Safe Patient Limits Would Help Combat Illinois’ Nursing Shortage

Registered nurses (RNs) contribute immensely to the well-being of society.

A new study, The Illinois Nursing Shortage: Assessing the Need for Safe Patient Limits and Collective Bargainingby the Illinois Economic Policy Institute (ILEPI) and Project for Middle Class Renewal (PMCR) at the University of Illinois at Urbana-Champaign presents data on Illinois’ RNs educational attainment, compensation, unionization, and safe patient limits (also called “safe-staffing ratios”).

For a one page fact sheet click here.

While nursing is an attractive route to upward economic mobility for women, who make up 89 percent of the nursing workforce, the nursing industry is experiencing a shortage of workers. The nursing deficit is largely caused by the aging population and relatively low retention rates of RNs in the industry.

The nursing shortage is only expected to worsen. Over the next ten years, Illinois is estimated to need around 20,000 additional RNs, a projected employment growth of 15 percent– nearly triple the rate for other occupations.

However, there are contributing factors that can be addressed to help retain RNs.

1. Addressing rampant workplace violence and reducing occupational hazards

Violence in the healthcare industry “accounts for almost a quarter of all violence at work.” A recent report by the University of Illinois at Urbana-Champaign surveyed 275 nurses in Illinois. Of those surveyed who experienced workplace violence, 90 percent experienced violence at least once in the past 12 months. The violence they experienced ranged from verbal abuse such as name calling, verbal threats, and blaming to physical assaults and sexual assaults such as groping and harassment. The report also found that 1-in-4 nurses in Illinois suffered from “psychological symptoms such as anxiety [and] sleeplessness.”

In addition, RNs suffer from overexertion, sprains, cuts, and other injuries. In fact, Illinois has the 2nd-highest injury rate for nurses in the Midwest. This is partially due to the fact that Illinois has relatively fewer nurses per capita than neighboring states like Iowa, Indiana, Kentucky, Missouri, and Ohio.

2. Increasing pay and promoting collective bargaining

Nurses are a highly-educated workforce. In Illinois, 67 percent of registered nurses have at least a bachelor’s degree – ranking 14th nationwide. However, Illinois nurses are relatively underpaid, with average incomes that place them 22nd in the nation. Illinois’ nurses earn between 6 percent and 10 percent less, on average, than their counterparts in other states, relative to their high levels of educational attainment.


The easiest way to address any labor shortage is to simply pay workers more. Numerous studies have shown the positive impact of unionization on wages. In fact, a robust regression analysis finds that unions statistically increase nurses’ weekly take-home pay by between 13 percent 15 percent. One way to raise the wages of Registered Nurses is to increase unionization from its current rate of 17 percent.

3. Enacting safe patient limits to promote better outcomes for patients and nurses.

Insufficient staffing is raising the stress level of nurses, impacting job satisfaction and driving many nurses to leave the profession. An estimated 30 percent to 50 percent of all new RNs decide to either change positions or leave nursing completely within the first three years of clinical practice. They leave due to insufficient staffing levels, high stress, and workplace violence.

Illinois should consider adopting safe patient limits to improve the retention rate of RNs. More than 75 percent of nurses say that the insufficient staffing levels hurts the quality of their work-life and the quality of patient care. While some Illinois nurses report that they are sometimes responsible for as many as 15 patients at one timeCalifornia has safe patient limits. In 2004, California mandated that there be at least one nurse for every 2 patients in intensive care units, 3 patients in labor and delivery, and 5 patients in medical-surgical units.

The research is clear that safe patient limits save lives. High nurse-to-patient ratios are associated with longer wait times as well as more medical errors, more infections, and more deaths. Patient mortality rates have been found to be 17 percent lower in hospitals that have better staffing levels. Patients also report greater satisfaction in hospitals with adequate staffing levels. Since California became the first state to implement safe patient limits, the likelihood of death, the time spent in intensive care units, and hospital re-admission rates have all fallen as well.

Ultimately, Illinois’ RNs shortage can be addressed.

To improve patient outcomes, Illinois needs to attract and retain more Registered Nurses. Broader support for collective bargaining can encourage more competitive RN salaries. In addition, safe patient limits for nurses would help reduce occupational hazards– which can dissuade many from joining the profession– while also improving patient outcomes and saving lives.


Featured Image Credit: COD Newsroom. (2014). “College of DuPage Hosts Multi-Discipline Health Simulation 130.” Flickr Creative Commons User. Attribution 2.0 Generic (CC BY 2.0).

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