Image from Flickr, COD Newsroom (2013).

REPORT: Safe Patient Limits and Unions Could Help Cure Illinois Nurse Shortage

La Grange:  Illinois projects that it will need to grow its supply of Registered Nurses (RNs) at three times the rate of other occupations, and a new report released today by the Illinois Economic Policy Institute (ILEPI) and Project for Middle Class Renewal (PMCR) at the University of Illinois at Urbana-Champaign suggests that legislation to impose safe patient limits for nurses and promoting increased unionization could be an important part of the solution.

Read the full report: “The Illinois Nursing Shortage: Assessing the Need for Safe Patient Limits and Collective Bargaining

As the medical needs of baby boomers continue to grow, Illinois is expected to need more than 19,000 new nurses over the next ten years– a growth rate of over 15%. Compounding this need are surveys suggesting that as many as one-in-six Illinois nurses plan to retire over the next five years.  One recent study cited insufficient staffing levels, high patient-to-nurse ratios, and workplace violence as contributing factors driving an estimated 30%-50% of all new RNs to decide to either change positions or leave nursing completely within the first three years of clinical practice.

“A number of factors, including below-average wages, high workplace injury rates, and other occupational hazards function as a barrier to retaining the professional nursing workforce that Illinois needs,” said report co-author Jill Manzo.  “Failing to confront these issues will only serve to erode the quality of patient care in our state.”

Manzo noted that relative to their educational attainment, the average Illinois nurse’s income lags other states by 6%-10%.  Overall, Illinois ranks 22nd nationally in this category, trailing neighboring states like Wisconsin and Minnesota and lower-wage states like Louisiana and Texas.

Roughly 89% of Illinois nurses are women.  In a recent survey outlining occupational hazards faced by these workers, more than 75% reported a problem with workplace violence– including physical attacks, verbal abuse, and sexual harassment.

“Obviously, when nurses are already stretched thin by understaffing and lower wages than their counterparts in other states, the potential for this type of widespread workplace abuse only adds another obstacle to the retention of qualified care providers,” Manzo added.

The ILEPI-PMCR report suggests that two specific reforms– more unionization of nurses and statutory standards on nurse staffing levels– could go a long way towards addressing the state’s nursing shortage and improving patient outcomes.

“The data shows that unionization increases an Illinois nurse’s weekly take-home pay by 13%-15%, and increased staffing results in fewer workplace injuries and better patient outcomes,” said study co-author and University of Illinois Project for Middle Class Renewal Director Dr. Robert Bruno.  “These dynamics not only boost the voices of care providers as patient advocates and the appeal of nursing as a profession, they also reduce employee turnover and injury costs that the current shortage imposes on hospitals and other health care employers.”

While fourteen U.S. states have enacted laws dealing with nurse staffing levels, the ILEPI and PMCR researchers highlight the strict limits enacted in California in 2004 as a particularly noteworthy model.  California mandated that there be at least one nurse for every 2 patients in intensive care units, 3 patients in labor and delivery, 4 patients in pediatrics, 5 patients in medical-surgical units, and 6 patients in psychiatrics.

“Hospitals that have implemented above-average nurse staffing levels have a 17% lower patient mortality rate,” added ILEPI Policy Director and study co-author Frank Manzo IV. “After California implemented safe patient limits for nurses, the likelihood of in-patient death, the time spent in intensive care units, and hospital readmission rates all fell as well.”


The Illinois Economic Policy Institute (ILEPI) is a nonprofit organization which uses advanced statistics, reliable surveying techniques, and the latest forecasting models to analyze policy issues affecting the Illinois economy.
 The Project for Middle Class Renewal at the University of Illinois investigates the working conditions of workers in today’s economy and elevate public discourse on issues affecting workers with research, analysis and education in order to develop and propose public policies that will reduce poverty, provide forms of representation to all workers, prevent gender, race, and LGBTQ+ discrimination, create more stable forms of employment, and promote middle-class jobs.

Featured Image: COD Newsroom. (2013). “EMT/Nursing Pediatric Emergency Simulation – April 2013 18.” Flickr Creative Commons User. Attribution 2.0 Generic (CC BY 2.0).

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