection shall be considered prohibited interference by the
hospital for purposes of this Act.
(g) An employee of a hospital employer who has authority to
take, direct others to take, recommend, or approve any
personnel action of the employer with respect to a direct care
registered nurse shall not, with respect to such authority,
take or fail to take, or threaten to take or fail to take, any
such action with respect to such nurse because the nurse
engages in conduct in furtherance of her or his duties and
rights as described in this Article 20, including, without
limitation, refusing to obey an order that the direct care

09700HB0282ham001 - 35 - LRB097 06642 DRJ 67048 a
registered nurse has determined, in the exercise of her or his
independent judgment, should be refused in accordance with the
direct care registered nurse's duty and right of patient
advocacy. Any such action or omission undertaken in the course
or scope of employment for a hospital shall be considered an
action or omission of the hospital for purposes of this Act.
(h) Any employee of a hospital employer who has authority
to take, direct others to take, recommend, or approve any
report of any incident, conduct, or circumstances involving a
direct care registered nurse employed by the hospital to any
professional licensing board, disciplinary body, or
investigatory function or officer for purposes of complaint,
investigation, or imposition of professional discipline or
other adverse action affecting the direct care registered
nurse's active license status or good standing to practice as a
duly licensed registered nurse in the State of Illinois, shall
not, with respect to such authority, take or fail to take, or
threaten to take or fail to take, any such action with respect
to such direct care registered nurse because the direct care
registered nurse engages in conduct in furtherance of her or
his duties and rights as described in this Article 20,
including, without limitation, refusing to obey an order that
the direct care registered nurse has determined, in the
exercise of her or his independent judgment, should be refused
in accordance with the registered nurse's duty of patient
advocacy.

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Section 20-45. Retaliation or discrimination prohibited. A
hospital employer may not discriminate or retaliate in any
manner against any patient, employee, or contract employee of
the hospital, or any other person, because that person has (i)
presented a grievance or complaint, (ii) initiated or
cooperated in any investigation or proceeding of any
governmental entity, regulatory agency, or private
accreditation body, (iii) made a civil claim or demand, or (iv)
filed an action relating to the care, services, or conditions
of that hospital or of any affiliated or related facility.
Article 25. Enforcement of Rights.
Section 25-5. Liability for damages or equitable relief.
(a) A hospital employer who violates any provision of
Article 20 is liable to the aggrieved employee for the
following:
(1) Damages equal to the amount of:
(A) any wages, salary, employment benefits, or
other compensation denied or lost to the employee by
reason of the violation; or
(B) in a case in which wages, salary, employment
benefits, or other compensation have not been denied or
lost to the employee, any actual monetary loss
sustained by the employee as a direct result of the

09700HB0282ham001 - 37 - LRB097 06642 DRJ 67048 a
violation.
(2) Interest on the amount of damages described in
paragraph (1), calculated at the prevailing rate.
(3) An additional amount as liquidated damages equal to
the sum of the amount of damages described in paragraph (1)
and the interest described in paragraph (2).
(b) In addition to the relief set forth in subsection (a),
a hospital employer is liable for such equitable relief as may
be appropriate, including including the aggrieved employee's
employment reinstatement.
Section 25-10. Action to recover damages or equitable
relief.
(a) An action to recover the damages or equitable relief
described in Section 25-5 may be maintained against any
hospital employer (including a public agency) in any court of
competent jurisdiction by any one or more employees for and in
behalf of the employee or employees as well as other employees
similarly situated.
(b) The court in an action under this Section shall award
to a prevailing plaintiff reasonable attorney's fees,
reasonable expert witness fees, and other costs of the action.
(c) An action may be brought under this Section not later
than 2 years after the date of the last event constituting the
alleged violation for which the action is brought.
(d) In the case of an action brought under this Section for

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a willful violation, the action may be brought within 3 years
after the date of the last event constituting the alleged
violation for which the action is brought.
Section 25-15. Retaliation against patient; presumption.
If a hospital engages in any type of discriminatory treatment
of a patient by whom, or upon whose behalf, a grievance or
complaint has been submitted, directly or indirectly, to any
governmental entity, regulatory agency, or private
accreditation body, and if that discriminatory treatment
occurs within 180 days after the filing of the grievance or
complaint, then the hospital's conduct raises a rebuttable
presumption that the action was taken by the hospital in
retaliation for the filing of the grievance or complaint.
Section 25-20. Retaliation against employee; presumption;
relief.
(a) If a hospital (i) engages in any type of discriminatory
treatment of an employee who has presented a grievance or
complaint, or initiated, participated in, or cooperated in any
investigation or proceeding by or before any governmental
entity or private accreditation body, and (ii) had knowledge of
the employee's initiation, participation, or cooperation, and
if that discriminatory treatment occurs within 180 days after
the filing of the grievance or complaint, then the hospital's
conduct raises a rebuttable presumption that the

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discriminatory action was taken by the hospital in retaliation
for the filing of the grievance or complaint. For purposes of
this Section, "discriminatory treatment of an employee"
includes discharge, demotion, suspension, or any other
unfavorable change in the terms or conditions of employment, or
the threat of any such action.
(b) An employee who has been discriminated against as
described in subsection (a) is entitled to reinstatement,
reimbursement for lost wages and work benefits caused by the
acts of the employer, and an award of reasonable attorney's
fees and costs as the prevailing party.
Section 25-25. Civil penalties.
(a) If a hospital employer is found to have violated or
interfered with any of the rights or protections provided and
guaranteed under this Article, the Department may assess a
civil penalty of not more than $25,000 for each such violation
or occurrence of prohibited conduct.
(b) If any member of a hospital's management, nursing
service, or medical personnel is found to have violated or
interfered with any of the rights or protections provided and
guaranteed under this Article, the Department may assess a
civil penalty of not more than $20,000 for each such violation
or occurrence of prohibited conduct.
(c) A hospital found to have violated or aided and abetted
a violation of any provision of Article 10 is subject (i) in

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addition to any other penalties that may be prescribed by law,
to enforcement action by the Department, including the use of
injunctive relief available to force compliance with that
Article or closure of the hospital and (ii) to a civil money
penalty assessed by the Department of not more than $25,000 for
each violation and an additional $10,000 per nursing unit shift
until the violation is corrected.
(d) The Attorney General shall enforce penalties imposed
under this Section in the county in which the violation
occurred.
(e) The penalties authorized under this Section are in
addition to any other penalties that may be imposed under this
Act. Penalties collected pursuant to this Section shall be
deposited into the General Revenue Fund.
Section 25-30. Posting of Act provisions. Every hospital
shall post the provisions of Articles 15 and 20 in a prominent
place for review by the hospital's employees and patients and
by the public. The posting shall have a title across the top in
no less than 35 point, bold typeface stating the following:
"RIGHTS OF REGISTERED NURSES AS PATIENT ADVOCATES AND OF
EMPLOYEES AND PATIENTS".
Article 90. Amendatory Provisions
Section 90-5. The Hospital Licensing Act is amended by

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adding Section 2.5 as follows:
(210 ILCS 85/2.5 new)
Sec. 2.5. Relationship to Hospital Patient Protection Act.
In the case of a conflict between a provision of this Act and a
provision of the Hospital Patient Protection Act, the Hospital
Patient Protection Act shall control.
Section 90-10. The Nurse Practice Act is amended by adding
Section 50-17 as follows:
(225 ILCS 65/50-17 new)
Sec. 50-17. Relationship to Hospital Patient Protection
Act. In the case of a conflict between a provision of this Act
and a provision of the Hospital Patient Protection Act, the
Hospital Patient Protection Act shall control.".