Nurse Staffing In Ohio

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Nurse Staffing In Ohio

• A Toolkit for Implementing HB 346
• (ORC 3727.50 to 3727.57)

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Learning Objectives

• After attending this session the participant will
  be able to
• Describe the role of the Chief Nursing Officer
  (CNO) in implementing the requirements of HB 346.
• Describe the duties of the staffing committee as
  required in HB 346.
• Describe the role of direct care nurses in
  implementing HB 346 and contributing to the
  development and once a year review of the
  hospital-wide nursing services staffing plan.

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Learning Objectives

• Identify methods to aid in successful committee
  process.
• Articulate key metrics and definitions for
  developing a nursing services staffing plan.

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The California Experience

• Mandatory RN to patient ratios implemented in
  2004 after legislation passed and became law in
  1999
• Key provisions
• Hospital must be in continuous compliance
• Hospital must utilize patient classification
  system staff to required ratios when system
  requires
• Hospital must develop a written staffing plan for
  each patient care unit that specifies staffing
  levels for RNs and other licensed and unlicensed
  staff

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The California Experience

• Hospital must maintain detailed documentation of
  assigned nurses by licensure category on
  shift-by-shift basis
• No more than 50 of licensed nurses can be
  comprised by LVNs
• RN only in Neonatal ICU, ED and OR

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California Ratios
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Reported California Outcomes

• 1st study - pre mandated ratios
• A Response to Californias Mandated Nursing
  Ratios, Bolton, Jones, Aydia, Donaldson, Brown,
  Lowe, McFarland and Haims, in June 2001 J.
  Nursing Scholarship
• 2nd Study 1st year after implementation
• Impact of California Licensed Nurse-patient
  Ratios on Unit Level Nurse Staffing and Patient
  Outcomes Donaldson, Bolton, Aydin, Brown,
  Elashoff, Sandhu in Aug 2005 Policy, Politics and
  Nursing Practice
• 3rd Study 2 years post implementation
• Mandated Nurse Staffing Ratios in California A
  Comparison of Staffing and Nursing-Sensitive
  Outcomes Pre- and Post regulation Bolton, Aydin,
  Donaldson, Brown, Sandhu, McFarland, Aronow in
  November 2007 Policy, Politics and Nursing
  Practice

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Ohio Safe Nurse Staffing Legislative History

• Substitute HB 346 was introduced by Rep. Jim
  Hughes
• HB 346 is a result of collaborative efforts
  between the founders of the Nursing 2015
  initiative
• The Ohio Hospital Association
• The Ohio Nurses Association
• The Ohio Organization of Nurse Executives
• Signed by Gov. Strickland on June 12, 2008
• Statute effective date is September 10, 2008

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Statute Implementation Timeline
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Statute 3727.50 Definitions

• Direct patient care care provided by a nurse
  with direct responsibility to carry out medical
  regimens or nursing care for one or more
  patients.
• Inpatient care unit - hospital unit, including
  operating room or other inpatient care are, in
  which nursing care is provided to patients who
  have been admitted to the hospital.
• Nurse a person who is licensed to practice as
  a registered nurse under Chapter 4723. of the ORC
  or, if hospital employs LPNs, a person licensed
  to practice as a licensed practical nurse under
  that chapter.

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3727.51 Establishment of hospital-wide nursing
care committee

• Convene committee within 90 days of statute
  effective date (9-10-08)
• Hospital will select committee members
• CNO shall be a member
• Minimum 50 of members shall consist of direct
  care nurses
• All types of nursing care services must be
  represented by direct care nurses
• CNO must have mechanism for obtaining input from
  all direct care inpatient nurses

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Sample Nursing Care Committee Composition
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Obtaining Input from Direct Care Nurses

• Surveys
• Pencil and paper
• Online
• Utilize committee members to design
• Unit specific staff meetings
• Open staff forums
• Open office hours
• Solicit emails from nurses
• Unit rounds

• Post drafts online for nurses to review and
  respond to
• Ask members of committee to hold unit meetings to
  discuss plan development
• Seek suggestions from Public Relations,
  Communications or Human Resources

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3727.52 Committee Charge

• Evaluate hospitals current nursing services
  staffing plan if one exists or
• Recommend a nursing services staffing plan
  consistent with current standards established by
  private accreditation organizations or
  governmental entities and addresses all of the
  following
• Selection, implementation and evaluation of
  minimum staffing levels for all inpatient units
  that ensure that the hospital has a staff of
  competent nurses with specialized skills needed
  to meet patient needs in accordance with
  evidence-based safe nurse staffing standards

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3727.52 Committee Charge

• The complexity of complete care,
• assessment on patient admission,
• volume of patient admissions,
• discharges and transfers,
• evaluation of the progress of a patients
  problems,
• the amount of time needed for patient education,
• ongoing physical assessments,
• planning for a patients discharge,
• assessment after a change in patient condition,
  and
• assessment of the need for patient referrals

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3727.52 Committee Charge

• Patient acuity and the number of patients for
  whom care is being provided
• The need for ongoing assessments of a units
  patients and its nursing staff levels
• The hospitals policy for identifying additional
  nurses who can provide direct patient care when
  patients unexpected needs exceed the planned
  workload for direct care staff.

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3727.53 Evidence-based staffing plan

• Each hospital shall create an evidence-based
  written staffing plan guiding the assignment of
  nurses hospital-wide.
• Staffing plan must be implemented within 90 days
  after the hospital-wide nursing care committee is
  convened, except
• If hospitals next fiscal year starts within 180
  days after date committee was convened the plan
  can be delayed in implementation until the next
  fiscal year starts.

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3727.53 Evidence-based staffing plan

• Staffing plan created under this provision shall,
  at a minimum, reflect current standards
  established by private accreditation
  organizations or governmental entities
• The plan shall be based on multiple nurse and
  patient considerations that yield minimum
  staffing levels for inpatient care units that
  ensure that the hospital has a staff of competent
  nurses with specialized skills needed to meet
  patient needs including
• Recommendations of the committee shall be given
  significant considerations

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3727.54 Annual Review

• At least once per year the hospital-wide nursing
  care committee shall do the following
• Review how the most current nursing services
  staffing plan does all of the following
• Affects inpatient care outcomes
• Affects clinical management
• Facilitates a delivery system that provides, on a
  cost-effective basis, quality nursing care
  consistent with acceptable and prevailing
  standards of safe nursing care and
  evidenced-based guidelines established by
  national nursing organizations.
• Make recommendations, based on the most recent
  review conducted, regarding how the most current
  nursing services staffing plan should be revised,
  if at all.

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3727.55 Adjusting Staffing Plan

• To provide flexibility to meet patient needs,
  every hospital shall identify a model for
  adjusting the nursing services staffing plan for
  each inpatient care unit.

• Short term Flexibility
• Shift-to-shift or day-to-day
• Voluntary overtime
• Float Pools
• In-house per diem staff
• Short term agency
• Staff floating

• Longer term flexibility
• New services or changes in patient types,
  expansion of beds
• What process would be used to evaluate staffing
  levels to determine if staffing resources require
  adjustment

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3727.56 Plan distribution

• Hospital shall provide copies of its nursing
  services staffing plan in accordance with both of
  the following
• A copy of the staffing plan and subsequent
  changes to the plan shall be provided to each
  member of the hospitals nursing staff free of
  charge.
• The staffing plan shall be provided to any person
  who requests it for a fee not to exceed actual
  copying costs.
• A notice shall be posted In a conspicuous
  location in the hospital informing the public of
  the availability of the staffing plan that
  specifies the appropriate person, office or
  department to be contacted to review or obtain a
  copy of the staffing plan.

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3727.57 Collective Bargaining

• Nothing in these sections shall be construed to
  limit, alter, or modify any of the terms,
  conditions, or provisions of a collective
  bargaining agreement entered into by a hospital.

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Questions