Proposed Illinois Nurse Staffing Laws: Their Potential Impact This is a power point designed to educate your nurses on the staffing law, the power they hold in staffing decisions and the detrimental effects of ratio legislation. Feel free to modify the slides as it fits your organization. We ask, if possible, to keep IONL information on the slides. We wish to show nurses that we are supportive of them and want them to feel empowered in the staffing process at their organization. There are several slides at the end that encourage dialogue with your nurses. Your Opportunity for Input

Agenda Staffing Ratios Proposals HB 282 & Amendment Proposals Within the Amendment Bill Presumptions & Exclusions Research Illinois Laws Discussion Further Action Resources

What Have You Heard about Proposed Illinois Staffing Laws? Ask your staff. Gather their input….

Staffing Ratios Eleven Years of Proposals What is Staffing Ratio Legislation? An outside policy making body determining a “best” way to staff every hospital in Illinois caring for complex patients in the same manner. Why Ratio Legislation is Not Necessary in Illinois… Illinois has implemented laws in effect to assist the nurse Nurse Staffing by Patient Acuity Prohibited Mandatory Overtime Law Hospital Report Card Act Adverse Event Reporting Illinois Center for Nursing Safe Patient Handling

HB282- Nursing Care & Quality Improvement Act Introduced January 28, 2011 Sponsored by Rep. Mary Flowers Link to the Act: http://www.ilga.gov/legislation/fulltext.asp?DocName=&SessionId=84&GA=97&DocTypeId=HB&DocNum=282&GAID=11&LegID=55310&SpecSess=&Session= HB282- Amendment Filed 3/2/12, by Rep. Flowers Link to the Amendment: http://www.ilga.gov/legislation/97/HB/PDF/09700HB0282ham001.pdf

Proposals in House Amendment #1 to HB282 General Will override the Hospital Licensing Act and the Illinois Nurse Practice Act Requires each patient be provided with IDPH number to report inadequate care- currently have standards & Processes in place. Prohibits charting by exception Additional documentation for patient advocacy

Proposals, continued Emergency Department No fewer than two direct care registered nurses when a patient is present; At least one direct care registered nurse for triage who shall perform triage functions only, with only direct care nurses assigned to triage; Triage direct care nurses, base radio responder direct care nurses and specialty/flight nurses do not count in the nurse-patient ratio calculation; and Critical trauma patient ratio of 1:1 shall be maintained at all times. Operating Room At least one direct care registered nurse assigned to duties of circulating nurse with a minimum of one additional person serving as scrub assistant;  

HB282 Proposals Not Considered in HB282 Mandate Not Considered in HB282 Mother Baby Cesarean delivery, when initiating epidural anesthesia in L&D, for unstable or in resuscitation period newborn, patients receiving conscious sedation 1:1 Loss of nurse based staffing committees and voice in care and assignments Acuity of the Patient Experience Level of the Nurse Type of Hospital (Rural vs. Trauma) The effect on personnel outside of nursing and possible job elimination Financial constraints on hospitals- potential impact on supplies and technologies CCU, ICU, NICU, L&D, PACU critical care patients in the ED, immediate post-partum patients 1:2 ED, Step Down, Telemetry combined labor/delivery/post-partum unit or patient care area, ante-partum patients who are not in active labor, mother-baby couplets 1:3 Med/Surg, pre-surgical/admission, ambulatory surgical, psychiatric, or other specialty care unit, post-partum patients, post-surgical gynecological, recently born infants, combined post-cesarean delivery mothers newborns 1:4 Well-baby nursery, rehabilitation unit, skilled nursing facility 1:5 In the event of multiple births, the total number of mothers plus infants assigned to a single direct care nurse shall never exceed 6

Proposals, continued For the first time, House Amendment #1 to HB282 also allows the Illinois Department of Public Health to impose civil monetary penalties against hospitals of $25,000 per violation or prohibited conduct, as well as other fines and penalties.

Potential Legislation Mandatory Nurse to Patient Ratio Bill Presumes: Proposed nurse to patient ratios for each type of nursing unit (i.e. ICU, Med-Surg, Pediatrics, etc.) Prescribes fixed number of patients for each nurse at all times Requires proposed ratios to be followed 24/7, even during breaks, meetings, in-services, etc. All patients have the same need All shifts require the same resources

Mandated Nurse-Patient Ratios Ignores: The existing law which requires that nurses who are members of staffing committees can make recommendations on staffing in their own hospital Nurse education & experience Variances in patient acuity Additional nursing resources – e.g., unit clerks, patient care techs, patient transport Different needs on different shifts Illinois requires Staffing Committees where nurses can make recommendations on staffing in their own hospitals. Nurses do not need a legislator to tell them how to care for their own patients. Important Consideration “Fixing” healthcare, addressing the nursing shortage and increasing patient and quality care, are not issues that are resolved by mandating to nurses the number of patients assigned to their care.

California Experience 1999 Staff Ratio Law: Four years to implement Staff nurses unhappy over lack of autonomy and breaks Unit support services reduced, less PCTs, unit clerks, LPNs, food service staff, transporters Increased use of travelers, 11 hospital closings, and ER diversions

Recent Research Has shown patient outcomes are improved by: Education and experience of the nurses Environment nurses work in Positive relationships among healthcare team Physicians, nurses, respiratory Resources available Standardized care based on evidence-based practice

Illinois Laws to Ensure Patient Safety & Proper Staffing 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) Illinois Staffing by Patient Acuity Law (2007)- Introduction of Nursing Care Committees in 2008

Brainstorming Exercise What would be the potential impact of this bill on….. New nurses? All nurses? Other resources? Patients?

Our Organization What our organization has done in the past 2-3 years to promote nursing practice and patient centered care: Shared Governance Interdisciplinary Collaboration Educational Assistance Support of Nursing Care Committees with at least 50% being direct care staff nurses Staff nurses unit by unit contribute to the development recommendations for nurse staffing patterns per shift This screen is customizable to the institution.

In Summary The Bill Mandates how we allocate our staff Mandates how we spend our money Takes control away from nurses- Professional nurses do not need laws and legislators to tell them how to care for their own patients Gives control to the government Will override the Hospital Licensing Act and the Illinois Nurse Practice Act Add an estimated $1 million of cost to hospitals at a time when hospitals are receiving less reimbursement. This may impact hospital closings.

What Can You Do to Continue to Have a Voice in Your Own Staffing? Speak Up! Inaction is Action

Finding Your Legislator www.ilga.gov Click on Legislator Look Up Looking on your Voter Identification Card

What Do I Do?

Communication Tips Identify yourself State your credentials State if you are a constituent OR your link to the legislator’s district State you are a member of a nursing organization State your reason for visiting, talking or writing Provide legislator with a fact sheet and/or position statement Request a response or follow up meeting Remember to say, “Thank You.”

Some Talking Points Nurse Staffing by Patient Acuity Allows Illinois’ 200+ hospitals and their nurses to specifically tailor their staffing plans to meet the unique needs of patients in each hospital. Assures that direct care nurses have a significant voice in the hospital’s staffing plan and process. Mandates that at least 50% of nurse committee addressing hospital’s staffing plan and process are direct care staff Allows each hospital and their nurses to plan staffing and then adjust that plan as patient needs change to account for a wide range of considerations, including: The number of patients The severity of their illnesses and their nursing needs The available staff skills mix Aligns staffing considerations based on patient needs and nursing resources.

Some Talking Points Describe hospital’s Acuity Committee: How committee established; Outline process for member selection and direct care staff input; o Provide meeting particulars – how often meet, issues discussed, recommendations and implementation efforts; Discuss how direct care staff who are not serving directly on the committee are encouraged to provide input to the committee and how the committee’s efforts are disseminated and shared with direct care staff and across the organization, e.g., minutes on hospital’s intranet, newsletter, staff meetings, etc.; Discuss major recommendations from direct care staff that have been taken into consideration in your hospital – and how they’ve improved the delivery of care for both your nurses and patients. Provide specific highlights, e.g. Rapid Response Teams for failure to rescue/new grad support; wound care nurse because higher trend in pressure ulcer incidence; “hourly rounding” because of fall prevention program, admissions/discharge nurse position because of increased flux of work at peak times, etc. Assures that direct care nurses have a significant voice in the hospital’s staffing plan and process. Mandates that at least 50% of nurse committee addressing hospital’s staffing plan and process are direct care staff

Full Talking Point List For a full list of talking points, visit the following websites: IONL- http://www.ionl.org/?page=policy_advocacy IHA- http://www.ihatoday.org/advocacy/ihas-2010-state-legislative-advocacy-agenda-2.aspx

In Follow Up Be sure to let IONL know the results of any contact with your legislator. Email Kathy Ferket at: kferket@nch.org

Resources Available at IONL All IONL Resources are available online. Some items are “members only” access Staffing Tool Kit Nursing Care Committees in Illinois Resources Minutes Charters Dashboards Presentations Staffing Ratio Information Bills Talking Points Articles Coming Soon Standardized Orientation to Care Committees Sharing Environment for Care Committees Best Practices

Contact IONL info@ionl.org Questions or Comments? Contact IONL info@ionl.org