Illinois Nurse Staffing Laws And You!

Illinois Environment Nurse Staff Laws & Regulation

Long-standing:  Nurse Practice and Advanced Nurse Practice Act   Hospital Licensing Act & Rules  Perinatal, Newborn, EMS/EMSC, Trauma JCAHO Staffing Effectiveness Standards Recent:   Hospital Report Card Act (2004) Prohibit Mandated Overtime (2005)  Adverse Event Reporting (2005)

Legislative Proposals

Patient Safety = Nurse Staffing

California Experience

1999 Staff Ratio Law (unfunded mandate):

    4 years to implement Staff nurses unhappy over lack of autonomy and breaks Unit support services reduced, less assistive nursing personnel, ancillary services Increased use of travelers, 11 hospital closings, and ER diversions

Impact Study Data (2005) CaNOC Study – no significant difference in falls reduction or pressure ulcer incidence

Illinois Solution: Hospital Report Card Act

Nurse Staffing = Public Information

What is HRCA Connection to Nurse Staffing? Public Access to Staffing Information (since 1/1/2004)  Nurse staff schedules   Nurse – patient assignment rosters Training info – for hire and retention Hospital-specific Report to Public (starting 2007)     Nursing coverage  Report in standardized units to reflect RN, LPN, assistive nursing personnel hours/pt day, avg daily census, avg daily hours Vacancy & turnover rates Patient Outcomes    Surgical site infection Ventilator-associated pneumonia Central-line related bloodstream Whistleblower protections

What are state mandated ratios?

 Prescribes fixed number for nurse to patient assignment  Reduces staffing function to only one dimension  Presumes:  all nurses are equal   all patients have same need all patient care units are alike

Mandated Nurse-Patient Ratios

Ignores :     Nurse education & experience Variances in patient acuity Add’l nursing resources – e.g., unit clerks, patient care techs, patient transport Evidence-based practice correlated to patient outcomes

“At All Times” Ratios

Proposed Illinois California Clinical Areas

1:2 1:2

OR/Trauma Critical Care: *Emeg. Critical Care *Intensive Care *L & D *Post-anes units Antepartum ER Peds Step-down Telemetry Inter. Care Nursery Specialty Care Med/Surg Acute Care Psych Rehab Postpartum - 3 couplets Well-baby

1:1 1:2 " " " " 1:3 1:3 1:3 1:3 1:3 1:4 1:4 1:4 1:4 1:5 1:6 1:6 1:2 active, 1:4 not active 1:2 1:4 1:4 1:4 (2008 - 1:3) 1:5 (2008 - 1:4) 1:5 (2008 1:4) 1:6 (2005 1:5) 1:6

Hospital

What are the Main Differences?

HRCA:

 Hospital-specific info  Dynamic process Provides public updated range of nurse staff information  Correlates nurse staffing to patient outcomes

Mandated Ratios:

 Uniform-one size fits all  Static fix - Addresses only one dimension of nurse staffing  Does not correlate nurse staffing to patient outcomes  Provides an ongoing & comprehensive picture of Illinois nurse staffing  Fails to reflect Illinois HRCA information and pitfalls of California experience

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Demographic Data

Our Hospital:

Nurse Career Enhancements

Number of Licensed Nurses AD/BSN/Master’s Prepared Tenure 5 yr, 10 yr, 15 yr, 20 yr     Career Ladder (e.g. STEPS) Certification/Continuing Education Support Tuition Reimbursement (e.g. ACE) On-site Nursing Degree Programs     Vacancy Rate Practice Environment Self-scheduling/Flexible Staffing Weekender Program Central Partnership Program Performance/Loyalty Recognition Staff Satisfaction    RN Refresher Courses Nurse Care Tech Internships Scholarship Funding

Performance Improvement Involvement

   Medication Use Process Nosocomial Prevention Clinical Informatics      Work Redesign Six Sigma Magnet Recognition Collaboratives: IHI, QIO, IHA Research Grant Initiatives

Community Partnership/Leadership

   Illinois Organization of Nurse Leaders Illinois Coalition for Nursing Resources Assoc for Professionals in Infection Control     Clinical site for Community college Faculty support Program sponsor Board Participant (IONL,ICNR, DPR, other)

Illinois HC Workforce Initiatives

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

Addressing the Issue

Multiple Stakeholders & Efforts:       Career Awareness Educational Matters Licensure Issues Funding Support Work Environment Data Needs

Hospital/College Partnerships

Objective - Increase Capacity:  Expand programming  Support Faculty  Improve Resource Utilization  Benchmark Best Practices

Feedback:

Staff Insights

 Questions  Expectations