Illinois Nurse Staffing Laws
And You!
Illinois Environment
Nurse Staff Laws & Regulation
Long-standing:
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Nurse Practice and Advanced Nurse Practice Act
Hospital Licensing Act & Rules
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Perinatal, Newborn, EMS/EMSC, Trauma
JCAHO Staffing Effectiveness Standards
Recent:
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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):
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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)
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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:
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all nurses are equal
 all patients have same need
 all patient care units are alike
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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
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“At All Times” Ratios
Proposed
Illinois
California
Clinical Areas
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
1:2
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
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Dynamic process Provides public updated
range of nurse staff
information
Correlates nurse staffing
to patient outcomes
Provides an ongoing &
comprehensive picture of
Illinois nurse staffing
Mandated Ratios:
 Uniform-one size fits all
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Static fix - Addresses
only one dimension of
nurse staffing
Does not correlate nurse
staffing to patient
outcomes
Fails to reflect Illinois
HRCA information and
pitfalls of California
experience
Our Hospital:
Nurse Staffing Matters
Demographic Data
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Number of Licensed Nurses
AD/BSN/Master’s Prepared
Tenure
5 yr, 10 yr, 15 yr, 20 yr
Vacancy Rate
Practice Environment
Self-scheduling/Flexible Staffing
Weekender Program
Central Partnership Program
Performance/Loyalty Recognition
Staff Satisfaction
Performance Improvement
Involvement
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Medication Use Process
Nosocomial Prevention
Clinical Informatics
Work Redesign
Six Sigma
Magnet Recognition
Collaboratives: IHI, QIO, IHA
Research Grant Initiatives
Nurse Career Enhancements
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Career Ladder (e.g. STEPS)
Certification/Continuing Education Support
Tuition Reimbursement (e.g. ACE)
On-site Nursing Degree Programs
RN Refresher Courses
Nurse Care Tech Internships
Scholarship Funding
Community
Partnership/Leadership
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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
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Hospital/College Partnerships
Objective - Increase Capacity:
Expand programming
 Support Faculty
 Improve Resource Utilization
 Benchmark Best Practices
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Staff Insights
Feedback:
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Questions
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Expectations