THE NURSE STAFFING IMPROVEMENT ACT OF 2021

A 21st-century solution for nurse staffing that recognizes each nurse’s individual contribution and added value as a provider of care.

Every bedside nurse knows what it feels like when staffing is not right. When you cannot provide the level of care you know your patients need, they suffer, and so do you.

  • Evidence shows that heavy patient workloads cause nurses stress, job dissatisfaction, and burnout. This leads some nurses to leave their jobs and some to leave the profession.
  • When nurses are overworked, patients are more likely to contract a hospital-acquired condition, stay in the hospital longer, be readmitted, and die.

However, nurses also know that one size does not fit all. No one staffing model is appropriate for all settings of care or situations. After all, our patients’ needs change continually, so quality care requires nurse-driven, flexible staffing plans.

Hospitals require two things: people needing care and the nurses that provide that care.

We know that it is only reasonable that those direct-care nurse-experts are the best judge of what patients need day to day and even hour by hour.

THE NURSE STAFFING IMPROVEMENT ACT OF 2021 ACHIEVES THREE THINGS:

  1. STRENGTHENS THE VOICE OF THE DIRECT-CARE REGISTERED NURSE
  2. STRENGTHENS THE ROLE OF THE NURSING CARE COMMITTEE
  3. HOLDS HOSPITALS ACCOUNTABLE

STRENGTHEN THE VOICE OF THE REGISTERED NURSE

  • Nursing Care Committee – 55% direct inpatient care nurses
  • One direct inpatient care nurse shall be selected annually by the direct inpatient care nurses to serve as the committee’s co-chair.

STRENGTHEN THE ROLE OF THE COMMITTEE IN DEVELOPING THE STAFFING PLAN

  • Must meet at least 6 times a year
  • Prepare and recommend the hospital’s written hospital-wide staffing plan to hospital administration.
  • Provide input and feedback on selection, implementation, and evaluation of minimum staffing levels for all inpatient care units
  • Provide input and feedback on selection, implementation, and evaluation of acuity model
  • Review nursing staffing plans for all inpatient areas – shall consider
    • Patient outcomes;
    • Complaints regarding staffing, including complaints about a delay in direct care nursing or an absence of direct care nursing;
    • Number of hours of nursing care provided through an inpatient hospital unit compared with the number of inpatients served by the hospital unit during a 24-hour period;
    • Aggregate hours of overtime worked by the nursing staff;
    • The extent to which actual nurse staffing for each hospital inpatient unit differed from the staffing specified by the staffing plan; and
    • Any other matter or changes to the staffing plan determined by the committee to ensure that the hospital is staffed to meet the health care needs of patients.
  • If the plan developed by the committee is not adopted – Chief Nursing Officer must provide a written explanation to the committee and detail the changes before the hospital approving the plan.
  • Provide written report twice a year on the staffing plan that will be available to all direct inpatient care nurses
  • Provide a written report annually to the hospital’s governing board that addresses the staffing plan, changes made to the plan, impact of such changes, and recommendations for future nurse staffing changes.
  • RN may report to the nursing care committee any variations where the nurse personnel assignment in an inpatient care unit is not in accordance with the adopted staffing plan and may make a written report to the nursing care committee based on the variations.
  • If a registered nurse on an inpatient care unit objects to a shift-to-shift adjustment, the registered nurse may submit a written report to the nursing care committee.
  • The nursing care committee shall develop a process to examine and respond to written reports on variations in unit staffing or shift to shift adjustments, including the ability to determine if a specific written report is resolved or should be dismissed.
  • The nursing care committee shall develop a process to examine and respond to written reports on variations in unit staffing or shift to shift adjustments, including the ability to determine if a specific written report is resolved or should be dismissed.

STRENGTHEN HOSPITAL ACCOUNTABILITY

EVERY HOSPITAL MUST HAVE AND IMPLEMENT A WRITTEN STAFFING PLAN

ENFORCEMENT –  

  • Fines for failing to adopt a staffing plan
  • 60 DAYS TO PROVIDE A PLAN OF CORRECTION
  • Fines for pattern or practice of failing to comply with the plan of correction
  • Fines increase on a second offense
  • IDPH will publicly disclose violations
  • Money from fines received related to Section 10.10 shall be deposited in the Nursing Education Scholarship Fund

VIOLATIONS

  • Retaliation prohibited. No hospital may discipline, discharge, or take any other adverse employment action against an employee solely because the employee expresses a concern or complaint regarding an alleged violation of this Section or concerns related to nurse staffing.
  • RNs report variations to the staffing plan to the committee.
  • RN may file a complaint with IDPH.

WRITTEN STAFFING PLAN

  • Produced by a nursing care committee or committees
  • Provide for minimum direct care professional registered nurse-to-patient staffing needs for each inpatient care unit
  • The plan shall include the following considerations:
  • The complexity of care – number of assessments or reassessments needed, discharge planning, the volume of admissions, transfers, discharges, need for referrals.
  • The complexity of clinical professional nursing judgment needed to design and implement a patient’s nursing care plan – Nurses professional preparation and experience level, need for specialized equipment and technology, skill mix of support personnel, professional preparation, and experience.
  • Patient Acuity and number of patients that require care
  • Ongoing assessments of every unit – patient acuity level and number of nurses necessary to provide care
  • Additional RNs available when the need arises
  • Identify an acuity model for adjusting the staffing plan.
  • Implement the plan and assign nursing personnel to each inpatient care unit in accordance with the plan.
  • Posted in a conspicuous and accessible location for both patients and direct care staff
  • Copy of the written staffing plan shall be provided to any member of the general public upon request.

(e) Nothing in this Section 10.10 shall be construed to limit, alter, or modify any of the terms, conditions, or provisions of a collective bargaining agreement entered into by the hospital.

Addressing Illinois’ Nurse Shortage Crisis

According to the Illinois Nursing Workforce Center, Illinois faces a regional nurse shortage and will lose one-third of the workforce to retirement in the next five years. To address this crisis, IHA is proposing the following:

  • Hospitals will provide $2 million during academic years 2021-2025 – through the Hospital Licensure Fund – for nurse scholarships to increase the number of new graduate nurses entering the profession.
  • Establish an income tax credit of 2.5% for nurse educators to recognize, reward, and retain registered nurses with graduate degrees in nursing employed by academic institutions that educate nursing students at all levels of higher education.