Safe Patient Limits

Each legislative session, our union fights to pass Safe Patient Limits across the state. This legislation would enact safe nurse to patient ratios in hospital settings throughout Illinois. Under current law in Illinois, there is no limit on how many patients an RN is responsible for.

HB 3338:

Will save lives by limiting the number of patients that can be assigned to a registered nurse, based on the level of care and designed to ensure safe and effective patient care.
Requires healthcare facilities to meet the safe patient limits without reducing other healthcare staff.
Covers acute-care hospitals, long-term acute-care hospitals, ambulatory surgery centers, freestanding emergency centers, and birth centers.
Safeguards nurses’ right to advocate in the exclusive interests of the patients under their care.
Protects nurse whistleblowers who speak out about assignments that are unsafe for the patient or nurse.
Authorizes both the Illinois Department of Public Health and the Attorney General to enforce RN patient limits.
Requires hospitals to annually develop safe staffing plans that meet the bill’s RN patient limits and provide for additional staffing based on individual patient care needs.
Would not interfere with the ability of hospitals to maintain an acuity system to determine staffing levels based on acuity, so long as the specific safe patient limits in the Act are met.
Requires that all registered nurses be trained, oriented, and meet competency requirements in a particular clinical setting in order to provide care in that setting.
Enacts fines for facilities that violate the safe patient limits, strongly deterring the attempt to save money by skirting the limits.

Safer for Nurses

OSHA cited understaffing in healthcare as a risk factor for workplace violence. Another published study found that the safe patient limits enacted in California reduced occupational illness and injury rates of nurses by over 30%. Notably, the nursing occupation currently generates more occupational injuries to working women than any other occupation.

Safer for Patients

With each additional patient assigned to an RN, the likelihood of a patient dying within 30 days of admission increases, and the odds of death due to treatable complications increases by 7% for each additional patient assigned. Inpatient mortality rates are 17% lower on surgical units with higher RN to patient ratios. As well as reducing preventable deaths, higher RN to patient ratios diminish adverse outcomes such as, but not limited to, hospital-acquired infections, pneumonia, shock, gastrointestinal bleeding, and cardiac arrest.

Safer for Hospitals

There is a nursing shortage in Illinois and elsewhere, which is linked to unrealistic workloads. Nurses and nurse managers agree that maximum patient ratios improve recruitment and retention of nurses. The average cost to a hospital of turnover for a bedside RN is $49,500. Each percentage change in RN turnover will either save or cost the average hospital $337,500.

The Ratios

4 patients to an RN in any acute care setting
2 critical care patients to an RN
3 stepdown/intermediate care patients to an RN
1 PACU patient under 18 years old to an RN
2 PACU patients 18 years or older to an RN
1 OR patient to an RN with at least 1 additional scrub assistant
3 ER patients to an RN
2 critical care ER patients to an RN
1 trauma ER patient to an RN
3 antepartum patients to an RN
2 antepartum patients requiring continuous fetal monitoring to an RN

1 active labor patient to an RN
1 immediate postpartum couplet to an RN with an additional RN for each baby in the case of multiple births
6 patients or 3 couplets to an RN postpartum
4 pediatric patients to an RN
4 psychiatric patients to an RN
4 medical or surgical patients to an RN
3 telemetry patients to an RN
4 observational patients to an RN
4 acute rehabilitation patients to an RN
4 specialty care patients to an RN

Learn the Facts

Fact #1

Illinois has no law limiting the number of patients a registered nurse (RN) can care for at one time. As a result, registered nurses are consistently required to care for more patients than is safe, compromising patient care and negatively impacting patient outcomes.

Fact #2

The number of patients an RN is required to care for varies considerably across Illinois hospitals. A study evaluating the 2020 Safe Patient Limits Act stated: “If Illinois enacted the Safe Patient Limits Act, our analysis suggests thousands of deaths per year could be avoided.” It added that if “nurses in Illinois hospital medical–surgical units cared for no more than four patients each… patients would experience shorter lengths of stay, resulting in cost-savings for hospitals” (Lasater).

Fact #3

A 2021 study found that “disparities in [in-hospital cardiac arrest] survival between black and white patients may be linked to the level of medical-surgical nurse staffing in the hospitals in which they receive care…”. The study also found “that the benefit of being admitted to hospitals with better staffing may be especially pronounced for black patients” (Carthon).

Fact #4

A 2015 study comparing occupational injury and illness rates before and after the California RN staffing ratios law was passed found that the law was associated with a 31.6 percent reduction in occupational injuries and illnesses among RNs working in hospitals in California (Leigh).

References

Aiken L., et al. 2010. Implications of the California Nurse Staffing Mandate for Other States. Health Services Research. 45(4):204-21. https://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2010.01114.x.

Carthon, M. B., et al. 2021. Better nurse staffing is associated with survival for Black patients and diminishes racial disparities in survival after in-hospital cardiac arrests. Medical care, 59(2), 169.

Lasater, K. B., et al. 2021. Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study. BMJ open, 11(12), e052899.

Leigh, J. P., et al. 2015 California’s Nurse-to-Patient Ratios Law and Occupational Injury. International Archives of Occupational and Environmental Health, 88(4) (pp. 477-484).

Texas Center for Nursing Workforce Studies. 2016. Hospital Nurse Staffing Study. https://www.dshs.texas. gov/chs/cnws/HNSS/2016/2016_HNSS_Vacancy-and-Turnover.pdf.