Research in California and other states shows that mandatory limits on the number of patients a registered nurse can care for at any one time would help reduce the nursing shortage in Illinois and improve patient care, a new report says.
What the Illinois Economic Policy Institute calls “safe patient limits” for nurses — a concept in a bill pending in the Illinois General Assembly that is strongly opposed by hospital officials statewide — would result in less-stressful working conditions for nurses and higher employee retention rates, according to the recently released report from the institute.
Illinois lawmakers also could address the shortage by taking steps to encourage unionization by nurses, said Robert Bruno, one of the report’s authors and a professor at the University of Illinois at Urbana-Champaign’s School of Labor and Employment Relations.
He said union contracts covering nurses are “connected to higher nursing satisfaction and higher and more-positive patient outcomes.”
Union contracts cover 17 percent of RNs in Illinois.
Another author of the report, Jill Manzo, Midwest researcher for the LaGrange-based institute, said, “Our study finds that the way to retain these professional workers is to pay them a competitive salary … and promote safe-staffing ratios or safe-patient limits to reduce occupational hazards for nurses while also improving patient outcomes and saving lives.”
Institute policy director Frank Manzo IV, who is Jill Manzo’s brother, said unionization also would boost RN pay in a state where these professionals are relatively underpaid.
In Illinois, nurses with bachelor’s degrees earn $66,401 per year, or 1.7 percent more than the average Illinois full-time worker with a bachelor’s, according to the report. Nationwide, RNs earn an average of 12.9 percent more than the average full-time worker with similar educational attainment, the report says.
A spokesman for the Illinois Health and Hospital Association cast doubt Wednesday on the report’s conclusions and noted that the not-for-profit Economic Policy Institute, which considers itself nonpartisan, includes on its board Alice Johnson, executive director of the Illinois Nurses Association.
The nurses association, a union representing nurses, is one of the groups pushing to pass House Bill 2604, the legislation that would set minimum staffing ratios and fine hospitals up to $25,000 per day for violating the law.
A vote in a House committee on the bill had been scheduled for this week but has been postponed until next week.
Institute spokesman Todd Stenhouse said Johnson’s participation on the board didn’t shape the report, which has been in the works for six to nine months.
HB 2604 would require one registered nurse for every four “medical and surgical” patients, one nurse for every three “intermediate-care” patients, and one nurse for every two “critical-care” or “intensive-care” patients.
After minimum nurse-staffing ratios were adopted in 2004 in California — the only state that mandates such minimum staffing levels — the likelihood of inpatient deaths within 30 days of hospital admission dropped, and the time spent in intensive-care units dropped by 24 percent, the report said, quoting studies from 2007 and 2010.
Another study mentioned in the report looked at hospitalized patients with pneumonia and showed that California had statistically lower rates of readmission than Massachusetts or New York because of higher levels of RN staffing.
The IHA disputes such studies and points to a 2018 report by the Massachusetts Health Policy Commission — a part of Massachusetts state government — that says California’s mandated minimum RN staffing ratios resulted in “no systematic improvement in patient outcomes.”
A ballot measure to impose nurse-staffing mandates in Massachusetts was soundly defeated in 2018.
The IHA says mandated ratios would “threaten financially struggling hospitals” and create “real barriers to hospitals and health systems as they work to best serve their patients and communities without improving patient outcomes or quality of care.”
California’s government hasn’t conducted its own studies of the impact of staffing ratios on patient care or costs to health-care providers, according to the California Department of Public Health.
Marsha Prater, chief nursing officer for Memorial Health System, which operates 500-bed Memorial Medical Center, said the Springfield-based system and hospital are constantly hiring more nurses.
The hospital’s staffing goals are at or near the levels mentioned in HB 2604, she said. But mandated ratios would be too rigid, create unnecessary waits for admitting new patients in certain parts of the hospital and not guarantee better care, she said.
“At this point, there is no preponderance of the evidence that says that conclusively, this is the ‘magic bullet,’” Prater said.
She disputed statements that unionization leads to better nurse retention rates or better patient care.
Memorial Medical Center’s 1,000 RNs aren’t unionized; the 850 RNs at 415-bed HSHS St. John’s Hospital aren’t unionized, either.
David Beach, chief human resources officer for Hospital Sisters Health System, said mandated staffing ratios would hamstring St. John’s Hospital leaders.
“We want to do what’s best for the patient and the staff,” he said.
Beach said St. John’s offers competitive salaries for nurses, but salaries aren’t the only tool for creating a top-quality workforce.
State Rep. Fred Crespo, D-Hoffman Estates, lead sponsor of HB 2604, said hospitals could afford mandatory staffing ratios. One option would be to reduce excessive administrative salaries, he said.
Patients would be better served, and nurses would be less stressed out and happier with enforced minimum staffing levels, he said.
“It’s to make this job more appealing,” said Crespo, noting that his wife of 32 years is a nonunion nurse. “It’s a very demanding job. Money should be going down to the people doing the real work.”
When asked Gov. J.B. Pritzker’s views on the nurse-staffing proposal, Jordan Abudayyeh, the Democrat’s spokeswoman, said in an email, “The governor is committed to ensuring people across the state receive quality health care and looks forward to reviewing the bill.”
Contact Dean Olsen: firstname.lastname@example.org,788-1543, twitter.com/DeanOlsenSJR.
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March 20, 2019 at 08:26PM