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Illinois Nurses, Hospital CEOs At Odds Over Patient Limits

Presidencia de la República Mexicana - Flickr / CC-by 2.0

Illinois lawmakers are being asked to decide whether nurses are dangerously overworked — and what to do about it.

Nurses want limits on how many patients they’re assigned. They argue it would improve patient outcomes and workplace safety. But opponents counter a “one size fits all” approach will not work.

Legislation being considered in the Illinois House would limit hospital nurses to four patients or less. That number would be lower in certain areas, like maternity wards, intensive care units and emergency rooms.

Credit Dana Vollmer / NPR Illinois
Dana Vollmer / NPR Illinois
Nursing advocates held a press conference on Feb. 27 in support of mandated nurse-to-patient ratios. Pictured here with state Rep. Theresa Mah (D-Chicago).

Doris Carroll is vice president of the Illinois Nurses Association. She told lawmakers about one nurse’s experience working alone in the ER.

“She had a waiting room full of 30 people. A woman was on the floor in terrible abdominal pain,” she said. “Next thing she saw a man walking through the door — an elderly man — who was clutching his chest. So she made the decision, because she felt this man was critical and was having a heart attack. And she was right. When she came back, that woman was dead.”

Carroll said the patient could have been saved if more nurses were present.

But hospital administrators argue it’s not that simple.

“There is no conclusive evidence that these one size fit all nurse staffing ratios actually improve patient outcomes or the quality of care,” said A.J. Wilhelmi, with the Illinois Hospital Association.

He said not every hospital has the same resources, and the legislation does not include funding to hire more nurses.

“About 42 percent of our hospitals are currently operating at a negative or very thin margin of less than two percent,” he said.

Wilhelmi said the plan would drive up healthcare costs by more than $2 billion a year — which would be especially burdensome for safety-net and critical-access hospitals, like Touchette Regional Hospital in Centreville, where Sulbrena Day is the CEO.

“Touchette is highly dependent upon the Medicaid program, which has historically and currently been a low and slow payer,” she said. “Two-thirds of our patients are covered by Medicaid. With the expansion of Medicaid managed care, our financial challenges have only worsened.”

Day told lawmakers her hospital is already expected to lose $1.4 million this year. She said adding another unfunded mandate could force them to cut services, including care to the homeless and dental anesthesia for people with developmental disabilities.

Hospital administrators also said strict ratios would hamper their flexibility in assigning nurses where they’re needed most.

That could be made even more challenging by the nursing shortage. The IHA said Illinois is expected to be down 21,000 nurses by next year.

Marti Smith is with National Nurses United. She used to work as a nurse in California, the only state with mandated nurse-to-patient ratios.

“Our experience in California shows that if you build it, they will come,” she said. “The number of actively licensed RNs increased by more than 90,000...almost seven times more than the total number state health officials said would be needed to meet the ratios for the general medical surgical units.”

Advocates argue that safe patient ratios would help Illinois attract and keep more nurses by improving working conditions and preventing burn-out.

Alice Johnson is with the Illinois Nurses Association.

“Not only do nurses face economic insecurity by the practice of low censusing, being sent home without pay and having to use their own benefit time,” Johnson said, “but they also face serious issues of workplace violence and occupational injury.”

Still, hospital administrators said they’re the ones who are best equipped to make staffing decisions.

Current law requires hospitals to take recommendations from a staffing committee that’s at least half nurses. But it doesn’t require them to implement the plan as recommended.

Under the legislation being considered, hospitals could be fined up to $25,000 for violating the proposed nurse-to-patient ratios.

The legislation is House Bill 2604.

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