IRI Intelligence Briefing

News and Developments Affecting the Workplace

Volume Number & Date: 
Vol. 5 No. 2 - May 2013

Are Mandatory Staffing Ratios Coming to Illinois?

Legislation to impose mandatory nurse-to- patient staffing ratios, long championed by unions affiliated with National Nurses United (NNU), is gathering strength on Capitol Hill and in statehouses across the country, including in Springfield. Illinois is one of 11 states and the District of Columbia to consider new ratio legislation since February 2012.

The NNU is running an extensive campaign to promote mandatory ratios in Illinois, spotlighting the issue in a Chicago town hall meeting on May 6 and building a base of support on its Facebook page. (see events/371415356296551). NNU represents nurses at the University of Chicago Medical Center and Jackson Park Hospital.

Nurses at NNU Protest

The union’s efforts in Illinois are part of its broader national strategy following the passage of the country’s only mandatory staffing ratio law 14 years ago in California. NNU is the driving force behind the current pressure to impose mandatory ratios on nursing units. Despite opposition from the American Nurses Association – a leading nursing professional trade association – the NNU has identified ratios as a top legislative priority, with support from labor-funded advocacy groups like the Patient Advocacy Coalition for Ratios.

Mandated staffing ratios are a contentious issue that NNU has successfully leveraged to place nurses and hospital leaders on seemingly opposite sides of safe patient care. Many question the value and effectiveness of a one-size-fits-all approach directed by lawmakers rather than leaving staffing decisions in the hands of clinical managers and nurses. Evaluating the efficacy of California’s staffing legislation has been complicated by mixed results from numerous studies. Currently, there is no consensus on the issue; several studies have drawn differing conclusions about the impact of California’s mandated ratios on patient outcomes.

While NNU’s California affiliate has focused on mandatory staffing ratios since its inception, the first few months of this year have seen the most concerted and broad-based effort to place the issue on the political stage since the 1999 passage of California’s ratio law.

One of the union’s most aggressive pushes for ratios is underway in the District of Columbia. NNU, which represents nurses at Washington D.C.’s largest hospital, drafted and is lobbying vigorously for passage of mandatory staffing ratios legislation. The proposed Patient Protection Act offers insight into the union’s tactics to advance its legislative agenda. At the bill’s introduction in D.C.’s City Council, nine of 13 council members co-sponsored the bill.

A citywide campaign, HealDC, has leveraged social media, the D.C. religious community, grassroots networking, door-to-door canvassing, visits on hospital nursing units, and a “patient-safety” survey of nurses to drum up support. The bill is scheduled for a hearing before the City Council’s Health Committee on May 14.

The NNU’s Chicago rally may be the starting point for a similar campaign in Illinois, with other efforts targeting labor-friendly legislatures in Florida, Minnesota, and Pennsylvania – all states with a significant NNU presence.

Status of Nurse Staffing Ratio Regulations

What Illinois-Area Healthcare Employers Should Do 

  • Ensure nurse leaders are aware of the NNU staffing rally in Chicago on May 6 and provide them with the information they need to respond to staff who may ask, “What’s so bad about mandated ratios? More nurses mean better care, right?”
  • Educate nurse leaders about NNU’s legislative and organizing agendas.

Chief nurse executives and others in nursing leadership should talk with nurses about how staffing plans are developed with a focus on patient volume, acuity and flexibility for nurses rather than on rigid mandated ratios that may not meet the unique needs of a patient care unit. Leaders also should engage nurses in conversations about how unions like the NNU use issues such as staffing ratios to recruit members and support the union’s organizing strategy.

Hospital management should work with state hospital associations and legislative affairs to monitor staffing legislation, and help educate lawmakers about their positions regarding staffing ratios.

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