Study urges patient limits to retain nurses

Illinois faces nurse shortage; UIUC-ILEPI study recommends Calif. model

Limiting the number of patients nurses have to care for improves hospital conditions and would help address a nurse shortage, according to a new study. (Shutterstock)

Limiting the number of patients nurses have to care for improves hospital conditions and would help address a nurse shortage, according to a new study. (Shutterstock)

By Ted Cox

Illinois faces a nurse shortage, and the key to solving it might be adopting patient-to-staff ratios already in place in California.

That’s the main finding of a new study released Monday by the Project for Middle Class Renewal at the University of Illinois at Urbana-Champaign and the Illinois Economic Policy Institute. “Do Nurse Staffing Standards Work? Evidence From a 2018 Survey of Registered Nurses” finds that working conditions for nurses in California are “dramatically superior” to what they face in Illinois.

“While past research has shown that Illinois faces a significant nurse shortage and retention problem, this survey directly links California’s safe-staffing law with dramatic improvements in the workplace environment and responsive patient care indicators,” said study co-author and UIUC Professor Emily E. LB. Twarog.

According to the study, California is the only state to have adopted patient limits. California mandated that there be at least one nurse for every two patients in intensive care, three patients in labor and delivery, four patients in pediatrics, five patients in medical-surgical units, and six patients in psychiatrics.

The new study draws on a survey of more than 9,000 nurses across the nation conducted last October by the grassroots group Nurses Take D.C. and finds that California produces “dramatically better” results in hospitals than in Illinois and elsewhere in the United States. It compares the responses of 331 California nurses to those of 508 Illinois nurses and finds that conditions are better for those in California on a range of issues.

The average nurse in California cares for 4.3 patients at a time, while in Illinois it’s 5.2 patients. Two-thirds of California nurses care for between one and four patients during a shift, but just 35 percent of Illinois nurses do. Almost half of California nurses, 47 percent, say staffing levels are based on patient needs, while just 32 percent of Illinois nurses feel the same. Forty percent of California nurses feel the patient-to-nurse ratio is safe, but only 18 percent of Illinois nurses do. Some 55 percent of California nurses fear retaliation if they report on staffing, but 61 percent of Illinois nurses fear retaliation as whistleblowers.

“As the only state with safe patient limits, California’s staffing standards and workplace safety have fostered an environment where more nurses feel that staffing is based on the needs of patients and more nurses feel that the patient-to-nurse ratio is safe,” the study stated. “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’s hospitals.”

State Rep. Fred Crespo of Hoffman Estates and state Sen. Cristina Castro of Elgin have both submitted legislation this year — House Bill 2604 and Senate Bill 1908 — to set patient limits for nurses, but the legislation failed to advance this spring in the General Assembly.

Instead, in Illinois adequate staffing levels are set by the Nurse Staffing by Patient Acuity Amendment to the Hospital Licensing Act of 2008, which requires hospitals to create a written staffing plan based on the recommendation of one or more “nursing care committees.” Yet, less than 29 percent of the Illinois nurses surveyed “reported having such a committee,” according to the study, “and more than half said the committee’s recommendations are not implemented in determining daily staffing levels.”

“This survey makes clear that Illinois’s existing nurse staffing guidelines are either not effective or not enforceable, or both,” Twarog said.

This survey makes clear that Illinois’s existing nurse staffing guidelines are either not effective or not enforceable, or both.
— University of Illinois Professor Emily E. LB. Twarog

Hospitals and other health-care firms have lobbied against staffing limits, saying they would be too costly. The Illinois Health and Hospital Association has projected that nurse staffing limits would require the hiring of an additional 20,000 nurses statewide, at a cost of $2 billion.

Yet an ILEPI study released this spring found that it would also provide benefits to health care and to hospitals’ bottom line, in that it would reduce nurse turnover, lower the injury rate, and improve patient-care costs that would actually erase about $1.4 billion of that investment. Improving conditions for nurses would also help to retain people in the field and reduce the statewide nurse shortage.

“Prior research has linked Illinois’s ongoing nurse shortage and retention problems to a variety of occupational hazards associated with staffing levels,” said study co-author Frank Manzo IV, ILEPI policy director. “At the same time, improved staffing levels have been found to lower mortality, lower hospital readmission rates, reduce patient time spent in high-cost hospital units, and reduce injury and turnover rates among nurses. These savings alone offset 75 percent of the cost of hiring the additional nurses that Illinois hospital administrators say they’d need to comply with a safe-patient-limits law.”

UIUC Professor Robert Bruno, head of the Project for Middle Class Renewal, said the findings of the survey were “unambiguous” in calling for Illinois to adopt nurse staffing levels.