Illinois Proposed Legislation Could Bring Mandatory Nurse-to-Patient Ratios

October 8, 2019

Illinois House Bill 2604 (HB 2604), the Safe Patient Limits Act, which establishes mandatory nurse-to-patient staffing ratios, is currently pending in the Illinois General Assembly. Among other things, HB 2604 sets specific limits on the number of patients that can be assigned to a registered nurse, depending on the type of hospital unit. Below are five things to know about this proposed legislation.

1. Overview of HB 2604. For all facilities subject to HB 2604, the bill would mandate specific nurse-to-patient ratios of between one and four patients per nurse, for each hospital unit, based on the type of care each patient needs. For example, the bill requires one nurse for every two critical-care patients and one for every three intermediate-care patients. For all units that are not specifically enumerated under the bill, the maximum number of patients assigned to a registered nurse cannot exceed four. Facilities subject to HB 2604 include hospitals licensed under the Hospital Licensing Act or organized under the University of Illinois Hospital Act, private or state-owned and -operated general acute-care hospitals, acute psychiatric or specialty hospitals, acute-care units within healthcare facilities, long-term acute-care hospitals and ambulatory surgical treatment centers.

2. Proposed Penalties. Under the proposed legislation, any facility that fails to comply with the mandatory nurse-to-patient ratios could be subject to a fine of up to $25,000 per day of noncompliance, starting the date the facility receives written notice of the violation from the Illinois Department of Public Health.

3. Current Status of HB 2604. Filed Feb. 14, 2019, the bill initially passed through a House committee, but the state’s legislative 2019 regular session closed without a vote on HB 2604 in the Illinois House. The bill remains stalled until a future legislative session.

4. Other State Enforcement. If HB 2604 is enacted, Illinois would join California in requiring mandatory nurse-to-patient ratios for each hospital unit. Since 2004, California has required healthcare facilities in the state to adhere to mandatory nurse-to-patient ratios for registered and licensed nurses, which ratios are based on the degree of patient care involved. HB 2604, if enacted, goes one step further than the California law by setting forth codified ratios for registered nurses. Massachusetts more recently passed a law specific to staffing minimums in the state’s intensive-care units, but this law does not provide for mandated ratios beyond intensive-care units.

5. Reactions. Supporters of HB 2604 argue that the mandated staffing ratios are necessary to adequately care for patients and will result in improved patient outcomes. On the other hand, opponents have expressed skepticism due to increased costs, longer patient wait times, lack of flexibility, potential for poor patient outcomes and stress due to the nursing shortage.

Overall, this bill, if enacted, would have a significant impact on Illinois healthcare facilities. Illinois currently has standards for nurse staffing that require hospitals to have a written plan based on the recommendation of one or more nursing care committees, but meeting the mandates of HB 2604 would likely require an overhaul of a healthcare institution’s current plans.

Further, other states may elect to follow suit. A number of other states have proposed legislation for the implementation of mandatory staffing ratios, so it remains to be seen if mandatory nurse staffing ratios will be a national trend and what additional actions states will take, including actions by the Illinois General Assembly.

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