Nurse Staffing Ratios

Senate Bill 2153: Nurse Staffing Improvement Act

In cooperation with the American Nurses Association – Illinois, SB 2153 was introduced to strengthen the existing Nurse Staffing by Patient Acuity Act and is meant to ensure that direct-care nurses have a stronger voice in determining staffing levels at hospitals. Specifically, the Nurse Staffing Improvement Act provides:

  • The Nursing Care Committee must be comprised of at least 55% direct care nurses and its Co-Chair must be a direct care nurse;
  • The Nursing Care Committee must produce a hospital-wide staffing plan, including inpatient emergency departments;
  • If the staffing plan developed by the Committee is not adopted by the hospital, the Chief Nursing Officer must provide a written explanation of the reasons why and an explanation of the changes that were made to the proposed plan;
  • Require the Nursing Care Committee to meet at least six times per year as opposed to once annually, with reports and information from the committee to be provided to direct care nurses;
  • Require the Nursing Care Committee to issue an annual report to the Hospital’s governing board, including recommendations for future changes to nurse staffing;
  • In reviewing the staffing plan, the Nursing Care Committee shall consider issues such as: patient outcomes; complaints related to staffing; the number of nursing hours provided compared to the number of patients on the unit; aggregate overtime nursing hours worked; the degree to which actual shifts worked varied from what is provided for in the staffing plan;
  • Require a mechanism for nurses to report variations from the staffing plan with respect to the assignment of nursing personnel and for a process for such reports to be reviewed and addressed;
  • Prohibit any retaliation for any employee who expresses a concern or complaint regarding a violation of the Nurse Staffing by Patient Acuity Act or concerns related to nurse staffing;
  • Money from fines for noncompliance will be deposited into the Hospital Licensure Fund and used for scholarships under the Nursing Education Scholarship Law.

SB 2153 garnered widespread, bipartisan support in both Chambers. The bill was recently sent to the Governor for further action and is effective upon becoming law.

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.
  • This is a significant and controversial issue that has been under discussion and before the General Assembly for several years. Legislation mandating minimum nurse staffing ratios was introduced during the 2021 Spring Legislative Session but the General Assembly did not act on the issue.
  • California is currently the only state that has mandated staffing ratios.

Why it matters?

  • 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 ad 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 treatments.
  • 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 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 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 and SB 2153 mandates additional inclusion and input, to ensure each clinical unit is appropriately staffed based on 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 support 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 existing nursing staff and do 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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