SPRINGFIELD – Advocates for a law that would limit the number of patients each hospital nurse is allowed to care for at one time are touting a new national survey that suggests such a rule would lead to better working conditions for nurses and better care for patients.
But Illinois’ leading hospital lobby group remains solidly opposed to the idea, arguing it would result in the closure of many hospitals, especially in rural areas, and accelerate the already rising cost of health care.
The survey was conducted in 2018 by the group Nurses Take DC, a national organization that lobbies for stricter nurse-to-patient ratios. Two Illinois-based organizations, the Illinois Economic Policy Institute and the University of Illinois' Project for Middle Class Renewal, then took the results of that survey and produced a report on the differences between Illinois and California, which so far is the only state to impose nurse-to-patient ratio limits.
“By reducing patient-to-nurse ratios, enacting a safe patient limits law in Illinois could improve occupational safety, increase nurse retention rates, and promote better health outcomes for patients and have little to no negative impact on the financial performance of Illinois’ hospitals,” the Illinois groups said in their report.
Illinois has standards for nurse staffing that require hospitals to have a written plan based on the recommendation of one or more nursing care committees.
However, the survey found, only 29 percent of Illinois nurses who responded to the survey indicated their hospital has such a committee. And of those, fewer than half (44 percent), said their recommendations were being implemented in daily staffing decisions.
In addition, the survey found that Illinois nurses, on average, are responsible for 5.2 patients at a time, compared to 4.3 patients in California, and that only 18 percent of Illinois nurses considered the nurse-patient ratio to be “safe,” compared to 40 percent in California.
Authors of the Illinois report said stretching a nursing staff too thin can create workplace stress that ultimately results in higher turnover rates, compounding the state’s already-existing nursing shortage.
“Illinois nurses suffer from over-exertion, sprains, workplace violence, sexual harassment and other on-the-job risks,” Frank Manzo, policy director at the Illinois Economic Policy Institute, said in an interview. “And studies have shown that the best way to retain these professional workers is to either pay them competitive salaries for which they’re willing to take on those occupational hazards or to promote safe staffing standards that reduce those hazards while improving patient outcomes.”
A bill that would have imposed minimum nurse staffing levels for hospitals was debated in an Illinois House committee earlier this year.House Bill 2604, sponsored by Rep. Fred Crespo, D-Hoffman Estates, passed out of the Labor and Commerce Committee in March but was never voted on by the full House.
That's partly due to strong opposition from the Illinois Health and Hospital Association, which argued strongly against the bill.
“Mandatory nurse-staffing ratios will not improve patient outcomes or quality,” IHA spokesman Danny Chun said in a separate interview.
Chun said 33 California hospitals closed in the first seven years after implementation of the bill in 2004 while other hospitals were forced to reduce services and other non-nursing staff.
And he said the results would be “devastating” for rural hospitals in Illinois, many of which are already struggling financially.
But the biggest issue, he said, is that Illinois already suffers from a nursing shortage, which is projected to stand at 21,000 nurses in 2020. And that shortage is expected to get worse over the next five years when one-third of the existing nursing staff is expected to retire.
“Where are the additional nurses going to come from to meet the ratios?” Chun said.
Robert Bruno, director of the Project for Middle Class Renewal at the University of Illinois at Urbana-Champaign and a co-author of the report, countered by saying the shortage is due in part to the poor working conditions for nurses, and that improving those conditions would draw more people into the profession.
“They’re not organic,” Bruno said of labor shortages generally. “They’re almost always constructed due to some policy decisions, some choices that are being made, and the argument is that you can increase the number of people who would be interested in going into the training and into the profession, not just through compensation but also in improving working conditions.”
Chun, meanwhile, said a better way to address the nursing shortage would be to join a multi-state compact that would make it easier for nurses from other states to obtain an Illinois license, something he said nurses unions in Illinois have opposed in the past.
Although the staffing ratio bill stalled in the Illinois House during the regular session this spring, it is still alive for the upcoming veto session or the 2020 session.