1. 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

3. Focus on Spending

4. 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

5. Legislative & Regulatory Environment

6. Over a Decade………

7. Current Staffing Law in Place

8. Hospital Report Card Act (2004)
First law of its kind (PA )
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

9. Hospital Report Card Act
Consumer Guide to Health Care & Hospital Report
Card Act (
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)

10. 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.
(PA )

11. 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

12. 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.

13. Hospital Patient Protection Act
HB 3585

14. 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

15. 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

16. 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

17. 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)

18. 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

19. 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

20. 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.

21. 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

22. 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

23. 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

24. Safe Patient Limits Act
HB 2604

25. 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

26. 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.

27. NURSE REPORTING TIME PAY
HB 3361

28. 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

29. Nurse Licensure Compact
HB 1459 / SB 152

30. 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

31. 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.

32. What can you do? Visit IONL’s Policy & Advocacy Page for Updates
Join IONL’s Policy & Advocacy Committee
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