SB3424 103RD GENERAL ASSEMBLY

LRB103 37533 CES 67656 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3424

Introduced 2/8/2024, by Sen. Christopher Belt

SYNOPSIS AS INTRODUCED:

See Index

Amends the Hospital Licensing Act. Provides that "hospital worker" means any person who receives an hourly wage directly or indirectly via a subcontractor by a hospital licensed under the Act. Replaces references to "nurse" with "hospital worker". Provides for additional staffing transparency and reporting requirements. Provides that hospitals licensed under the Act must employ and schedule enough hospital workers to provide quality patient care and ensure patient safety. Provides that hospitals must make available, at the beginning of each calendar year and upon request, all staffing matrices and other staffing metrics, if any, used to assess and maintain safe staffing levels for hospital workers in each unit. Provides that the Department of Public Health shall produce an annual report based on staffing disclosures. Provides that the Department shall make recommendations for minimum staffing standards for hospital workers in each hospital unit. Provides that hospitals licensed under the Act shall conduct, within the first month of employment and at no cost, a competency validation for each hospital worker hired. Provides that a hospital must submit documentation of each hospital worker's competency validation to the Department within 4 weeks after the worker's start date. Provides that hospitals shall conduct ongoing verification for each hospital worker employed during a given calendar year to determine each worker's continued competency to perform the worker's job and shall submit documentation of each worker's ongoing verification to the Department within 2 weeks of completion. Provides that hospitals shall submit a list of all competent employees currently employed at the end of each calendar year. Provides for a public registry of all competent employees to be maintained by the Department. Provides for the imposition of civil penalties for specified violations of the Act. Describes an assignment despite objection resolution process to be implemented by each hospital that is licensed under the Act. Provides for a Hospital Safety Advocate role to be created within the Department.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Hospital Licensing Act is amended by changing Section 10.9 and by adding Sections 10.15 and 10.20 as follows:

(210 ILCS 85/10.9)

Sec. 10.9. Hospital worker Nurse mandated overtime prohibited.

(a) Definitions. As used in this Section:

"Mandated overtime" means work that is required by the hospital in excess of an agreed-to, predetermined work shift. Time spent by nurses required to be available as a condition of employment in specialized units, such as surgical nursing services, shall not be counted or considered in calculating the amount of time worked for the purpose of applying the prohibition against mandated overtime under subsection (b).

"Hospital worker" means any person who receives an hourly wage, directly or indirectly, via a subcontractor by a hospital licensed under this Act.

"Nurse" means any advanced practice registered nurse, registered professional nurse, or licensed practical nurse, as defined in the Nurse Practice Act, who receives an hourly wage and has direct responsibility to oversee or carry out nursing care. For the purposes of this Section, "advanced practice registered nurse" does not include a certified registered nurse anesthetist who is primarily engaged in performing the duties of a nurse anesthetist.

"Related to the subcontractor" means that the subcontractor is, to a significant extent, associated or affiliated with, owns, or is owned by, or has control of or is controlled by, the organization furnishing services to a hospital licensed under this Act.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes organizations related to the subcontractor that have a contract with the subcontractor.

"Unforeseen emergent circumstance" means (i) any declared national, State, or municipal disaster or other catastrophic event, or any implementation of a hospital's disaster plan, that will substantially affect or increase the need for health care services or (ii) any circumstance in which patient care needs require specialized nursing skills through the completion of a procedure. An "unforeseen emergent circumstance" does not include situations in which the hospital fails to have enough nursing staff to meet the usual and reasonably predictable patient care nursing needs of its patients.

(b) Mandated overtime prohibited. No hospital worker nurse may be required to work mandated overtime except in the case of an unforeseen emergent circumstance when such overtime is required only as a last resort. Such mandated overtime shall not exceed 4 hours beyond an agreed-to, predetermined work shift.

(c) Rest period required Off-duty period. When a hospital worker nurse is mandated to work up to 12 consecutive hours, the worker nurse must be allowed at least 8 consecutive hours of off-duty time off immediately following the completion of a shift.

(d) Retaliation prohibited. No hospital may discipline, discharge, or take any other adverse employment action against a hospital worker nurse solely because the worker nurse refused to work mandated overtime as prohibited under subsection (b).

(e) Violations. Any employee of a hospital that is subject to this Act may file a complaint with the Department of Public Health regarding an alleged violation of this Section. The complaint must be filed within 45 days following the occurrence of the incident giving rise to the alleged violation. The Department must forward notification of the alleged violation to the hospital in question within 3 business days after the complaint is filed. Upon receiving a complaint of a violation of this Section, the Department may take any action authorized under Section 7 or 9 of this Act.

(f) Proof of violation. Any violation of this Section must be proved by clear and convincing evidence that a hospital worker nurse was required to work overtime against the worker's his or her will. The hospital may defeat the claim of a violation by presenting clear and convincing evidence that an unforeseen emergent circumstance, which required overtime work, existed at the time the employee was required or compelled to work.

(Source: P.A. 100-513, eff. 1-1-18.)

(210 ILCS 85/10.15 new)

Sec. 10.15. Additional staffing transparency and reporting requirements.

(a) As used in this Section:

"Hospital worker" means any person who receives an hourly wage, directly or indirectly, via a subcontractor by a hospital licensed under this Act.

"Related to the subcontractor" means that the subcontractor is, to a significant extent, associated or affiliated with, owns, or is owned by, or has control of or is controlled by, the organization furnishing services to a hospital licensed under this Act.

"Staffing metric" means any tool used by hospital management to determine safe staffing levels in a patient care or support services unit.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. This includes organizations related to the subcontractor that have a contract with the subcontractor.

"Unit" means a functional division of a hospital that provides patient care or support services.

(b) Hospitals licensed under this Act must employ and schedule enough hospital workers to provide quality patient care and ensure patient safety.

(c) In order to ensure compliance with safe staffing practices, hospitals licensed under this Act shall make available, upon request, all the staffing matrices and other staffing metrics, if any, used to assess and maintain safe staffing levels for hospital workers in each unit.

(d) Hospitals shall share any and all staffing matrices, staffing metrics, and underlying materials used to determine staffing levels with the Department at the beginning of each calendar year.

(e) The Department shall produce an annual report based on staffing disclosures required under this Section beginning the first year after implementation.

(f) The Department shall make recommendations for minimum staffing standards for hospital workers in each hospital unit based on the information collected under this Section.

(210 ILCS 85/10.20 new)

Sec. 10.20. Hospital worker competency validation and assignment despite objection process.

(a) Findings. The Legislature finds and declares all of the following:

(1) The State of Illinois has an obligation to ensure hospitals provide quality patient care.

(2) Numerous studies have linked patient outcomes, including in-hospital mortality rates, to hospital worker staffing.

(3) In spite of the preponderance of evidence that adequate staffing improves patient outcomes, hospitals in Illinois and elsewhere too often systemically and intentionally understaff to maximize profit even at the expense of quality patient care.

(4) The COVID-19 pandemic both exposed and exacerbated these unsafe staffing practices.

(5) The State asserts that based on their demonstrated competencies and training, hospital workers themselves are best positioned to identify unsafe conditions that jeopardize quality patient care, including, especially, short staffing.

(6) Hospitals perform competency validations and ongoing verifications to ensure workers know how to perform their jobs safely and to identify unsafe practices including short staffing.

(7) The State should require hospitals to affirm that hospital workers have received the necessary training to safely perform their work via competency validations and ongoing verification and empower these workers to identify and formally object to unsafe working conditions, including short staffing.

(8) To facilitate this, the State should create a dispute resolution process for hospital workers to formally object to unsafe working conditions.

(b) Definitions. As used in this Section:

"Assignment despite objection" means a formal process by which hospital workers notify management when they receive an assignment that, based on their training, is potentially unsafe.

"Competent employee" means a hospital worker whose employer has received a competency validation or ongoing verification during a given calendar year.

"Competency validation" means a determination based on a hospital worker's satisfactory performance of each specific element of the employee's job description and of specific requirements of the unit in which they are employed in a safe and ethical manner.

"Hospital worker" means any person who receives an hourly wage, directly or indirectly, via a subcontractor by a hospital licensed under this Act.

"Ongoing verification" means annual redetermination based on a hospital worker's satisfactory performance of each specific element of the hospital worker's job description and the specific requirements of the unit in which the worker is employed in a safe and ethical manner.

"Related to the subcontractor" means that the subcontractor is, to a significant extent, associated or affiliated with, owns, or is owned by, or has control of or is controlled by, the organization furnishing services to a hospital licensed under this Act.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes organizations related to the subcontractor that have a contract with the subcontractor.

(c) Competency Validation Credential.

(1) Hospitals licensed under this Act shall conduct a competency validation for each hospital worker hired as a condition of employment within the first month after employment and at no cost to the new hire.

(2) The competency validation formally affirms the hospital has adequately trained a hospital worker to perform all aspects of the hospital worker's job safely and to identify unsafe conditions, including inadequate staffing.

(3) Hospitals must submit documentation of each hospital worker's competency validation to the Department of Public Health within 4 weeks after the worker's start date.

(4) Hospitals licensed under this Act shall also conduct an ongoing verification for each hospital worker employed during a given calendar year to determine the continued competency of each hospital worker to perform the worker's job and shall submit documentation of ongoing verification of each hospital worker to the Department of Public Health within 2 weeks after completion.

(5) Hospitals licensed under this Act shall submit a list of all competent employees currently employed at the end of each calendar year.

(6) The Department shall maintain a registry of all competent employees that includes the name, address, contact information and current employer of the worker and make this registry available to the public.

(7) Following notice and an opportunity to be heard, the Department shall impose, for each day that a hospital licensed under this Act is in violation of this subsection (c), a civil penalty against the hospital in an amount equal to 0.1% of the hospital's annual revenue during the most recently completed fiscal year.

(d) Assignment despite objection.

(1) A hospital licensed under this Act must create an assignment despite objection form that is applicable and accessible to all of its hospital workers that enables the hospital workers to formally object to unsafe working conditions, including unsafe staffing levels, and that assigns to the hospital liability for requiring a hospital worker to work in an unsafe manner.

(2) The assignment despite objection form must include the following language: "This is to confirm that I notified you that, in my professional judgment derived from my competency validation, today's assignment is unsafe and places patients at risk. As a result, the facility is responsible for any adverse effects on patient care."

(3) The hospital must retain a copy of each assignment despite objection form and provide a copy to the hospital worker's union, if any, and the Department. Hospitals must provide, at the end of each calendar year, a report of all assignment despite objection forms filed during the calendar year and must maintain these records for a minimum of 5 years.

(4) Hospitals must not retaliate against hospital workers for filing an assignment despite objection form or otherwise reporting or objecting to unsafe conditions.

(e) Resolution Process.

(1) Hospitals must develop a transparent, fair, and expedient assignment despite objection resolution process for all hospital workers either via collective bargaining or in accordance with Department process articulated below.

(2) Hospital workers currently covered by a collective bargaining agreement that includes an assignment despite objection resolution process shall abide by the process included in the collective bargaining agreement.

(3) Hospital workers not covered by a collective bargaining agreement that includes an assignment despite objection resolution process may access the following Department mandated assignment despite objection resolution process:

(A) The objecting hospital worker shall make a good faith effort to inform the hospital worker's manager or supervisor at the time of the objection to assignment.

(B) If the manager or supervisor fails to resolve the unsafe situation to the reporting hospital worker's satisfaction, the hospital worker shall then complete an assignment despite objection form, shall submit a copy to that person's manager or supervisor and that person's representative organization, if covered by a collective bargaining agreement, and shall keep a copy for their records.

(C) Hospital management must respond in writing to the assignment despite objection form within one week after its receipt and shall provide a copy of the response to the hospital worker's representative organization, if the hospital worker is covered by a collective bargaining agreement.

(D) In any instance in which the affected hospital worker(s) is unsatisfied with management's response, the hospital must convene a Safety Review Panel composed of 3 representatives selected by the hospital and 3 representatives selected by hospital workers via a transparent democratic process. The representatives selected by hospital workers are not required to be hospital employees. The panel shall attempt to resolve the dispute within 15 days of referral, unless extended by mutual consent.

(E) If the Safety Review Panel cannot resolve the dispute within 15 days after referral, the Department shall appoint a mutually agreed upon neutral third-party to assist in resolving the dispute. The neutral third-party shall make a binding decision to resolve the dispute.

(4) Following notice and an opportunity to be heard, the Department shall impose, for each day that a hospital licensed under this Act is in violation of subsection (d) or this subsection, a civil penalty against the hospital in an amount equal to 0.1% of the hospital's annual revenue during the most recently completed fiscal year.

(5) The Department shall create a Hospital Safety Advocate position responsible for enforcing the new competency credentialing and assignment despite objection requirements and developing additional rules, as needed.