Have Changes in Illinois Nurse-Patient Ratios Had Effects?

In 2004, California became the first state to pass legislation capping the number of patients per nurses. The law requires that each nurse in a particular unit of the hospital is not responsible for more than a certain number of patients. For example, a nurse working in the intensive care unit may only care for two patients at a time, whereas a nurse in the pediatric unit may care for four patients at one time.

A recently published study set out to measure the effect, if any, that the mandatory minimums had on patient outcomes. The results show that the law saves lives. By comparing patient situations in California to similar situations in Pennsylvania and New Jersey, two states without mandatory ratios, the study showed that patient mortality was significantly lower in California than either of the two unregulated states. According to the study, if Pennsylvania and New Jersey had enacted similar laws, 468 lives may have been saved in those states.

Illinois passed a similar nurse-patient ratio measure in 2007. Titled the Nurse Staffing by Patient Acuity Act, the Illinois law requires hospitals to create committees with at least 50 percent of the positions held by nurses. The committees are charged with creating a staffing plan based on the nursing needs of different areas of the hospitals. The staffing plan is used to create minimum nursing ratios similar to that of California. The major difference between the Illinois and the California laws is that the Illinois law allows the committees to set the minimums, whereas the California legislature chose to set the minimums by statute. Since the Illinois law has only been in existence for a handful of years, the exact benefits are not quite clear yet. However, based on the regulation's success in California, the Illinois law should be saving lives.

Proponents of such measures point out the important role that a nurse plays in quickly diagnosing sudden health problems and being the first responder in most situations. When the nurse is dividing his or her time among six patients instead of three, for example, this important role may be compromised. However, installing mandatory ratios has its drawbacks as well. Health care costs are higher than ever and continue to increase. Forcing a hospital to staff more nurses for the same number of patients only drives the cost per patient higher. Even the recent study on mandatory ratios did not definitively forecast the potential for cost savings.

Recently, in the wake of the attention that the national health care debate garnered, most of the bills proposed in Illinois are related to health insurance, affordability of health care and cracking down on health care fraud. However, as legislators feel pressure to create a better health care environment and as health care costs continue to rise, the lawmakers of Illinois will continue to propose regulation aimed at increasing the quality of patient care while, at the same time, decreasing the overall costs.