Staffing Matters

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Staffing Matters 2007 Legislative Activity
by Cathy Grossi, B.S.N., J.D. Illinois
Hospital Association October 16, 2007

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Program Purpose

• Provide update and overview for new laws
  impacting nursing in Illinois
• Nurse Practice Act
• Nurse Staffing by Patient Acuity
• Discuss implications of key provisions for
  hospitals
• Identify concerns related to implementation
• Respond to your questions w/commitment to
  pursue additional info as needed

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(No Transcript)
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Illinois Nursing Legislation

• Comprehensive Context
• Hospital Report Card Act (2004)
• Prohibit Mandated Nurse OT (2005)
• Adverse Health Care Reporting (2005)
• Center for Nursing (2006)
• Nurse Practice Act (2007)
• Nurse Staffing by Patient Acuity (2007)

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Nurse APN Practice ActRewrite Activity

• Mandated Sunset 1/08
• IDFPR August 2005 -155 Participants (LPN/RN/APN)
• 27 Hospitals
• 12 Professional Nursing Organizations
• 29 Nursing Schools
• 24 Nursing Specialties

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IDFPR Sunset Committee

• Guiding Principles
• Promote public health and safety
• Promote better patient outcomes
• Advance nursing excellence

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Nurse Practice Act

• SB 360/HB 119
• Sen. Ronen/Rep.Saviano
• Intro 2/7/07 - Shell bill
• General Assembly 7/11/07
• Gov signed on 10/5/07
• Became law w/Governors signature!

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Nurse Practice Act Public Act 95-0639

• Key Provisions
• License-Pending
• Boards of Nursing
• Delegation
• Scope of Practice
• APN
• Written Collaborative Agreements Hospital
  Credentialing Privileging
• Schedule II drugs
• CEUs

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Nurse Practice Act225 ILCS 65/X-X

• Means
• Title 225
• Act 65
• Article 50, 55, 60, 65, and 70
• Section (too many to mention!)

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Nurse Practice Act (225 ILCS 65)

• Almost 300 pg document
• Initial 75 pages reflect this change in 16
  related Acts, e.g. ASTC Act
• Newly Organized
• Article 50 All Licensees
• Article 55 LPNs
• Article 60 RNs
• Article 65 APNs
• Article 70 Administration Enforcement
• Sunsets - 2018

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Article 50 All Licensees

• 50-10 Definitions
• 50-15 Policy application of Act
• 50-20 Unlicensed practice
• 50-25 RNs and LPNs prohibited from doing
  refractions
• 50-30 Social Security on license application
• 50-35 Criminal history records background check
• 50-50 Prohibited acts
• 50-60 Nursing Coordinator Assistant Nursing
  Coordinator
• 50-65 Board
• 50-70 Concurrent theory and clinical practice
• 50-75 Nursing delegation

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Article 55 LPNs

• 55- 5 LPN education program requirements
• 55-10 Qualifications for LPN licensure
• 55-15 LPN license expiration renewal
• 55-20 Restoration of LPN license temporary
  permit
• 55-25 Inactive status of a LPN license
• 55-30 LPN scope of practice
• 55-35 Continuing education for LPN licensees

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Article 60 RNs

• 60- 5 RN education program requirements
  out-of-state programs
• 60-10 Qualification for RN licensure
• 60-15 Registered nurse externship permit
• 60-20 Expiration of RN license renewal
• 60-25 Restoration of RN license temporary
  permit
• 60-30 Inactive status of a RN license
• 60-35 RN scope of practice
• 60-40 Continuing education for RN licensees

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Article 65 APNs

• 65- 5 Qualifications for APN licensure
• 65-10 APN license pending status
• 65-15 Expiration of APN license renewal
• 65-20 Restoration of APN license temporary
  permit
• 65-25 Inactive status of a APN license
• 65-30 APN scope of practice
• 65-35 Written collaborative agreements
• 65-40 Prescriptive authority
• 65-45 Advanced practice nursing in hospitals or
  ambulatory surgical treatment centers
• 65-50 APN title
• 65-55 Advertising as an APN
• 65-60 Continuing education (remains 50 hours/2
  year cycle)
• 65-65 Reports relating to APN professional
  conduct

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Article 70 Administration and Enforcement

• Applies to all Licensees
• 70- 5 Grounds for disciplinary action
• 70-10 Intoxication and drug abuse
• 70-15 Disciplinary and non-disciplinary options
  for the impaired nurse
• 70-20 Suspension of license for failure to pay
  restitution
• 70-25 Returned check fines
• 70-30 Roster
• 70-35 Licensure requirement internet site
• 70-40 Educational resources internet link
• 70-45 Fees
• 70-50 Nursing Dedicated and Professional Fund
• 70-55 Statute of Limitations (5 years)
• 70-60 to 165 Procedural Due Process Provisions

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Practice Act Highlights

• Definitions (Article 50-10)
• APN CNM, CNP, CRNA, CNS
• Collaboration
• Credentialed/Privileged
• License Pending RN/APN
• note LP-LPN not provided a definition
  here

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Practice Act Highlights

• Additions to Prohibited Acts (Article 50-50)
• No person shall.
• (17) Retaliate against any nurse who reports
  unsafe, unethical, or illegal health care
  practices or conditions.
• (18) Be deemed a supervisor when delegating
  nursing activities or tasks as authorized under
  this Act

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Practice Act Highlights

• Board of Nursing (Article 50-65)
• IDFPR Secretary appointees
• Combined APN Nurse Bds to One
• 13 Members/3year terms
• LPN/RN/APN nurse actively engaged in direct pt
  care, RN actively engaged in direct pt care
• 4 APNs
• Board Activities
• Recommend Rules
• Education Programs
• Discipline
• Same level oversight for scope of practice
• APN rules to Med. Lic. Bd for review and
  comment.-.IDFPR Secretary has final approval

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Practice Act Highlights

• Nursing Delegation (Article 50-75)
• Delegation
• Means authority transfer to perform selected
  nursing activity or task
• Nursing Activity
• Use of knowledge acquired by completion of
  approved program for LPN/RN
• Task
• Work not requiring nursing knowledge, judgment or
  decision-making

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Delegation Specifics

• Nursing Delegation (Article 50-75)
• APN may delegate to RN/LPN and others (presumably
  nursing activities tasks)
• RN may delegate nursing activities to RN or LPN
• RN may delegate tasks to licensed and unlicensed
• RN shall NOT delegate any nursing activity to an
  unlicensed person, including medication
  administration
• LPN may not re-delegate nursing activity
• APN/RN may refuse to delegate, stop or rescind

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Licensure Sections (LPN/RN/APN)

• Article 55/60/65
• Education Program
• Qualifications for Licensure
• Scope of Practice
• Continuing Education
• 3 years to complete application
• if not, return to school
• 1 year after passing exam to apply for license
• if not, must retake pass again

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License Pending LPN/RN

• Qualifies for Employment
• Completed and passed licensure exam
• Present employer w/official written notification
• Applied for state license meet all other
  requirements
• Fee background check
• Effective until
• 3 months since date of passage as indicated on
  official notification (may be extended by rule)
• Receive actual license
• IDFPR notification re Denial or Terminate
  practice until decision

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License Pending APN

• May Practice as LP - CNS/CNM/CNP/CRNA
• Not longer than 6 months
• Applied for state APN license and paid fees
• Proof of application for natl certifying exam
• Proof of completion of graduate advanced practice
  education program
• Existing Illinois RN license
• LP status precludes delegation of prescriptive
  authority

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LPN Scope of Practice (Article 55-30)

• Basic nursing practice as delegated by RN/APN or
  as directed by PA, physician, dentist or
  podiatrist
• W/without compensation
• Includes, but not limited to
• Collect data and collaborate in pt assessment
• Collaborate w/RN/APN in developing evaluating
  care plan
• Implement plan as delegated
• Provide input for P P to support pt safety

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RN Scope of Practice (Article 60-35)

• Full scope of nursing, w/or w/out compensation
  across all settings
• Includes, but not limited to
• Assessment/Care plan/Eval
• Patient advocacy
• Med adm or delegation to LPN
• Safe and effective nursing care
• Communicating and collaborating w/other hlth care
  professionals
• Procurement and application of new knowledge and
  technologies
• Provide input for P P to support pt safety

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APN Scope of Practice (Article 65-30)

• Based on knowledge skills acquired throughout
  APNs educ, training and experience
• Includes, but is not limited to
• RN Scope of Practice
• Adv nurse assess diagnosis
• Order diagnostic and therapeutic tests
  procedures
• Interpreting using results to treat illness
  improve health
• Provide palliative and end-of-life
• Prescriptive authority as defined in Article 65-40

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Written Collaborative Agreement (Article 65-35)

• Required for all APNs engaged in clinical
  practice
• Exemption for APNs authorized to practice in
  hospitals or ASTCs
• WCA describes working relationship
  w/collaborating physician, podiatrist or dentist
  and authorizes the categories of care, treatment
  or procedures to be performed by APN
• Does NOT require employment relationship
• Must meet in person 1x/month for collaboration
  consultation
• CRNAs Anesthesiologist, physician, podiatrist or
  dentist must discuss agree w/anesthesia plan
  docs must remain physically present on the
  premises during delivery of anesthesia services
• Must address notice for termination of agreement

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Prescriptive Authority Article 65-40

• As part of the written collaborative agreement,
  collaborating physician or podiatrist may
  delegate
• OTC, medical gases, Schedule III, III-N, IV or V
  Ctrld Sub
• Collaborating doc must have valid current IL
  Ctrld Sub license federal registration to
  delegate authority to APN
• Expanded now to Schedule II or II-N drugs
• No more than 5 Sched II or II-N oral drugs
• Must be same that physician would prescribe
• Limited to 30 day prescription supply then Dr.
  approves continuation
• APN must discuss meds monthly w/delegating
  physician, podiatrist or dentist

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APN Hospital ASTC Exemption (Article 65-45)

• May provide services w/out a written
  collaborative agreement or prescriptive
  authority
• If hosp or ASTC grants clinical privileges and/or
  prescriptive authority, including controlled
  substances, as recommended by medical staff
• Medical staff must periodically review APN
  privileges
• Provides that patients attending physician shall
  determine APNs authority role in cases not
  addressed by medical staff bylaws (hospital) or
  consulting medical staff committee (ASTC)
• CRNAs Must discuss anes. w/anesthesiologist,
  physician, dentist or podiatrist who must remain
  physically present on premises during delivery of
  services consistent w/HLA sec. 10.7 (3)(B)

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Nurse Pt Ratios

• Annual Effort by Proponents
• Multiple bill versions introduced (HB 392, SB
  605)
• 2006 2007 Adverse Committee Action
• Passed w/HOLD from House/Senate to Floor

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Advocacy Efforts

• CNE Nurse Work Group Awareness Activism
• IHA/IONL Discussion Guide Power Point
• Grassroots Advocacy
• CNE Education Program (Oct 2006)
• Conference Calls
• CNE Own-A-Week
• Guidance Documents
• Springfield participation
• Compliance Costs
• Hosting Legislator Site Visits
• Contact Your Legislator Tool Guide

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Nurse Staffing by Patient Acuity ActPublic Act
95-0401

• SB 867
• Applies only to hospitals
• Passed unanimously from both chambers
• House Sponsor - Rep. Esther Golar
• Signed by the Governor on 8/24/07
• Effective January 1, 2008

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Overview

• Act Combines Plan Process
• First law of its kind
• Intentionally broad
• Not a hospital policy
• Balancing static plan w/dynamic process
• Does NOT mandate purchase of acuity tool
• Comply in good faith
• Remember..
• IDPH Administrative Rules on the horizon!!!!

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Nurse Staffing by Patient Acuity Act

• Two pages
• Amends Hospital Licensing Act (210 ILCS 85) as
  section 10.10
• 4 parts
• (a) Findings
• (b) Definitions
• (c) Written staffing plan
• (d) Nursing Care Committee

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Nurse Staffing by Patient Acuity

• Major Driver..
• Voice of Direct Care Staff !!!!!

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Nurse Staffing by Patient Acuity(a) Findings

• Objective
• Promote quality patient care consistent with
  professional nursing standards supported by
  evidence-based studies

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Nurse Staffing by Patient Acuity (b) Definitions

• Reference source for other Act sections
• Specifies Act provisions apply to RNs only
• Modeled direct pt care definition w/HRCA
• Broadly defines
• acuity model - assessment tool
• nursing care committee in whole or in part
• Written staffing plan to guide assignment of
  nurse staff based on multiple considerations

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Nurse Staffing by Patient Acuity Act(c) Written
Staffing Plan

• Requires
• Hospital-wide to address inpatient population
• Recommended by a nursing care committee or
  committees
• Balances both patient and nurse considerations to
  yield appropriate resources for quality care
• Ongoing assessments by Unit manager (or designee)
  
• Strategy to meet unexpected surge in patient
  needs
• Allows hospital to select preferred acuity model
  best for each inpatient unit
• Public posting

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Nurse Staffing by Patient Acuity Act(d) Nursing
Care Committee

• Mandates
• Hospital appointed committee(s) See Definition!
• 50 RN direct care nurse input
• Advisory role that hospitals will give
  significant regard wt
• Voice on staffing levels, acuity model tools,
  written staffing plan
• Review staffing guidelines for all inpatient
  areas current acuity tools and measures
• Semi-annual review

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Nursing Care Committee

• Act definition
• Means an existing or newly created
  hospital-wide committee or committees of nurses
  whose functions, in part or in whole, contribute
  to the development, recommendation, and review of
  the hospitals staffing plan established pursuant
  to subsection (d)

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ADVOCACY Resources

• Your Voice is Critical!
• Tools
• www.ilga.gov
• www.ihatoday.org
• Breaking News
• Nurse Staff Laws
• Bill Summaries, Talking Points, Position Papers

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Questions

• Cathy Grossi
• cgrossi_at_ihastaff.org
• 630/276-5706