Safe Staffing in Illinois: Not Over Yet

Melissa Mills, BSN

Legislation to set maximum nurse-to-patient staffing ratios is a hot topic these days. Currently, California is the only state to enforce a staffing ratio mandate. However, several other states have some sort of legislation in place regarding safe staffing. The laws vary from telling the hospitals they must have committees to set the ratios to have standards for specific nursing units.

Last week, nurses across the state of Illinois were hopeful that their state would join the ranks of California and become a state which placed patient and nurse safety as a priority. The Safe Patient Limits Act, House Bill 2604, was before lawmakers to mandate how many patients could be assigned to one nurse, depending on the setting. The bill would require med-surg units to only assign up to four patients to each nurse, three-to-one assignments in intermediate care units, and intensive care units would be limited to two patients per nurse. The bill has similarities to the California law that was passed in 2004. However, HB 2604 was the first of its kind to provide minimum staffing ratios for ambulatory surgical centers and long-term acute hospitals, too. The bill passed through a committee, then stalled in the final week of session. Ultimately, it never came to a full vote before the House.

Alice Johnson, executive director of the Illinois Nurses Association, told Herald & Review in a recent article, "Of course we want to see the bill passed into law because we know it's going to save lives, but we're looking at it like....it's not the law yet. We're going to keep advocating and keep working on this until we get it done.”

The Opposition

Hospital administrators across the state weren't supportive of the proposed legislation. Many felt that hiring more nurses to meet the mandated ratios would strap the hospitals financially. Danny Chun, a spokesman for the Illinois Health and Hospital Association, told Herald & Review that the bill could cause some hospital units to close and negatively impact patient care. Chun also called the bill a "one-size-fits-all" approach that wouldn't meet the needs of the different hospital settings across the state.

The interesting thing about this position is that without nurses, hospitals would be more than financially strapped to provide care. These healthcare facilities would be without care. Nurses are the epitome of patient care, and without them, hospitals are nothing more than a large building where people who are ill, recovering, and dying would go to commiserate in the knowledge that nobody is there to do the hard work that must be done 24-7.

The Support

If you're like 99% of the nurses I know, you probably went into nursing intending to help others. Maybe you wanted to help the sick, be there to support new moms as they deliver babies, or ease the discomforts of death for people as they die. Regardless of why you went into nursing or where you work now, you should support nursing staff ratios.

Inadequate nurse to patient ratios create adverse outcomes for patients. It can also prolong hospital stays and increase the risk of hospital-related complications, including death. Adequate staffing has shown to decrease the following:

Medication errors
Hospital readmissions
Length of stay
Preventable adverse events
Cost of care

One of the most comprehensive studies that support safe staffing compared hospitals in California, who have mandates on staffing, to hospitals in Pennsylvania and New Jersey. This study came out in 2010 and reviewed data from 22,336 nurses in all three states in 2006, as well as the state hospital discharge databases. It also compared nurse workloads and patient outcomes. The facilities in California boasted better health outcomes for similar patients, lower surgical mortality rates, and fewer inpatient deaths within 30 days of admission.

Along with this study and others, several organizations support safe staffing initiatives, too, although they don't all agree on how to achieve this. A few of these organizations include the America Nurses Association, many state nursing organizations, NursesTakeDC, and the Department for Professional Employees, AFL-CIO (DPE).

Nurses on the Move

This isn't the last lawmakers in Illinois will hear about HB 2604. Johnson said that there are plans to meet with lawmakers this Summer to provide more education on the impact of the bill. They will work with the sponsors to get it back in front of the session this fall or at the start of 2020, if necessary.

If you take a look at the Illinois Nurses Association facebook page, you'll notice that the support of nurses doesn't seem to have waned in light of last week's events. The active nursing advocacy group isn't only worried about staffing ratios, but they continue to support other issues in Illinois like the Howard Brown Health employees who are fighting for a fair labor contract.

How to Get Involved

If you're interested in helping nursing initiatives in your state and across the country, there are a few ways you can get involved. Look up your state nursing association or search for their social media page on facebook. You can also join movements supported by national organizations like NursesTakeDC to stay up-to-date.

Do you have any other unique ways to move staffing ratios forward in your state or facility? I would love to hear how you support this critical healthcare issue.

Safe Staffing in Illinois: Not Over Yet

The Opposition

The Support

Nurses on the Move

How to Get Involved

About Melissa Mills, BSN

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