Illinois Nurse Staffing Laws Illinois Nurse Staffing Laws

And You!And You!

Illinois EnvironmentIllinois EnvironmentNurse Staff Laws & Nurse Staff Laws &

RegulationRegulation

Long-standing:Long-standing: Nurse Practice and Advanced Nurse Practice ActNurse Practice and Advanced Nurse Practice Act Hospital Licensing Act & RulesHospital Licensing Act & Rules

Perinatal, Newborn, EMS/EMSC, TraumaPerinatal, Newborn, EMS/EMSC, Trauma JCAHO Staffing Effectiveness Standards JCAHO Staffing Effectiveness Standards

Recent:Recent: Hospital Report Card Act (2004)Hospital Report Card Act (2004) Prohibit Mandated Overtime (2005)Prohibit Mandated Overtime (2005) Adverse Event Reporting (2005)Adverse Event Reporting (2005)

Legislative ProposalsLegislative Proposals

Patient Safety = Nurse StaffingPatient Safety = Nurse Staffing

California ExperienceCalifornia Experience1999 Staff Ratio Law (unfunded mandate):1999 Staff Ratio Law (unfunded mandate):

4 years to implement4 years to implement Staff nurses unhappy over lack of autonomy and Staff nurses unhappy over lack of autonomy and

breaksbreaks Unit support services reduced, less assistive nursing Unit support services reduced, less assistive nursing

personnel, ancillary servicespersonnel, ancillary services Increased use of travelers, 11 hospital closings, and Increased use of travelers, 11 hospital closings, and

ER diversionsER diversions

Impact Study Data (2005)Impact Study Data (2005) CaNOC Study – no significant difference in falls CaNOC Study – no significant difference in falls

reduction or pressure ulcer incidencereduction or pressure ulcer incidence

Illinois Solution: Illinois Solution: Hospital Report Card ActHospital Report Card Act

Nurse Staffing = Public InformationNurse Staffing = Public Information

What is HRCA Connection to What is HRCA Connection to Nurse Staffing? Nurse Staffing?

Public Access to Staffing Information (since 1/1/2004)Public Access to Staffing Information (since 1/1/2004) Nurse staff schedulesNurse staff schedules Nurse – patient assignment rostersNurse – patient assignment rosters Training info – for hire and retentionTraining info – for hire and retention

Hospital-specific Report to Public Hospital-specific Report to Public (starting 2007)(starting 2007) Nursing coverage Nursing coverage

Report in standardized units to reflect RN, LPN, assistive Report in standardized units to reflect RN, LPN, assistive nursing personnel hours/pt day, avg daily census, avg nursing personnel hours/pt day, avg daily census, avg daily hoursdaily hours

Vacancy & turnover rates Vacancy & turnover rates Patient OutcomesPatient Outcomes

Surgical site infectionSurgical site infection Ventilator-associated pneumoniaVentilator-associated pneumonia Central-line related bloodstreamCentral-line related bloodstream

Whistleblower protectionsWhistleblower protections

What are state mandated What are state mandated ratios?ratios?

Prescribes fixed number for nurse Prescribes fixed number for nurse to patient assignment to patient assignment

Reduces staffing function to only Reduces staffing function to only one dimension one dimension

Presumes:Presumes: all nurses are equal all nurses are equal all patients have same needall patients have same need all patient care units are alike all patient care units are alike

Mandated Nurse-Patient Mandated Nurse-Patient RatiosRatios

IgnoresIgnores : :

Nurse education & experience Nurse education & experience Variances in patient acuityVariances in patient acuity Add’l nursing resources – e.g., unit clerks, Add’l nursing resources – e.g., unit clerks,

patient care techs, patient transportpatient care techs, patient transport Evidence-based practice correlated to Evidence-based practice correlated to

patient outcomespatient outcomes

““At All Times” RatiosAt All Times” RatiosClinical Areas

OR/Trauma 1:1 1:2Critical Care: 1:2 1:2 *Emeg. Critical Care " *Intensive Care "

*L & D "1:2 active, 1:4

not active *Post-anes units " 1:2Antepartum 1:3ER 1:3 1:4Peds 1:3 1:4Step-down 1:3 1:4 (2008 - 1:3)Telemetry 1:3 1:5 (2008 - 1:4)Inter. Care Nursery 1:4Specialty Care 1:4 1:5 (2008 1:4)Med/Surg 1:4 1:6 (2005 1:5)Acute Care Psych 1:4 1:6Rehab 1:5Postpartum - 3 couplets 1:6Well-baby 1:6

Proposed Illinois

California Hospital

What are the Main What are the Main Differences?Differences?

HRCA:HRCA: Hospital-specific infoHospital-specific info

Dynamic process -Dynamic process -Provides public Provides public updated range of nurse updated range of nurse staff informationstaff information

Correlates nurse Correlates nurse staffing to patient staffing to patient outcomesoutcomes

Provides an ongoing & Provides an ongoing & comprehensive picture comprehensive picture of Illinois nurse staffingof Illinois nurse staffing

Mandated Ratios:Mandated Ratios: Uniform-one size fits Uniform-one size fits

allall

Static fix - Addresses Static fix - Addresses only one dimension of only one dimension of nurse staffingnurse staffing

Does not correlate Does not correlate nurse staffing to nurse staffing to patient outcomespatient outcomes

Fails to reflect Illinois Fails to reflect Illinois HRCA information and HRCA information and pitfalls of California pitfalls of California experience experience

Our Hospital:Our Hospital: Nurse Staffing MattersNurse Staffing Matters

Demographic DataDemographic Data Number of Licensed NursesNumber of Licensed Nurses AD/BSN/Master’s Prepared AD/BSN/Master’s Prepared TenureTenure

5 yr, 10 yr, 15 yr, 20 yr5 yr, 10 yr, 15 yr, 20 yr Vacancy RateVacancy Rate Practice EnvironmentPractice Environment

Self-scheduling/Flexible StaffingSelf-scheduling/Flexible Staffing

Weekender ProgramWeekender Program

Central Partnership ProgramCentral Partnership Program Performance/Loyalty RecognitionPerformance/Loyalty Recognition Staff SatisfactionStaff Satisfaction

Nurse Career EnhancementsNurse Career Enhancements Career Ladder (e.g. STEPS)Career Ladder (e.g. STEPS) Certification/Continuing Education Certification/Continuing Education SupportSupport Tuition Reimbursement (e.g. ACE)Tuition Reimbursement (e.g. ACE) On-site Nursing Degree ProgramsOn-site Nursing Degree Programs RN Refresher CoursesRN Refresher Courses Nurse Care Tech InternshipsNurse Care Tech Internships Scholarship FundingScholarship Funding

Performance Improvement Performance Improvement InvolvementInvolvement Medication Use ProcessMedication Use Process Nosocomial PreventionNosocomial Prevention Clinical InformaticsClinical Informatics Work RedesignWork Redesign Six SigmaSix Sigma Magnet RecognitionMagnet Recognition Collaboratives: IHI, QIO, IHACollaboratives: IHI, QIO, IHA Research Grant InitiativesResearch Grant Initiatives

Community Community Partnership/LeadershipPartnership/Leadership Illinois Organization of Nurse LeadersIllinois Organization of Nurse Leaders Illinois Coalition for Nursing ResourcesIllinois Coalition for Nursing Resources Assoc for Professionals in Infection Assoc for Professionals in Infection ControlControl Clinical site for Community collegeClinical site for Community college Faculty supportFaculty support Program sponsorProgram sponsor Board Participant (IONL,ICNR, DPR, Board Participant (IONL,ICNR, DPR, other)other)

Illinois HC Workforce Illinois HC Workforce InitiativesInitiatives

Major Objective:Major Objective:

Adequate Adequate numbers of numbers of qualified qualified and available and available staff staff to deliver full to deliver full range of safe, quality range of safe, quality patient care services.patient care services.

Addressing the IssueAddressing the Issue

Multiple Stakeholders & Efforts:Multiple Stakeholders & Efforts:

Career AwarenessCareer Awareness Educational MattersEducational Matters Licensure IssuesLicensure Issues Funding SupportFunding Support Work EnvironmentWork Environment Data NeedsData Needs

Hospital/College PartnershipsHospital/College Partnerships

Objective - Increase Capacity:Objective - Increase Capacity:

Expand programmingExpand programming Support Faculty Support Faculty Improve Resource UtilizationImprove Resource Utilization Benchmark Best PracticesBenchmark Best Practices

Staff InsightsStaff Insights

Feedback:Feedback:

QuestionsQuestions

ExpectationsExpectations