Vol. 5 Issue 20
State of Affairs
Illinois: Staffing by Acuity
Governor signs staffing bill, what's next?
Our country's market-oriented healthcare system warrants legislation to regulate hospital staffing of nurses if there are one or more reasons the optimal level of staffing is not reached without intervention.1 Market forces have not resolved the issues of patient safety and the quality of care related to nurse staffing.
Massive reductions in nursing budgets have resulted in fewer nurses working longer hours, while caring for sicker patients.2 Nurses have requested the assistance of elected officials on the state and federal level to protect patients by holding hospitals accountable for the provisions of adequate nurse staffing through legislative or regulatory means.3
Staffing the Hospital Setting
Hospital nurse staffing is a matter of major concern because of its effects on patient safety, quality of care and establishing optimal patient outcomes.4 Several legislative proposals over the past 5 years are contributing to an ongoing debate as to whether Illinois would benefit from the state mandating fixed nurseÐto-patient ratios 24 hours a day, 7 days a week.5
Recent researched publications have established a strong link between nurse staffing and the quality of patient care.1 These studies and evidence suggest richer nurse staffing has the potential to reduce inpatient morbidity and mortality rates, lower failure-to-rescue rates, reduce medical error rates, decrease adverse events, cut medical costs and decrease length of stay in the hospital.6
Nevertheless, the literature offers minimal support for specific mandated nurse-to-patient ratios for nursing units in acute care hospitals, especially without also adjusting for patient acuity.7
Reaching a Compromise
In May 2007, Illinois passed SB 867, the Nurse Staffing by Patient Acuity Act. While other staffing legislation has failed in Illinois over the years, the Illinois Nurses Association (INA) successfully spearheaded this plan requiring nurse staffing in hospitals to be based on patient acuity versus nurse-to-patient ratios.8
Supporters of the legislation, including INA and the Illinois Hospital Association (IHA), opposed the statewide mandated fixed staffing ratio plan, which was first introduced by State Rep. Mary E. Flowers (D-31st District) in January 2007.
The bill proposed by Flowers, HB 0392, mandates specific nurse-to-patient ratios based on the type of hospital unit. Currently, a few states now require specific ratios in specialty areas such as critical care and labor and delivery units, but none require ratios in every patient care unit in every hospital as required in the California regulations. (California has passed a bill that requires a specific nurse-to-patient ratio, which took effect in January 2005).2
The key provisions of the Nurse Staffing by Patient Acuity Act according to the IHA include the following:
staff planning using a hospital's acuity model based on recommendations from a nursing care committee comprised of 50 percent direct care nurses;
direct care staff as a significant voice in the nurse staffing process;
staffing considerations based on patient needs and nursing resources;
an evidence-based approach to nurse/patient staffing;
a wide range and mix of hospitals and their nursing staffs; and
complementing current hospitals' staffing policies and practices.
What Is Next?
On Aug. 24, Gov. Rod R. Blagojevich signed the Nurse Staffing by Patient Acuity Act, which will take effect Jan. 1, 2008. This bill mandates each hospital throughout Illinois will implement a written staffing plan aligning patient care needs with RN expertise.
The staffing plan determines how many nurses at a specific expertise and skill level should be assigned to each inpatient care unit, identify additional RNs available for patient care when unexpected needs exceed the nursing staffing plan, and must be posted in a location easily accessible to patients and staff. Other considerations when developing the staffing plan include the volume of patients, complexity of care needed for patients in each unit, number of referrals needed for patients, and the need for special equipment and technology when establishing how many nurses are necessary for each shift.9
In addition to the baseline written staffing plan, each hospital will implement a patient acuity tool to provide direction in determining additional nursing staff needed due to the changes in patient care acuity.8
The hallmark of SB 0867 is the participation of direct care staff nurses in determining both the written staffing plan and identifying the patient acuity tool. A nursing care committee comprised of 50 percent direct care staff nurses will identify the various staffing options in relation to patient needs and nurse expertise. Because patient care varies depending on the illness of patients and the size of the facilities, the plans must be flexible and developed by healthcare providers as well as administrators.
References for this article can be accessed at www.advanceweb.com/nurses. Click on References on the left navigation bar under Education.
Jennifer Wallenberg is a nurse in the critical care unit at Advocate Good Samaritan Hospital in Downers Grove, IL.