1. 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

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

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

4. 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

5. HB282- Nursing Care & Quality Improvement Act
Introduced January 28, 2011
Sponsored by Rep. Mary Flowers
Link to the Act:
HB282- Amendment
Filed 3/2/12, by Rep. Flowers
Link to the Amendment:

6. 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

7. 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;

8. 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

9. 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.

10. 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

11. 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.

12. 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

13. 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

14. 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

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

16. 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.

17. 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.

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

19. Finding Your Legislator
Click on Legislator Look Up
Looking on your Voter Identification Card

20. What Do I Do?

21. 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.”

22. 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.

23. 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

24. Full Talking Point List
For a full list of talking points, visit the following websites: IONL- IHA-

25. In Follow Up
Be sure to let IONL know the results of any contact with your legislator.
Kathy Ferket at:

26. 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

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