[brian]

Nurses at the University of Illinois Medical Center will decide how many nurses are needed according to patient acuity as part of their new contract between the Illinois Nurses Association and the University of Illinois Medical Center. This decision is a first in the City of Chicago, and is a precedent setting decision in the Nation.

"Other unions have talked about this, but INA is the first to make it happen," said Tom Renkes, eecutive drector of the Illinois Nurses Association.

"Nurses need to decide what is safe staffing for the patients in their care, by choosing our own ratios, we will provide the best patient care' said Roberta LaMonica RN, member of the INA Negotiating Team at UIC.

"The Illinois Nurses Association achieved the contract by focusing on the needs of both the nurses and the patients. Acuity based staffing was only one of many gains our nurses saw in this contract," said LaMonica.

"This contract represents the collaborative efforts of the medical center and the INA to implement a nursing model that enhances patient safety and a positive work environment for our nurses," said Barbara Vela, chief nursing officer at the University of Illinois Medical Center. "The medical center has championed acuity based staffing and an evenly distributed workload and we strive to serve as a leader for hospitals across the nation."

As many hospitals across the country try to stretch their nurses to dangerous limits, the nurses at University of Illinois Medical Center are planning to implement a Synergy system. This system allows nurses to take into account the actual level of care that a patient needs when making staffing decisions.

Nurses working in a hospital setting are usually staffed according to pre set benchmarks, assigning one nurse to as many as ten patients on a medical unit for example. Patients are seeking care later, and often after their symptoms have exacerbated to a point where they can no longer cope. This delayed care results in patients being admitted more acutely ill, requiring nurses to be more vigilant to keep the patient's condition from worsening. When hospitals only look at numbers, nurses are left overworked and patient care is negatively affected.

"Illinois Nurses Association's contract with the Medical Center will change the way nursing care is delivered in Illinois, and probably in the entire country," Renkes said.
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The Illinois Nurses Association is the largest nurses association and representative of nurses in collective bargaining in the state of Illinois. INA works to improve the practice of nursing and the working environment of all nurses throughout Illinois.

[oramar]

Wow!

[beepeadoo]

I'm not surprised. My sister was at UIC this past summer for a cavernous angioma. The level of care, across the board, top to bottom, was exceptional.

[traumaRUs]

I live in downstate IL and UIC has a great reputation and this is only going to improve it.

[ocankhe]

Does anyone have a link to the actual contract language, or can cut and paste the actual contract language for all to see?

[star0910]

I live in nw IN and I've heard amazing stories about UIC. If you get a job there and live in IN, usually you have some jealous friends!

[lee1]

Many hospitals will tell you that they staff by acuity as some STATE LAWS require this. HOWEVER, what I want to know is HOW they are figuring out the acuity??? Especially on a shift by shift basis. Do they have some kind of electronic data that backs them up or is it just a supervisory determination on top of their already determined FTE ratios. THEN, where do extra nurses come from ??? Are they floating nurses all over the place???

Patient classification/acuity systems are NOT that easy to come by. Where did they get theirs??? Did they make it up themselves???

[lee1]

Anyone have any answers???

[Sheri257]

Originally Posted by lee1

Many hospitals will tell you that they staff by acuity as some STATE LAWS require this. HOWEVER, what I want to know is HOW they are figuring out the acuity??? Especially on a shift by shift basis. Do they have some kind of electronic data that backs them up or is it just a supervisory determination on top of their already determined FTE ratios. THEN, where do extra nurses come from ??? Are they floating nurses all over the place???

Patient classification/acuity systems are NOT that easy to come by. Where did they get theirs??? Did they make it up themselves???

Originally Posted by lee1

Anyone have any answers???

Apparently they're going to be using this "synergy model", developed by the American Association of Critical Care Nurses, to evaluate and assign patients based on acuity. Some company is also selling it and they claim it's been used with 1,500 nurses.

http://www.aacn.org/certcorp/certcor...sic%20Informat

http://findarticles.com/p/articles/m...15577#continue

Although, after reading some of this, it's still not clear to me how this would actually work. But it seems to like they would need extra nurses or, what they call "partners."

"In allocating the 3 roles, a greater number of partner and senior partner nurses may be needed in critical care areas where patients have highly complex needs and a comparably high level of knowledge and skills to meet them," Cox said.

So I guess you would have to have floaters, or something like that.

Our California ratio law doesn't address acuity but, what one hospital in my area has done is create a team of two ICU or similarly trained nurses who are on call during the entire shift to help intervene when patient acuity levels are worsening, before they start crashing all together. From what I understand, it's reduced code blues by something like 80 percent. Maybe that's what they talking about or ... something similar, I dunno.

[pickledpepperRN]

Actually the California Ratio LAW AB 394 which passed in 1999 required increased staffing by acuity.
Before that in 1996 the regulations required the hospital to staff according to a patient classification system.

Here is language of the current regulations. Acuity starts on page 7:
http://www.dhs.ca.gov/lnc/pubnotice/...ation_Text.pdf

...In addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements. The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, licensed psychiatric technicians, who shall be assigned to direct patient care. Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:

(1) Individual patient care requirements.

(2) The patient care delivery system.

(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.

(c) A written staffing plan shall be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan shall be developed and implemented for each patient care unit and shall specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel. In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a). The plan shall include the following:

(1) Staffing requirements as determined by the patient classification system for each unit, documented on a day-to-day, shift-by-shift basis.

(2) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.

(3) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.

(d) In addition to the documentation required in subsections (c)(1) through (3) above, the hospital shall keep a record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments to individual patients by licensure category, documented on a day-to-day, shift-by-shift basis. The hospital shall retain:

(1) The staffing plan required in subsections (c)(1) through (3) for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey process, and

(2) The record of the actual registered nurse, licensed vocational nurse and licensed psychiatric technician assignments by licensure category for a minimum of one year.

(e) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.

(f) At least half of the members of the review committee shall be registered nurses who provide direct patient care.

(g) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.

(h) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.

(i) The administrator of nursing services shall not be designated to serve as a charge nurse or to have direct patient care responsibility, except as described in subsection (a) above.

(j) Registered nursing personnel shall:

(1) Assist the administrator of nursing service so that supervision of nursing care occurs on a 24-hour basis.

(2) Provide direct patient care.

(3) Provide clinical supervision and coordination of the care given by licensed vocational nurses and unlicensed nursing personnel.

(k) Each patient care unit shall have a registered nurse assigned, present and responsible for the patient care in the unit on each shift.

(l) A rural General Acute Care Hospital as defined in Health and Safety Code Section 1250(a), may apply for and be granted program flexibility for the requirements of subsection 70217(i) and for the personnel requirements of subsection (j)(1) above.

(m) Unlicensed personnel may be utilized as needed to assist with simple nursing procedures, subject to the requirements of competency validation. Hospital policies and procedures shall describe the responsibility of unlicensed personnel and limit their duties to tasks that do not require licensure as a registered or vocational nurse.

(n) Nursing personnel from temporary nursing agencies shall not be responsible for a patient care unit without having demonstrated clinical and supervisory competence as defined by the hospital's standards of staff performance pursuant to the requirements of subsection 70213(c) above.

(o) Hospitals which utilize temporary nursing agencies shall have and adhere to a written procedure to orient and evaluate personnel from these sources. Such procedures shall require that personnel from temporary nursing agencies be evaluated as often, or more often, than staff employed directly by the hospital.

(p) All registered and licensed vocational nurses utilized in the hospital shall have current licenses. A method to document current licensure shall be established.

(q) The hospital shall plan for routine fluctuations in patient census. If a healthcare emergency causes a change in the number of patients on a unit, the hospital must demonstrate that prompt efforts were made to maintain required staffing levels. A healthcare emergency is defined for this purpose as an unpredictable or unavoidable occurrence at unscheduled or unpredictable intervals relating to healthcare delivery requiring immediate medical interventions and care.