On Wednesday, March 27, the Illinois House Labor & Commerce Committee held a hearing on House Bill 2604 regarding safe patient limits. Frank Manzo IV, MPP, Policy Director of the Illinois Economic Policy Institute (ILEPI) testified before the committee. Here is what he said.

Click here to read the full testimony and here to read a one-page fact sheet on safe patient limits.

Good afternoon, Mr. Chairman and Members of the Committee. My name is Frank Manzo IV. I am the Policy Director of the Illinois Economic Policy Institute, a nonprofit research organization that provides candid and dynamic analyses on major subjects affecting the Illinois economy.

Illinois is experiencing a shortage of Registered Nurses caused by numerous factors, including rising demand for health care services, labor market competitiveness, and insufficient staffing levels that can exacerbate occupational hazards and make it difficult to retain nurses. Over the next ten years, Illinois will need about 20,000 more Registered Nurses. In addition, one-third of Illinois nurses say that they intend to retire in the next five years.

Insufficient staffing levels negatively impact both patients and the nursing workforce. More than 75% of nurses report that insufficient staffing levels hurt the quality of their work-life and the quality of patient care. In addition to the stress caused by understaffing, Illinois’ nurses face occupational hazards. A 2018 study by the University of Illinois found that 90% of nurses experienced workplace violence at least once in the past 12 months. The experiences ranged from verbal threats and name calling, to physical assaults to sexual harassment.

Between 30% and 50% of all new nurses either change positions or leave the profession entirely within the first three years on the job. They leave due to insufficient staffing levels, high stress, and workplace violence. So, this is primarily a retention problem. And, while there are many ways to address the nursing shortage, one of the biggest is to improve nurse retention rates.

In a March 2019 study that we co-authored with Professor Robert Bruno from the University of Illinois, we found that Illinois’ nurses are highly educated but relatively underpaid. Illinois ranks 14^th in the nation in nurse educational attainment, with 67% of our full-time Registered Nurses having earned a bachelor’s degree or higher. But the average income earned by Illinois nurses ranks just 22^nd in the nation, behind states with lower costs of living like Wisconsin, Minnesota, Arizona, and Texas. One way to retain nurses and address the labor shortage is to simply pay them a competitive salary.

However, we know that nurses suffer from overexertion, cuts, workplace violence, sexual harassment, psychological trauma, and other risks. The injury and illness rate for Illinois nurses is the 2^nd highest in the Midwest. States with more nurses per capita have lower nurse injury rates than Illinois. High injury rates and insufficient staffing are barriers to retaining qualified nurses in Illinois.

The academic research demonstrates that safe patient limits save lives. High patient-to-nurse ratios are associated with longer wait times, more medical errors, more infections, and more deaths. Patient mortality rates have been found to be 17% lower in hospitals that have better staffing levels. And patients report greater satisfaction in hospitals with adequate staffing levels because they have more patient surveillance and better patient education.

While media reports show that some Illinois nurses have as many as 15 patients at a time, California has safe patient limits. In 2004, California required 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. After California implemented these safe patient limits, the likelihood of in-patient death within 30 days, the time spent in intensive care units, and hospital readmission rates all fell.

At the same time, research has found that staffing standards have no negative impact on the financial performance of hospitals. And here’s why: more nurses improve patient outcomes, reduce occupational injuries, and reduce turnover– all of which produce savings for hospitals. In competitive hospital markets, researchers from the U.S. and the U.K. have found that better nurse staffing levels have a positive association with hospital profit margins.

In conclusion, Illinois is experiencing a shortage of Registered Nurses, caused in part by occupational hazards that make it difficult to retain nurses. The way to retain these professional workers is to pay them competitive salaries and promote staffing standards, through safe patient limits, to reduce occupational hazards for nurses while improving patient outcomes and saving lives.

I thank you for allowing me the opportunity to submit my testimony.

Click here for a full version of this testimony. 

Click here for the March 2019 report: The Illinois Nursing Shortage: Assessing the Need for Safe Patient Limits and Collective Bargaining.