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
Statute effective date September 10, 2008
Nursing care committee convenes within 90 days after statute becomes effective or within 90 days after hospital begins treating patients December 9, 2008
Written nursing services plan shall be implemented within 90 days after nursing care committee convenes or on first day of FY if FY begins within 180 days after nursing care committee convenes March 9, 2009 or up to June7, 2009 if FY begins within 180 days of nursing care committee being convened
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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