Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 250 - HOSPITAL LICENSING REQUIREMENTS › Subpart I - NURSING SERVICE AND ADMINISTRATION › Section 250.1130 - Nurse Staffing by Patient Acuity

Current through Register Vol. 48, No. 28, July 12, 2024
a) As used in this Section, the following
				definitions apply:
"Acuity Model" - means assessment tool selected and
				  implemented by a hospital, as recommended by a nursing care committee, that
				  assesses the complexity of patient care needs requiring professional nursing
				  care and skills and aligns patient care needs and nursing skills consistent
				  with professional nursing standards.
"Direct Patient Care" - means care provided by a
				  registered professional nurse with direct responsibility to oversee or carry
				  out medical regimens or nursing care for one or more patients.
"Nursing-sensitive Care Performance Measure" - means data
				  that examine nursing contributions to inpatient hospital care, including, but
				  not limited to, the data collected and analyzed under the Hospital Report Card
				  Act, the Illinois Adverse Health Care Events Reporting Law of 2005, and the
				  National Database for Nursing Quality Indicators. The National Database for
				  Nursing Quality Indicators may be accessed at
https://www.pressganey.com/products/clinical-excellence/national-database-nursing-quality-indicators
.
				  Hospitals are not required to subscribe to the database.
"Nursing Care Committee" - means a hospital-wide
				  committee or committees of nurses whose functions, in part or in whole,
				  contribute to the development, recommendation, and review of the hospital's
				  nurse staffing plan established pursuant to subsection
(b). (Section
				  10.10(b) of the
				  Act)
"Patient Acuity" - means the complexity of patient care needs
				  requiring the skill and care of a nurse, which is addressed when aligning
				  nursing resources and professional practice standards as part of the patient's
				  treatment plan.
"Registered Professional Nurse" - means a person
				  licensed as a Registered Nurse under the
Nurse Practice Act.
"Written Staffing Plan for Nursing Care Services" -
				  means a written plan for the assignment of patient care nursing staff based on
				  multiple nurse and patient considerations that yield minimum staffing levels
				  for inpatient care units and the adopted acuity model aligning patient care
				  needs with nursing skills required for quality patient care consistent with
				  professional nursing standards.
(Section
				  10.10(b) of the
				  Act)
b)
Written
				Staffing Plan
1)
Every
				hospital shall implement a written hospital-wide staffing plan, prepared by a
				nursing care committee or committees, that provides for minimum direct care
				professional registered nurse-to-patient staffing needs for each inpatient care
				unit, including inpatient emergency departments.
2)
If the staffing plan prepared by
				the nursing care committee is not adopted by the hospital, or if substantial
				changes are proposed, the chief nursing officer shall either provide a written
				explanation to the committee of the reasons the plan was not adopted or provide
				a written explanation of any substantial changes made to the proposed plan
				prior to it being adopted by the hospital.
3)
The written hospital-wide staffing
				plan shall include, but need not be limited to, the following
				considerations:
A)
The
				complexity of complete care, assessment on patient admission, volume of patient
				admissions, discharges and transfers, evaluation of the progress of a patient's
				problems, ongoing physical assessments, planning for a patient's discharge,
				assessment after a change in patient condition, and assessment of the need for
				patient referrals;
B)
The complexity of clinical professional nursing judgment needed to
				design and implement a patient's nursing care plan, the need for specialized
				equipment and technology, the skill mix of other personnel providing or
				supporting direct patient care, and involvement in quality improvement
				activities, professional preparation
(credentials)
, and
				experience;
C)
Patient acuity and the number of patients for whom care is being
				provided;
D)
The
				ongoing assessments of a unit's patient acuity levels and nursing staff needed,
				routinely made by the unit nurse manager or his or her designee;
and
E)
The identification
				of additional registered nurses available for direct patient care when
				patients' unexpected needs exceed the planned workload for direct care
				staff
and the process to add additional staff
.
(Section 10.10(c) of the
				Act)
F) The process for submitting
				the nursing care committee's recommendations to hospital; and
G) The process for providing feedback to the
				nursing care committee from the hospital administration regarding unresolved or
				ongoing issues.
4) A
				written staffing plan shall consider the time required for nursing staff
				documentation of patient care.
5)
In order to provide staffing flexibility to meet patient needs, every
				hospital shall identify an acuity model for adjusting the staffing plan for
				each inpatient care unit.
6)
Each hospital shall implement the
				staffing plan and assign nursing personnel to each inpatient care unit,
				including inpatient emergency departments, in accordance with the staffing
				plan.
A)
A registered nurse
				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.
B)
Shift-to-shift adjustments in
				staffing levels required by the staffing plan may be made by the appropriate
				hospital personnel overseeing inpatient care operations. If a registered nurse
				in an inpatient care unit objects to a shift-to-shift adjustment, the
				registered nurse may submit a written report to the nursing care
				committee.
C)
The
				nursing care committee shall develop a process to examine and respond to
				written reports submitted under
subsections (b)(6)(A) and
				(b)(6)(B)
, including the ability to determine if a specific written
				report is resolved or should be dismissed.
(Section
				10.10(c)(2.5)
				of the Act)
7)
The written staffing plan shall be posted, either by physical or
				electronic means, in a conspicuous and accessible location for both patients
				and direct care staff, as required under the Hospital Report Card Act. A copy
				of the written staffing plan shall be provided to any member of the general
				public upon request.
(Section
				10.10(c)(3) of
				the Act)
8) In addition to the
				hospital providing a copy of the written staffing plan per subsection (b)(6),
				the hospital shall allow members of the public to schedule an appointment with
				the Chief Nursing Officer or their designee to review the staffing plan and
				address any questions.