Bill Text: IL HB3338 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in Act. Provides that nothing in the Act precludes the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act; however, the maximum patient assignments in the Act may not be exceeded, regardless of the use and application of any patient acuity system. Provides that the Department of Public Health shall adopt rules governing the implementation and operation of the Act. Provides that all facilities shall adopt written policies and procedures for training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides specified requirements for the Act's implementation by a facility. Establishes recordkeeping requirements. Provides that the written policies and procedures for the training and orientation of nursing staff shall require that all temporary personnel receive the same amount and type of training and orientation that is required for permanent staff. Provides specified nurse rights and protections. Provides that the Act's provisions are severable. Contains other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Amends the Nurse Practice Act. Provides that the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice shall be provided in the exclusive interests of the patient.

Spectrum: Partisan Bill (Democrat 11-0)

Status: (Introduced) 2024-04-24 - Added Co-Sponsor Rep. Lilian Jiménez [HB3338 Detail]

Download: Illinois-2023-HB3338-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3338 Introduced , by Rep. Theresa Mah SYNOPSIS AS INTRODUCED:
New Act
210 ILCS 85/10.10
210 ILCS 85/50-15.15 new
Creates the Safe Patient Limits Act. Provides the maximum number of patients that may be assigned to a registered nurse in specified situations. Provides that nothing shall preclude a facility from assigning fewer patients to a registered nurse than the limits provided in Act. Provides that nothing in the Act precludes the use of patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act; however, the maximum patient assignments in the Act may not be exceeded, regardless of the use and application of any patient acuity system. Provides that the Department of Public Health shall adopt rules governing the implementation and operation of the Act. Provides that all facilities shall adopt written policies and procedures for training and orientation of nursing staff and that no registered nurse shall be assigned to a nursing unit or clinical area unless that nurse has, among other things, demonstrated competence in providing care in that area. Provides specified requirements for the Act's implementation by a facility. Establishes recordkeeping requirements. Provides that the written policies and procedures for the training and orientation of nursing staff shall require that all temporary personnel receive the same amount and type of training and orientation that is required for permanent staff. Provides specified nurse rights and protections. Provides that the Act's provisions are severable. Contains other provisions. Amends the Hospital Licensing Act. Provides that a hospital shall not mandate that a registered professional nurse delegate nursing interventions. Amends the Nurse Practice Act. Provides that the exercise of professional judgment by a direct care registered professional nurse in the performance of his or her scope of practice shall be provided in the exclusive interests of the patient.
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A BILL FOR
HB3338 LRB103 30963 CPF 57543 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the Safe
Patient Limits Act.
Section 5. Definitions. In this Act:
"Couplet" means one postpartum patient and one baby.
"Critical trauma patient" means a patient who has an
injury to an anatomic area that (i) requires life-saving
interventions, or (ii) in conjunction with unstable vital
signs, poses an immediate threat to life or limb.
"Department" means the Department of Public Health.
"Direct care registered professional nurse" means a
registered professional nurse who has accepted a hands-on,
in-person patient care assignment and whose primary role is to
provide hands-on, in-person patient care.
"Facility" means a hospital licensed under the Hospital
Licensing Act or organized under the University of Illinois
Hospital Act, a private or State-owned and State-operated
general acute care hospital, an LTAC hospital as defined in
Section 10 of the Long Term Acute Care Hospital Quality
Improvement Transfer Program Act, an ambulatory surgical
treatment center as defined in Section 3 of the Ambulatory

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Surgical Treatment Center Act, a freestanding emergency center
licensed under the Emergency Medical Services Systems Act, a
birth center licensed under the Birth Center Licensing Act, an
acute psychiatric hospital, an acute care specialty hospital,
or an acute care unit within a health care facility.
"Health care emergency" means an emergency that is
declared by an authorized person within federal, state or
local government and is related to circumstances that are
unpredictable and unavoidable and that affect the delivery of
medical care and require an immediate or exceptional level of
emergency or other medical services at the specific facility.
The term does not include a state of emergency that results
from a labor dispute in the health care industry or consistent
understaffing.
"Health care workforce" means personnel employed by or
contracted to work at a facility that have an effect upon the
delivery of quality care to patients, including, but not
limited to, registered nurses, licensed practical nurses,
unlicensed assistive personnel, service, maintenance,
clerical, professional, and technical workers, and other
health care workers.
"Immediate postpartum patients" means those patients who
have given birth within the previous 2 hours.
"Nursing care" means care that falls within the scope of
practice as described in Section 55-30 or 60-35 of the Nurse
Practice Act or is otherwise encompassed within recognized

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standards of nursing practice.
"Rapid response team" means a team of health care
providers that provide care to patients with early signs of
deterioration to prevent respiratory or cardiac arrest.
"Registered nurse" or "registered professional nurse"
means a person who is licensed as a registered professional
nurse under the Nurse Practice Act and practices nursing as
described in Section 60-35 of the Nurse Practice Act.
"Specialty care unit" means a unit which is organized,
operated, and maintained to provide care for a specific
medical condition or a specific patient population.
For the purposes of this Act, a patient is considered
assigned to a registered nurse if the registered nurse accepts
responsibility for the patient's nursing care.
Section 10. Maximum patient assignments for registered
nurses.
(a) The maximum number of patients assigned to a
registered nurse in a facility shall not exceed the limits
provided in this Section. However, nothing shall preclude a
facility from assigning fewer patients to a registered nurse
than the limits provided in this Section. The requirements of
this Section apply at all times during each shift within each
clinical unit and each patient care area.
(b) In all units with critical care or intensive care
patients, including, but not limited to, coronary care, acute

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respiratory care, medical, burn, pediatric, or neonatal
intensive care patients, the maximum patient assignment of
critical care patients to a registered nurse is 1.
(c) In all units with step-down or intermediate intensive
care patients, the maximum patient assignment of step-down or
intermediate intensive care patients to a registered nurse is
3.
(d) In all units with post-anesthesia care patients,
regardless of the type of anesthesia administered, the maximum
patient assignment of post-anesthesia care patients or
patients being monitored for the effects of any anesthetizing
agent to a registered nurse is 1.
(e) In all units with operating room patients, the maximum
patient assignment of operating room patients to a registered
nurse is one, provided that a minimum of one additional person
serves as a scrub assistant for each patient.
(f) In the emergency department:
(1) In a unit providing basic emergency services or
comprehensive emergency services, the maximum patient
assignment at any time to a registered nurse is 3.
(2) The maximum assignment of critical care emergency
patients to a registered nurse is 1. A patient in the
emergency department shall be considered a critical care
patient when the patient meets the criteria for admission
to a critical care service area within the facility.
(3) The maximum assignment of critical trauma patients

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in an emergency unit to a registered nurse is one.
(4) At least one direct care registered professional
nurse shall be assigned to triage patients. The direct
care registered professional 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 professional nurse
assigned to triage patients shall perform triage functions
only and may not be assigned the responsibility of the
base radio. Triage, radio, or flight registered nurses
shall not be counted in the calculation of direct care
registered nurse staffing levels.
(g) In all units with maternal child care patients:
(1) The maximum patient assignment to a registered
nurse of antepartum patients requiring continuous fetal
monitoring is 2.
(2) The maximum patient assignment of other antepartum
patients who are not in active labor to a registered nurse
is 3.
(3) The maximum patient assignment of active labor
patients to a registered nurse is one.
(4) The maximum patient assignment of patients with
medical or obstetrical complications, during the
initiation of epidural anesthesia, or during circulation
for a caesarean section delivery to a registered nurse is
one.

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(5) The maximum patient assignment during birth is one
registered nurse responsible for the patient in labor and,
for each newborn, one registered nurse whose sole
responsibility is that newborn patient.
(6) The maximum patient assignment of postpartum
patients when the parent has given birth within the
previous two hours is one couplet to one registered nurse,
and in the case of multiple births, one registered nurse
for each additional newborn.
(7) The maximum patient assignment of couplets to a
registered nurse is 2.
(8) The maximum patient assignment of patients
receiving postpartum or postoperative gynecological care
to a registered nurse is 4 when the registered nurse has
been assigned only to patients receiving postpartum or
postoperative gynecological care.
(9) The maximum patient assignment of newborn patients
when the patient is unstable, as assessed by a direct care
registered professional nurse, to a registered nurse is
one.
(10) The maximum patient assignment of newborn
patients to a registered nurse is 2 when the patients are
receiving intermediate care or the nurse has been assigned
to a patient care unit that receives newborn patients
requiring intermediate care, including, but not limited
to, an intermediate care nursery.

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(h) In all units with pediatric patients, the maximum
patient assignment of pediatric patients to a registered nurse
is 3.
(i) In all units with psychiatric patients, the maximum
patient assignment of psychiatric patients to a registered
nurse is 4.
(j) In all units with medical and surgical patients, the
maximum patient assignment of medical or surgical patients to
a registered nurse is 4.
(k) In all units with telemetry patients, the maximum
patient assignment of telemetry patients to a registered nurse
is 3.
(l) In all units with observational patients, the maximum
patient assignment of observational patients to a registered
nurse is 3.
(m) In all units with acute rehabilitation patients, the
maximum patient assignment of acute rehabilitation patients to
a registered nurse is 4.
(n) In all units with conscious sedation patients, the
maximum patient assignment of conscious sedation patients to a
registered nurse is one.
(o) In any unit not otherwise listed in this Section,
including all specialty care units not otherwise listed in
this Section, the maximum patient assignment to a registered
nurse is 4.

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Section 15. Use of rapid response teams as first
responders prohibited. A rapid response team registered nurse
shall not be given direct care patient assignments while
assigned as a registered nurse responsible for responding to a
rapid response team request.
Section 20. Implementation by a facility.
(a) A facility shall implement the patient limits
established by Section 10 without diminishing the staffing
levels of the facility's health care workforce, as defined in
Section 5. A facility may not lay off licensed practical
nurses, licensed psychiatric technicians, certified nursing
assistants, or other ancillary support staff to meet the
patient limits under Section 10.
(b) Each patient shall be assigned to a direct care
registered professional nurse who shall directly provide the
comprehensive patient assessment, development of a plan of
care, supervision, implementation, and evaluation of the
nursing care provided to the patient at least every shift and
who has the responsibility for the provision of care to a
particular patient within the registered nurse's scope of
practice.
(c) There shall be no averaging of the number of patients
and the total number of registered nurses in each clinical
unit or patient care area in order to meet the patient limits
under Section 10.

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(d) Only registered nurses providing direct patient care
shall be considered when evaluating compliance with the
patient limits under Section 10. Ancillary staff and
unlicensed personnel shall not be considered when evaluating
compliance with the patient limits under Section 10.
(e) The hours in which a nurse administrator, nurse
supervisor, nurse manager, charge nurse, and other licensed
nurse provides patient care shall not be considered when
evaluating compliance with the patient limits under Section 10
and with the patient assignment requirement under subsection
(b) of Section 20 unless the registered nurse:
(1) has a current and active direct patient care
assignment;
(2) provides direct patient care in compliance with
the requirements of this section and Section 45;
(3) has demonstrated to the facility current
competence in providing care on the particular unit; and
(4) has the principal responsibility of providing
direct patient care and has no additional job duties
during the time period during which the nurse has a
patient assignment.
(f) The hours in which a nurse administrator, nurse
supervisor, nurse manager, charge nurse, and other licensed
nurse provides direct patient care may be considered when
evaluating compliance with the patient limits under Section 10
and with the patient assignment requirement under subsection

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(b) of Section 20 only if the nurse is providing relief for a
direct care registered professional nurse during breaks,
meals, and other routine and expected absences from the unit.
(g) At all times during each shift within a facility unit,
clinical unit, or patient care area of a facility, and with the
full complement of ancillary support staff, at least two
direct care registered nurses shall be physically present in
each facility unit, clinical unit, or patient care area where
there are patients present.
(h) Identifying a clinical unit or patient care area by a
name or term other than those listed in this Act does not
affect a facility's requirement to staff the unit consistent
with the patient limits identified for the level of intensity
or type of care described in this Act.
(i) A registered nurse providing direct care to a patient
has the authority to determine if a change in the patient's
status places the patient in a different category requiring a
different patient limit under Section 10.
(j) A facility shall assign direct care professional
registered nurses in a patient care unit in accordance with
subsection 10 in order to meet the highest level of intensity
and type of care provided in the patient care unit. If multiple
paragraphs of subsection 10 apply to a patient, a facility
shall assign a direct care professional registered nurse in
accordance with the lowest numerical patient assignment.
(k) A facility shall provide additional staffing of direct

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care registered professional nurses, above the number of
direct care registered professional nurses required to comply
with the patient levels under Section 10, or additional
staffing of licensed practical nurses, certified nursing
assistants, or other licensed or unlicensed ancillary support
staff based on the direct care registered professional nurse's
assessment of each assigned individual patient, the individual
patient's nursing care requirements, and the individual
patient's nursing care plan.
(l) A facility shall not employ video monitors, remote
patient monitoring, or any form of electronic visualization of
a patient as a substitute for the direct in-person observation
required for patient assessment by the registered nurse or for
patient protection. Video monitors or any form of electronic
visualization of a patient shall not constitute compliance
with the patient limits under Section 10.
(m) A facility must provide relief by a direct care
registered professional nurse with unit-specific education,
training, and competence during another direct care registered
professional nurse's meal periods, breaks, and routine
absences as part of the facility's obligation to meet the
patient limits under Section 10 at all times.
Section 25. Changes in patient census.
(a) A facility shall plan for routine fluctuations in its
patient census, including, but not limited to, admissions,

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discharges, and transfers.
(b) If a health care emergency causes a change in the
number of patients in a clinical care unit or patient care
area, a facility must be able to demonstrate that immediate
and diligent efforts were made to maintain required staffing
levels under this Act.
(c) A facility shall immediately notify the Department if
a health care emergency under Section (b) causes a change in
the number of patients in a clinical care unit or patient care
area and shall report to the Department efforts made to
maintain required staffing levels under this Act.
Section 30. Record of staff assignments.
(a) A facility shall keep a record of the actual direct
care registered professional 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 shall submit copies of its records to
the Department quarterly and keep copies of its staff
assignments on file for a period of 7 years.
(b) The documentation required by subsection (a) shall be
submitted to the Department as a mandatory condition of
licensure, with a certification by the chief nursing officer
of the facility that the documentation completely and
accurately reflects registered nurse staffing levels by the
facility for each shift in each facility unit, clinical unit,

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and patient care area in which patients receive care. The
chief nursing officer shall execute the certification under
penalty of perjury, and the certification must contain an
expressed acknowledgment that any false statement constitutes
fraud and is subject to criminal and civil prosecution and
penalties.
Section 35. Implementation by the Department. The
Department shall adopt rules governing the implementation and
operation of this Act, including methods for facility staff,
facility staff's collective bargaining representatives, and
the public to file complaints regarding violations of this Act
with the Department. The Department shall conduct periodic
audits to ensure implementation of this Act.
Section 40. Education.
(a) All facilities shall adopt written policies including:
(1) procedures for the education, training, and orientation of
nursing staff to each clinical area where the staff will work;
and (2) criteria for the facility to use in determining if a
registered nurse has demonstrated current competence in
providing care in a clinical area.
(b) No registered nurse shall be assigned to a facility
unit, clinical unit, or patient care area unless that
registered nurse has first received education, training, and
orientation in that clinical area that is sufficient to

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provide safe, therapeutic, and competent care to patients in
that clinical area and has demonstrated competence in
providing care in that clinical area.
(c) No registered nurse shall be assigned to relieve a
direct care professional registered nurse during breaks,
meals, and routine absences from a facility unit, clinical
unit, or patient care area unless that registered nurse has
first received education, training, and orientation in that
clinical area that is sufficient to provide safe, therapeutic,
and competent care to patients in that clinical area and has
demonstrated competence in providing care in that clinical
area.
(d) A health care facility may not assign any nursing
personnel from temporary nursing agencies to a facility unit,
clinical unit, or patient care area unless the nursing
personnel have first received education, training, and
orientation in that clinical area that is sufficient to
provide safe, therapeutic, and competent care to patients in
that clinical area and have demonstrated competence in
providing care in that clinical area.
Section 45. Enforcement.
(a) In addition to any other penalty prescribed by law,
the Department may impose a civil penalty against a facility
that violates this Act of up to $25,000 for each violation,
except that the Department shall impose a civil penalty of at

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least $25,000 for each violation if the Department determines
that the health care facility has a pattern of such violation.
A separate and distinct violation shall be deemed to have been
committed on each day during which any violation continues
after receipt of written notice of the violation from the
Department by the facility.
(b) The Department shall post on its website the names of
facilities against which civil penalties have been imposed
under this Act, the violation for which such penalty was
imposed, and such additional information as the Department
deems necessary.
(c) A facility's failure to adhere to the limits set by
Section 10, any other violation of this Act, or any violation
of Section 10.10 of the Hospital Licensing Act shall be
reported by the Department to the Attorney General for
enforcement, for which the Attorney General may bring action
in a court of competent jurisdiction seeking injunctive relief
and civil penalties.
(d) It is a defense to an enforcement action under this Act
if the facility demonstrates that a health care emergency was
in force at the time of the alleged violation and that the
facility made immediate and diligent efforts to maintain
required staffing levels under this Act.
Section 50. Nurse rights and protections.
(a) A registered professional nurse may object to or

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refuse to participate in any activity, practice, assignment,
or task if:
(1) in good faith, the registered nurse reasonably
believes it to be a violation of the direct care
registered professional nurse maximum patient assignments
or other provision established under this Act or a rule
adopted by the Department implementing this Act; or
(2) the registered nurse, based on the registered
nurse's nursing judgment, reasonably believes the
registered nurse is not prepared by education, training,
or experience to fulfill the assignment without
compromising the safety of any patient or jeopardizing the
license of the registered nurse.
(3) in the registered nurse's nursing judgment, the
activity, policy, practice, assignment or task would be
outside the registered nurse's scope of practice or would
otherwise compromise the safety of any patient or the
registered nurse.
(b) A facility shall not retaliate, discriminate, or
otherwise take adverse action in any manner with respect to
any aspect of a nurse's employment, including discharge,
promotion, compensation, or terms, conditions, or privileges
of employment, based on the nurse's refusal to complete an
assignment under subsection (a).
(c) A facility shall not file a complaint against a
registered professional nurse with the Board of Nursing based

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on the nurse's refusal to complete an assignment under
subsection (a).
(d) A facility shall not retaliate, discriminate, or
otherwise take adverse action in any manner against any person
or with respect to any aspect of a nurse's employment,
including discharge, promotion, compensation, or terms,
conditions, or privileges of employment, based on that nurse's
or that person's opposition to any facility policy, practice,
or action that the nurse in good faith believes violates this
Act.
(e) A facility shall not retaliate, discriminate, or
otherwise take adverse action against any patient or employee
of the facility or any other individual on the basis that the
patient, employee, or individual, in good faith, individually
or in conjunction with another person or persons, has
presented a grievance or complaint, or has initiated or
cooperated in any investigation or proceeding of any
governmental entity, regulatory agency, or private
accreditation body, made a civil claim or demand, or filed an
action relating to the care, services, or conditions of the
facility or of any affiliated or related facilities.
(f) A facility shall not do either of the following:
(1) Interfere with, restrain, or deny the exercise of,
or attempt to deny the exercise of, a right conferred
under this Act.
(2) Coerce or intimidate any individual regarding the

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exercise of, or an attempt to exercise, a right conferred
by this Act.
Section 55. Severability. The provisions of this Act are
severable under Section 1.31 of the Statute on Statutes.
Section 60. The Hospital Licensing Act is amended by
changing Section 10.10 and by adding Section 50-15.15 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.

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(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.

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(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

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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

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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

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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

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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)

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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.
(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

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violation of this Section, the Department may take any action
authorized under Sections 7 or 9 of this Act.
(h) Delegation of nursing interventions by a registered
professional nurse must be in accordance with the Nurse
Practice Act.
(i) A hospital shall not mandate that a registered
professional nurse delegate any element of the nursing
process, including, but not limited to: nursing interventions,
medication administration, nursing judgment, comprehensive
patient assessment, development of the plan of care, or
evaluation of care. A delegation of a nursing intervention
granted by a registered professional nurse shall not be
re-delegated to another.
(j) The Department shall establish procedures to ensure
that the documentation submitted under this Section is
available for public inspection in its entirety.
(k) Nothing in this Section shall be construed to limit,
alter, or modify the requirements of the Safe Patient Limits
Act.
(Source: P.A. 102-4, eff. 4-27-21; 102-641, eff. 8-27-21;
102-813, eff. 5-13-22.)
(210 ILCS 85/50-15.15 new)
Sec. 50-15.15. Nursing judgment.
(a) Performance of the scope of practice of a direct care
registered professional nurse requires the exercise of nursing

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judgment in the exclusive interests of the patient. The
exercise of such nursing judgment, unencumbered by the
commercial or revenue-generation priorities of a hospital,
long term acute care hospital, or ambulatory surgical
treatment center or other employing entity of a direct care
registered professional nurse, is necessary to ensure safe,
therapeutic, effective, and competent treatment of patients
and is essential to protect the health and safety of the people
of Illinois.
(b) The exercise of nursing judgment by a direct care
registered professional nurse in the performance of the scope
of practice of the registered professional nurse under Section
60-35 or the scope of practice of the advanced practice
registered nurse under Section 65-30 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 interests of
the employer.
(c) No hospital, long term acute care hospital, ambulatory
surgical treatment center, or other health care facility shall
adopt policies that:
(1) limit a direct care registered professional nurse
in performing duties that are part of the nursing process,
including full exercise of nursing judgment in assessment,

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planning, implementation and evaluation of care;
(2) Substitute recommendations, decisions, or outputs
of health information technology, algorithms used to a
achieve a medical or nursing care objective at a facility,
systems based on artificial intelligence or machine
learning, or clinical practice guidelines for the
independent nursing judgment of a direct care registered
professional nurse or penalize a direct care registered
professional nurse for overriding such technology or
guidelines if, in that registered nurse's judgment, and in
accordance with that registered nurse's scope of practice,
it is in the best interest of the patient to do so; or
(3) limit a direct care registered professional nurse
in acting as a patient advocate in the exclusive interests
of the patient.