National Nurses Survey Offers Strong Evidence for Safe Patient Limits Law

La Grange:  As Illinois lawmakers continue debating whether to enact nurse staffing standards in the state’s hospitals, a new national survey of registered nurses has linked the proposal with dramatically superior workplace outcomes in California, the only state that has enacted such a law. The survey was sponsored by grassroots organization Nurses Take D.C. and compiled over 9,000 responses in all 50 states and the District of Columbia. The results were then aggregated and analyzed by the Project for Middle Class Renewal (PMCR) at the University of Illinois and the Illinois Economic Policy Institute (ILEPI).

Read the Report: Do Nurse Staffing Standards Work?  Evidence from a 2018 Survey of Registered Nurses

 “While past research has shown that Illinois faces a significant nurse shortage and retention problem, this survey directly links California’s safe staffing law with dramatic improvements in the workplace environment and responsive patient care indicators,” said study co-author and University of Illinois Professor Emily E. LB. Twarog.

On everything from actual nurse-patient ratios to perceptions about the safety of staffing levels and responsiveness to patient acuity, the 331 California survey respondents had dramatically better workplace outcomes than all other U.S. states, including the 508 respondents from Illinois.


National Nurses Take D.C. Survey: California and Illinois Nurse Staffing Responses, October 2018

  • The average nurse in California has 4.3 patients at one time while the average nurse in Illinois has 5.2 patients at one time;
  • 66% of nurses in California care for between one and four patients at a time during a shift compared to just 35% in Illinois;
  • 47% of nurses in California report that staffing levels are based on the needs of patients in their units compared to just 32% in Illinois;
  • 40% of nurses in California believe the patient-to-nurse ratio in their units is safe compared to just 18% in Illinois; and
  • 55% of nurses in California fear retaliation for providing input about staffing in their units compared to 61% in Illinois.

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Illinois nurse staffing levels are currently informed by the Nurse Staffing by Patient Acuity Amendment to the Hospital Licensing Act in January 2008, which requires hospitals to create a written hospital-wide staffing plan based on the recommendation of one or more “nursing care committees.”  However, less than 29% of the Illinois nurses surveyed reported having such a committee, and more than half said the committee’s recommendations are not implemented in determining daily staffing levels.

“This survey makes clear that Illinois’ existing nurse staffing guidelines are either not effective or not enforceable, or both,” Professor Twarog added.

In compiling the survey results, PMCR and ILEPI researchers also reviewed existing research on the nurse staffing shortage and the effects that nurse staffing limits have had on key patient care indicators in California and could have on the bottom lines of hospitals in Illinois.

“Prior research has linked Illinois’ ongoing nurse shortage and retention problems to a variety of occupational hazards associated with staffing levels,” said ILEPI Policy Director and study co-author Frank Manzo IV.  “At the same time, improved staffing levels have been found to lower mortality, lower hospital readmission rates, reduce patient time spent in high-cost hospital units, and reduce injury and turnover rates amongst nurses. These savings alone offset 75% of the cost of hiring the additional nurses that Illinois hospital administrators say they’d need to comply with a safe patient limits law.”

Illinois’ proposed Safe Patient Limits Act was introduced in 2019 as House Bill 2604 and Senate Bill 1908.  It is modeled off a similar statute enacted in California in 2004. State law in California requires that there be at least one nurse for every 2 patients in intensive care units and labor and delivery, 4 patients in pediatrics, and 5 patients in medical-surgical units.

“Because prior research has already linked nurse staffing limits to better patient outcomes without negatively impacting the financial performance of hospitals, the key question that this survey poses is whether there is a better solution than the patient acuity guidelines that are currently on the books in Illinois and many other states,” said PMCR Director and University of Illinois Professor Robert Bruno.  “This survey answers that latter question with an unambiguous yes.”

Read the report here.


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.

The Illinois Economic Policy Institute (ILEPI) is a nonprofit organization which uses advanced statistics and the latest forecasting models to develop timely and dynamic analysis of policy issues affecting the Illinois economy.