1. Illinois Nurse Staffing Laws And You!

2. Illinois Environment Nurse Staff Laws & Regulation Long-standing: Nurse Practice and Advanced Nurse Practice Act Nurse Practice and Advanced Nurse Practice Act Hospital Licensing Act & Rules Hospital Licensing Act & Rules Perinatal, Newborn, EMS/EMSC, Trauma Perinatal, Newborn, EMS/EMSC, Trauma JCAHO Staffing Effectiveness Standards JCAHO Staffing Effectiveness StandardsRecent: Hospital Report Card Act (2004) Hospital Report Card Act (2004) Prohibit Mandated Overtime (2005) Prohibit Mandated Overtime (2005) Adverse Event Reporting (2005) Adverse Event Reporting (2005)

3. Legislative Proposals Patient Safety = Nurse Staffing

4. California Experience 1999 Staff Ratio Law (unfunded mandate): 4 years to implement 4 years to implement Staff nurses unhappy over lack of autonomy and breaks Staff nurses unhappy over lack of autonomy and breaks Unit support services reduced, less assistive nursing personnel, ancillary services Unit support services reduced, less assistive nursing personnel, ancillary services Increased use of travelers, 11 hospital closings, and ER diversions 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

5. Illinois Solution: Hospital Report Card Act Illinois Solution: Hospital Report Card Act Nurse Staffing = Public Information Nurse Staffing = Public Information

6. What is HRCA Connection to Nurse Staffing? What is HRCA Connection to Nurse Staffing? Public Access to Staffing Information (since 1/1/2004) Nurse staff schedules Nurse staff schedules Nurse – patient assignment rosters Nurse – patient assignment rosters Training info – for hire and retention Training info – for hire and retention Hospital-specific Report to Public (starting 2007) Nursing coverage Nursing coverage Report in standardized units to reflect RN, LPN, assistive nursing personnel hours/pt day, avg daily census, avg daily hours Report in standardized units to reflect RN, LPN, assistive nursing personnel hours/pt day, avg daily census, avg daily hours Vacancy & turnover rates Vacancy & turnover rates Patient Outcomes Patient Outcomes Surgical site infection Surgical site infection Ventilator-associated pneumonia Ventilator-associated pneumonia Central-line related bloodstream Central-line related bloodstream Whistleblower protections Whistleblower protections

7. What are state mandated ratios? Prescribes fixed number for nurse to patient assignment Prescribes fixed number for nurse to patient assignment Reduces staffing function to only one dimension Reduces staffing function to only one dimension Presumes: Presumes: all nurses are equal all nurses are equal all patients have same need all patients have same need all patient care units are alike all patient care units are alike

8. Mandated Nurse-Patient Ratios Ignores : Nurse education & experience Nurse education & experience Variances in patient acuity Variances in patient acuity Add’l nursing resources – e.g., unit clerks, patient care techs, patient transport Add’l nursing resources – e.g., unit clerks, patient care techs, patient transport Evidence-based practice correlated to patient outcomes Evidence-based practice correlated to patient outcomes

9. “At All Times” Ratios

10. What are the Main Differences? HRCA: Hospital-specific info Hospital-specific info Dynamic process - Provides public updated range of nurse staff information Dynamic process - Provides public updated range of nurse staff information Correlates nurse staffing to patient outcomes Correlates nurse staffing to patient outcomes Provides an ongoing & comprehensive picture of Illinois nurse staffing Provides an ongoing & comprehensive picture of Illinois nurse staffing Mandated Ratios: Uniform-one size fits all 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

11. Our Hospital: Nurse Staffing Matters Demographic Data Number of Licensed Nurses Number of Licensed Nurses AD/BSN/Master’s Prepared AD/BSN/Master’s Prepared Tenure Tenure 5 yr, 10 yr, 15 yr, 20 yr 5 yr, 10 yr, 15 yr, 20 yr Vacancy Rate Vacancy Rate Practice Environment Practice Environment Self-scheduling/Flexible Staffing Self-scheduling/Flexible Staffing Weekender Program Weekender Program Central Partnership Program Central Partnership Program Performance/Loyalty Recognition Performance/Loyalty Recognition Staff Satisfaction Staff Satisfaction Nurse Career Enhancements Career Ladder (e.g. STEPS) Career Ladder (e.g. STEPS) Certification/Continuing Education Support Certification/Continuing Education Support Tuition Reimbursement (e.g. ACE) Tuition Reimbursement (e.g. ACE) On-site Nursing Degree Programs On-site Nursing Degree Programs RN Refresher Courses RN Refresher Courses Nurse Care Tech Internships Nurse Care Tech Internships Scholarship Funding Scholarship Funding Performance Improvement Involvement Medication Use Process Medication Use Process Nosocomial Prevention Nosocomial Prevention Clinical Informatics Clinical Informatics Work Redesign Work Redesign Six Sigma Six Sigma Magnet Recognition Magnet Recognition Collaboratives: IHI, QIO, IHA Collaboratives: IHI, QIO, IHA Research Grant Initiatives Research Grant Initiatives Community Partnership/Leadership Illinois Organization of Nurse Leaders Illinois Organization of Nurse Leaders Illinois Coalition for Nursing Resources Illinois Coalition for Nursing Resources Assoc for Professionals in Infection Control Assoc for Professionals in Infection Control Clinical site for Community college Clinical site for Community college Faculty support Faculty support Program sponsor Program sponsor Board Participant (IONL,ICNR, DPR, other) Board Participant (IONL,ICNR, DPR, other)

12. Illinois HC Workforce Initiatives Illinois HC Workforce Initiatives Major Objective: Adequate numbers of qualified and available staff to deliver full range of safe, quality patient care services.

13. Addressing the Issue Multiple Stakeholders & Efforts: Career Awareness Career Awareness Educational Matters Educational Matters Licensure Issues Licensure Issues Funding Support Funding Support Work Environment Work Environment Data Needs Data Needs

14. Hospital/College Partnerships Objective - Increase Capacity: Expand programming Expand programming Support Faculty Support Faculty Improve Resource Utilization Improve Resource Utilization Benchmark Best Practices Benchmark Best Practices

15. Staff Insights Feedback: Questions Questions Expectations Expectations