Nurse Staffing Ratios

What’s new?

  • This is a significant and controversial issue that has been under discussion and before the General Assembly for several years.
  • We anticipate that legislation mandating minimum nurse staffing ratios will be introduced in the General Assembly again during the Fall Veto and/or Spring Legislative sessions.

What is the issue?

  • Minimum nurse staffing ratios are an attempt to define what staffing levels are necessary for quality patient care.
  • These proposals generally require rigid nurse-to-patient ratios for various types of patients, regardless of hospital size, location or individual needs of patients.
  • California is currently the only state that has mandated staffing ratios.

Why does it matter?

  • Nurse staffing is complex – Rigid, one-size fits all ratio requirements take away flexibility from our direct care-givers to use their clinical expertise to make the best decisions for our patients and practice at the top of their license.
  • By their nature, mandatory ratios are inflexible and imprecise to meet the unique clinical models of all types of hospitals within a geographic area.
  • Nurse staffing ratios ignore nurse education, knowledge and experience in determining the optimal minimum ratios for the number of patients, their level of acuity, and required treatments.
  • Staffing ratios could have unintended consequences – such as loss of autonomy for nurses, reduction in non-nursing support staff, forcing RNs to perform other duties and preventing them from practicing at the top of their license
  • Nurse staffing ratios are unfunded mandates that exacerbate underlying concerns of nurse staffing shortages, despite purporting to be a staffing solution.
  • There is no conclusive evidence – from many studies – that nurse staffing ratios improve patient outcomes.
  • Registered nurses in California saw a decrease in job satisfaction after the passage of the staffing ration legislation because of an increase in their workload, especially with respect to non-nursing care.[i]


What is the AMITA Health perspective?

  • Changes to nurse staffing ratios would have a direct impact on how AMITA Health operates.
  • AMITA Health uses nursing sensitive quality measures developed by national consensus-based entities like the National Quality Forum to assess the quality of care furnished to patients and to quantify the effect that nurses and nursing interventions have on patient outcomes and on quality of care processes. The results of these performance measurements is used to support evidence-based nurse staffing plans in response to nursing shortages and patient needs as well as to improve patient care.
  • AMITA Health has a process in place that includes our direct care nurses, to ensure that each clinical unit is appropriately staffed based on the individual patient needs and the skills, training and capabilities of the entire clinical care team under the state’s Nurse Staffing by Patient Acuity requirements.
  • We are committed to flexible and collaborative staffing model. The input of practicing professional nurses with flexible and collaborative model is key to ensuring high quality patient care. Hospitals need to establish their own unique models that meet their patients’ needs while effectively leveraging their strengths and resources.
  • We respect our associates.  Mandating nurse staffing ratios would impact our ability to have our nurses practicing at the top of their license rather than expanding their responsibilities to include lower level, critical care work currently provided by patient care technicians, transport and lab technicians. AMITA Health recognizes that nurses at times face workflow issues and we strive to be partners to find solutions when that occurs.
  • AMITA Health innovates to provide support to our associates. AMITA Health works with our nursing staff to identify opportunities to deploy technology and other services such as telehealth to increase quality and safety, at our own cost. These programs are additive to the existing nursing staff and does not replace bedside care. For example, AMITA Health’s tele-ICU program decreased ICU rate of mortality from severe sepsis by 38% in 2017.
  • Unnecessary mandates increase costs without achieving patient safety. Mandatory ratios ignore the impact on costs to patients and payers by treating each person the same when some patients may in fact require more or less resources than others. Mandatory staffing ratios put significant financial pressure on hospitals that are already vulnerable or have a higher reliance on Medicaid. Unless staffing ratios are accompanied by increased government reimbursement, it is unlikely that many hospitals could absorb this cost on their already thin operating margins.

Featured News

Featured news includes articles and tweets from multiple viewpoints and is designed to keep you abreast of the current debate around issues that are important to AMITA Health. This information should not be construed as our point of view.

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‘What is a life worth?’ Nurses, hospitals prepare for showdown in Springfield over nurse-patient ratio proposal.

Ahead of state legislators’ return to Springfield next week, supporters of controversial legislation that would mandate patient-nurse staffing ratios in all hospitals in Illinois are touting a ...

Chicago Tribune + April 25, 2019 + View Article

Guest View: Nurse-to-patient ratios would be detrimental for patients

The devil is always in the details.  On the surface, a proposal to mandate rigid nurse-to-patient ratios in Illinois hospitals sounds like a good thing. ...

State Journal Register + April 09, 2019 + View Article