Current Illinois Policy and its Effect on the Workplace Debra Quintana MS, APRN, NEA-BC, CPHQ Chair, IONL Policy & Advocacy Committee Director of Clinical Operations AMITA Health Resurrection Medical Center, Chicago Contributions by Sharon Rangel

Focus on Spending

External Interests & Pressures Agency for Healthcare Research & Quality CMS Hospital Compare US News & World Report Facility Specific Tribune Commercial Payers National Quality Forum Consumer Reports Health Grades IL Hospital Report Card Why Not the Best? Commonwealth Fund

Legislative & Regulatory Environment

Over a Decade………

Current Staffing Law in Place

Hospital Report Card Act (2004) First law of its kind (PA93-0563) Provides public a picture of each hospital’s staffing process as it relates to patient outcomes Profiles RN/LPN/assistive nursing personnel by clinical service area & vacancy/turnover Mandates sharing current unit schedules, nurse-pt assignments and methodologies for staffing levels upon request http://www.healthcarereportcard.illinois.gov/

Hospital Report Card Act Consumer Guide to Health Care & Hospital Report Card Act (www.healthcarereportcard.illinois.gov) Volume & cost of services in hospitals & ASTCs Nurse Staffing Quality process of care, readmission rates, 30 day mortality, inpatient mortality, inpatient utilization Safety surgical care improvement, CLABSI/CDI/MRSA, patient safety (e-codes)

Mandatory Overtime Prohibited (2005) Only in the event of an emergent circumstance may nurses be required to work overtime and then only for four hours beyond a nurse’s predetermined, agreed work shift. Nurses may choose to work extra hours. (PA94-0242)

Nurse Staffing by Patient Acuity (2007) Staffing in the acute care setting should be based on the complexity of patient care needs all aligned with available nursing skills to promote quality patient care that is consistent with professional nursing standards

Staffing by Patient Acuity (2007) Committee requirements An existing or newly created hospital-wide committee or committees. Contribute to development, recommendation & review of the hospital’s staffing plan. Hospital shall appoint members of a committee, w/at least 50% are RNs providing direct patient care. RN members must be broadly representative of clinical service areas, as reasonable, e.g., surgery, critical care, pediatrics. When not practical to include representative from each clinical service area at one time – may schedule for rotating representation, for a defined period of time, to achieve input from all clinical service areas, every three years.

Hospital Patient Protection Act HB 3585

HB 3585: Hospital Patient Protection Act Introduced by Representative Theresa Mah Co-Sponsored by Representative Will Guzzardi Provides for nurse to patient ratios in: hospitals, LTAC’s, and ambulatory surgical treatment centers Each hospital shall provide staffing in requirements of this Act No hospital can assign a nurse to a unit unless Demonstrated and validated current competence Received orientation on that unit P&P stating criteria for above

HB 3585: Hospital Patient Protection Act Ratios in the Emergency Department 2 nurses must be physically present in the ED at all times; 1 assigned to only triage Nurse Patient 1 Nurse 1 Critical Trauma Patient 2 Critical Care Patients 3 Non-Critical, Non-Critical Trauma Patients

HB 3585: Hospital Patient Protection Act Ratios in Patient Care Areas 1 Nurse : 1 Patient in the Following: Active Labor Conscious Sedation During a Cesarean Delivery Initiating Epidural Anesthesia in L&D Medical Complications Obstetrical Complications Unstable or in Resuscitation Period, Newborn For OR Circulating Nurse

HB 3585: Hospital Patient Protection Act Ratios in Patient Care Areas 1 Nurse : 2 Patients in the Following: Acute Respiratory Care Burn Units Coronary Units Critical Care Immediate Post-Partum Patients Intensive Care Labor & Delivery NICU Patient Care Areas Post Anesthesia Recovery (regardless of type of anesthesia)

HB 3585: Hospital Patient Protection Act Ratios in Patient Care Areas 1 Nurse : 3 Patients in the Following: Ante-Partum, not in active labor Clinical Decision Unit Combined Labor/Delivery/Post-Partum Units Observation Unit Pediatric Unit Step-Down or Intermediate Intensive Care Unit Telemetry Unit

HB 2604: Safe Patient Limits Act Ratios in Patient Care Areas 1 Nurse : 4 Patients in the Following: Combined Post C-Section Delivery, mothers & newborns unit Medical Unit Mothers Only Unit Post-Partum Unit Post-Surgical Gynecological Unit Pre-Surgical/Admission Unit or Patient Care Area Psychiatric of Other Specialty Care Unit or Patient Care Area Recently Born Infants Unit Surgical Unit

HB 3585: Hospital Patient Protection Act Ratios in Patient Care Areas 1 Nurse : 5 Patients in the Following: Rehabilitation Unit or Patient Care Area Skilled Nursing Facility Well-Baby Nursery 1 Nurse : 6 Patients in the Following: PostPartum Units or Patient Care Areas In the event of multiple births, the total number of mothers plus infants assigned to a single nurse should never exceed 6.

HB 3585: Hospital Patient Protection Act Other Key Points Changing the name of a unit other than those in the Article does not change the staffing requirement The use of “acuity-adjustable” clinical units or patient care areas is strictly prohibited Any tool used to create or evaluate a staffing plan, shall be established in coordination with the nurses The assigned nurse determines: if patients assigned should be reduced and if additional nursing staff (LPN, C.N.A.) should be assigned Every hospital should keep a record of staff assignments for 3 years Every hospital, LTAC & ASTC must post the minimum staffing ratio and a toll- free telephone number for IDPH to report inadequate staffing or care

HB 3585: Hospital Patient Protection Act Other Key Points Hospital, LTACs and ASTC are prohibited from UAP may not perform nursing functions under the supervision of a nurse Mandatory Overtime may not be imposed to meet the requirements Lay-Offs of LPNs, C.N.A’s or Ancillary Staff may not be imposed to meet the ratio requirements Medical Assistants may not be assigned to clinical care units or patient care areas A hospital, LTAC or ASTC shall not employ video monitors or any form of electronic visualization of a patient as a substitute for nurse Use of rapid response teams as a first responder is prohibited Provides whistleblower protection The practice of “charting by exception” is expressly prohibited

HB 3585: Hospital Patient Protection Act Violations Any violation of the requirements of the Act result in Enforcement by the Department, forcing compliance or closure of the hospital A civil money penalty assessed by the Department of not more than $25,000 for each violation and an additional $10,000 per shift for each clinical care unit or patient care area until the violation is corrected The Attorney General shall enforce penalties in the county occurred Penalties collected shall be deposited into the General Revenue Fund Amends the Hospital Licensing Act and the Nurse Practice Act to provide that in case of conflict, the Hospital Patient Protection Act prevails Effective January 1, 2020

Safe Patient Limits Act HB 2604

HB 2604 Safe Patient Limits Act Companion Bill Submitted by Representative Fred Crespo Ratios ED same as other bill 1:1 for active labor, during birth (1 mom, 1 baby), OR, PACU <18 1:2 for Antepartum, Critical Care, Immediate Post Partum, PACU =/>18 1:3 for Acute Rehab, Antepartum without monitoring, Step down, Tele 1:4 for all other units not listed

HB 2604 Safe Patient Limits Act Nothing in the Act precludes patient acuity systems consistent with the Nurse Staffing by Patient Acuity Act. However, maximum patient assignment may not be exceeded All facilities should adopt written P&P for training and orientation of nursing staff. Demonstrated competence in unit providing care. Civil penalty of up to $25,000 each day during a violation The requirements of this Act will be suspended during a public health emergency declared by the state or federal government.

NURSE REPORTING TIME PAY HB 3361

HB 3361 Nurse Reporting Time Pay Submitted by Representative Fred Crespo Amends the minimum wage law If a nurse is required to report to work, but is not put to work or works less than ½ of their day (low census), the nurse must be paid for half of their usual pay, but not less than 4 hours. If a nurse is required to report to work for a second time, but does not work, the nurse shall be paid for 2 hours. Not applicable when: utility failure, act of God, This does not apply to a nurse on paid standby time (on-call) Effective January 1, 2020

Nurse Licensure Compact HB 1459 / SB 152

HB 1459 / SB 152 Nurse Licensure Compact Introduced by ANA-IL Multiple legislators sponsoring Allows for nurses in participating states to have one multistate license with the ability to practice and communicate with patients and students, both physically and electronically NURSYS national database- assures license requirements are met including verification of license, background check, discipline and practice privileges Illinois would be the 34th state joining the compact

IONL’s Position IONL supports the current Illinois Hospital Report Card Act and the Illinois Nurse Staffing by Patient Acuity Act, which mandate the development of a staffing committee that includes at least 50% bedside nurses. IONL does not support legislation that mandates specific nurse-to- patient ratios for all hospitals. IONL supports Multistate Licensure Many factors are important and considered when developing a staffing plan for each patient care area and when finalizing the staffing needs and patient assignments for each RN on each shift on each unit. Factors include the number, acuity and clinical needs of patients, education and transition needs of patients, psychosocial and emotional needs of patients; skills, experience and education of the RNs working, skills, experience, and education of UAPs (unlicensed assistive personnel), involvement of multidisciplinary team members (e.g., pharmacists, respiratory therapists, physical therapists, dietitians). organizational and unit factors such as medication and dietary delivery systems, unit layout, support systems, equipment, documentation, etc. The process of staffing is too dynamic and complex to rely on a simple nurse-to-patient ratio system that assumes all patients are the same, all nurses are the same, and all units are the same. While many of the ratios appear appropriate on the surface, there is no flexibility in their application based on patient, staff, and organizational factors. Ratios are arbitrary, focusing on numbers of patients and RNs, rather than patient needs, staff skills and experience, and desired patient outcomes.

What can you do? Visit IONL’s Policy & Advocacy Page for Updates https://www.ionl.org/page/policy_advocacy Join IONL’s Policy & Advocacy Committee IONL is in the process of crafting letters, advocacy alerts and template letters to send to your legislator- stay tuned! Visit your legislator! Write a letter!