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The Current Condition of the Illinois Nurse

By: Bryce Ilano

Introduction

The job of nursing is itself a challenge but those in the workforce, alongside the entire world, faced its biggest opponent in 2020, COVID-19. During this period, many nurses were faced with and eventually fell victim to issues such as a more demanding work environment, high risk of infection, and a massive increase in burnout. Those left were faced with the even bigger problem of trying to fill in and carry the load with lesser load. 3 years out, we are most likely past those troubling times but how much has the healthcare working environment changed since then? As a nursing major, starting in the midst of the pandemic, I always wonder what type of work am I getting myself into. Nursing already has the reputation of being a tough job but is it harder than it is made to be? Especially since conditions must have improved since the pandemic; As nothing can match what those nurses had to go through. Will eventually graduating nurses, like myself, reap the benefits of a vastly improved and accommodating work environment or are there still flaws hampering the overall state of nursing in Illinois?

Background

Nursing in the state of Illinois can be traced all the way back to the Civil War with the women of Illinois motivated to volunteer aid in military hospitals. In 1893, from the World鈥檚 Fair and Columbian Exposition being held in Chicago, the first meeting between nurses from the United States, Canada, and England took place. This conference between nursing leaders consisted of solving the issues of the education of nurses, hospital care for the sick, and the need of nurses to unite in order to advance the profession. This would result in the first national nursing organization, the American Society of Superintendents of Training Schools of Nursing, which would then lead to the American Nurses鈥� Association of today. In 1903, the Illinois Nursing Association, consisting of 100 nurses from 14 different training schools, completed and submitted a bill to state legislation; calling for the promotion of state registration of nursing and sparking years of developing several more bills tackling other issues such as the State Board of Health and religious based training schools marking the first nurse practice act in Illinois.

After many alterations in the years in between, In 1998, a bill was passed that altered the Illinois Nursing Practice Act to include provisions that organized medicine envisioned for Advanced Practice Nursing Licensure was passed; making Illinois the fiftieth state to recognize advanced nursing practice. In 1991, the supreme court upheld a decision that allowed nurses to organize for the purposes of Collective Bargaining which resulted in the nurses of St. Joseph鈥檚 Hospital to become the first group to petition for representation by the Illinois鈥� Nursing Union in response to the hospital鈥檚 poor record for Nurse Recruitment and retention. This resulted in a 61 day strike, beginning in 1993, and ended with a three-year agreement that included salary improvements, new scheduling, and other benefits to the nurses.

Fast forwarding to the present day, Nursing is still recovering after being hit quite hard by the changes caused by the COVID-19 pandemic. On a national level, 100,000 nurses left the workforce in the past 2 years. The state of Illinois was affected by this as from 2020 to 2021, the number of active nursing licenses from the state of Illinois was 221,549 to 219,409, which is not great for a career with a usually constantly increasing number. From a survey of over 2,200 nurses conducted by the Illinois Economic Policy Institute and the UIUC project for middle class renewal, during the pandemic, 93% of nurses experienced moral distress, 43% cared for more than 6 patients at one time, and 51% considered leaving in the next year. Now in 2023, how has the workforce experience changed for nurses; especially in the state of Illinois.

Some of these issues were even prevalent before COVID, 33,462 registered nurses from New York and Illinois were analyzed from December 2019 to February 2020; right before the pandemic. 40% reported burnout and 1 out of 4 were dissatisfied with their jobs while 56% reported poor working conditions due to staff shortages. On top of that, in 2017, a survey led by Emory University of nearly 4 million respondents, a little over 400,000 stated to have left their jobs with burnout being a common reason. The pandemic just so happened to exacerbate these existing issues.

Methods

For secondary sources, I tried to pull from more verifiable and respectable sources such as the state government, universities, books, and news sources. Information regarding nursing the pandemic, I was able to find a survey jointly conducted by researchers from the University of Illinois and the Illinois Economic Policy Institute asking nurses about the working conditions during that period and general statements from nursing organizations like National Nurses United and the American Nursing Americans. I think the benefit for having sources as such is that they are quite reputable sources that are easily trusted and that they also are relevant within the state. I had the idea to rely on sources as such with the idea of since I鈥檓 not a nurse yet and I can鈥檛 speak for them; why not have them speak for themselves which is essentially what these articles or surveys are.

For my primary sources, I wanted to interview current nurses that are possibly actually experiencing the reported issues that are causing nurses to strike or increase burnout. Luckily, I was able to interview two subjects that are actively in different stages of the job but I think the contrast in position will be good to show different perspectives based on it.

The Current State

On the surface, it may seem that conditions may have improved when you attribute that the number of nursing licenses has increased to 234,622 as of writing and the average pay of a nurse being improved to a range of $65,000-$85,000, but even with these being positive. Are they really just hospitals compensating for the current problems affecting the work environment? Recently, major events in the form of strikes have happened on both a national level and state level. On October 4, 2023, 75,000 healthcare workers for hospitals run by Kaiser Permanente went on the largest healthcare strike in U.S. history citing issues with pay and staffing practices (understaffing). This was a recurring issue within the state, in August 2023 at ironically enough, Ascension St. Joseph in Joliet, IL, as it had its own two-day strike after their bargaining agreement had expired in order to negotiate solutions to similar problems. Nurse Beth Corsetti saying "We don't have enough nurses. We don't have enough aides to keep patients clean. It's as simple as that,鈥� Corsetti said (ABC7 Chicago),鈥� relating to the working conditions of St. Joseph Hospital. To add on, the mayor of Joliet, Terry D鈥橝rcy, would show his support to the nurses; take that as you may. Furthermore, another two-day strike was held in November with Ascension bringing on substitute nurses and having a statement from a spokesperson expressing disappointment with the union鈥檚 choice to negotiate and re-iterating their 鈥済ood faith鈥�.

Another instance occurring back in 2021, with 900 nurses with Cook County Health held a one- day strike over staffing issues. When it came to the bargaining, what was being said to be the issue was the failure to address this issue. An article coming from NBC5 Chicago stating, 鈥淭he nurses' contract expired seven months prior in November, with the union saying that although Cook County Health has hired nearly 800 nurses in the past year, they are still short hundreds more鈥� (NBC5 Chicago).

Numbers and Outlook

Looking at the numbers gives a clearer picture of the issue. In May of 2023, there were 228,307 in comparison to May of 2022 when according to the Federal Bureau of Labor Statistics, there were 139,950 actively employed nurses leaving a discrepancy of nearly 88,000 nurses and pointing out a clearing staffing issue. Granted it鈥檚 a year's difference but I highly doubt a gap of that number could be filled up in such a short amount of time. This fact inspired the nurses of Chicago and the National Nurses United to pursue a proposed Illinois Safe Patient Limit Act which as the name suggests limits the total number of patients a nurse can care for at one time. A big problem during COVID which spurred burnout and overall safety issues on nurses as well as enforcing the importance of hiring an adequate amount of staff to support the current number of nurses.

As shown above are survey results from the American Nurses Foundation, an arm of the American Nurses Association, taken from their Annual Assessment Survey conducted in November 2022. Out of the 12,581 respondents nationally, 250 were from Illinois and the graph shown is their results which exhibit the issue of inadequate staffing and the relation to burnout. Additionally, what can further worsen this situation is a projected shortage of nurses in the state of Illinois in the near future. According to the American Nurses Association, based on a workforce report by the Illinois Nursing Workforce Center, there will be a shortage of 15,000 RNs by 2025. Furthermore, the ANA mentions that 52% of nurses in the state of Illinois being over 55鈥� with 27% planning to retire in the next 5 years鈥� will be set to outnumber the 8,000 nurse graduates per year coming in.

Results from the 2022 Illinois Nursing Workforce Center Annual Report, the most recent one, had 55% of the 58,385 participants were above the age of 55. Additionally, the number of nurses planning to retire within the next 5 years stayed at 27% whilst 41% planned to retire within a decade in contrast to the 7,000 graduates that came in that year.

This begs the question of what solutions do we have to fix this; the American Nurses Association recommended potential solutions to the Senate Health Committee. The fixes they suggested were:

- Require workforce-related collection data at the time of license renewal to give a more complete picture of the nursing workforce

- Pass the Nurse Licensure Compact to remove barriers to nurses working in nearby geographical areas and protect current Illinois

- Increase focus on nursing education by increasing enrollment and funding faculty investment

- Invest in nursing programs and provide loan forgiveness to nurses

- Allow new graduates and student nurses to practice with limited, temporary licenses under the supervision of an RN

- Address the salary of nurses at all levels

They are basically proposing that fixes be made at the root of the issue and rather than keep people from leaving, changes should be made to allow more people job opportunities to fight the shortage. The Workforce Report also makes a similar conclusion as to fixing education to quell this issue. As it states, 鈥淭o maintain an adequate RN pipeline, there is a need for more nursing faculty in both pre-licensure nursing education and post-licensure education. To rapidly increase both the number of nurses with expertise in health equity and the number of nurses in specialties where there are significant shortages, including public and community health, behavioral health, primary care, long-term care, geriatrics, school health and maternal health, consider expanding student loan forgiveness programs that require both obtaining degrees with expertise in these areas and working in those areas post-graduation (IDFR 2022).

Primary Research Findings

For my primary research, I managed to interview two nurses, one experienced and the other quite young, to see if the age made a difference in opinion and to get an understanding from people actually working through such issues today. First, I interviewed an experienced nurse who has been in the field for 35 years. I asked about her experience working before and then during the pandemic; then how it is now in comparison working in the present day. She mentioned how nursing was already a tough job but during the pandemic was quite harder due to the increased number of patients to chart and keep track of. When it came to the current day, she made it clear that 鈥渨hile it is easier; that nursing isn鈥檛 a perfect job and there are always issues that they have to deal with鈥�. The issues that she was speaking about are the ones mentioned in this paper so when I asked her about thoughts of nurses striking and changes she wanted to see for the profession, she spoke of the safety of staff and patients being a top priority and the danger to both by giving a nurse to many patients that they can handle. As for the changes, she wanted to see more promotion for the education of nurses as she believes that there is a nursing shortage with there not enough people going for the profession.

I then interviewed a current nursing student who currently works as a CNA; the answers he provided ended up being more similar to the older nurse than I previously thought they would be. To differentiate, I asked more about the education aspect and he would mention how education is a part of the issue. When asked if he thinks nursing education will sufficiently prepare him for the understaffing and stress, He explained that he already has been exposed to it due to being a CNA. For his opinion of the strikes, he called them terrible as he claimed the hospitals failed to pay the staff adequately whilst urgently paying other nurses to fill in whilst the others were striking. Where the similarities come in is his view of education as when I asked him of his desired changes to the job, he replied primarily about issues of getting into college into the profession. He thinks that college should be made more affordable and a cause for the incoming shortage is due to the price of higher schooling preventing people from getting required education for the job. This adds in to him saying that this isn鈥檛 a matter of the hospitals not hiring enough nurses but there never being enough nurses in general.

Conclusion

The reputation of the nursing profession or jobs in the healthcare field is already seen as a very difficult position to be in. Existing issues are getting much worse and potentially growing issues like workplace violence, in the form of physical assault, mental and verbal abuse, harassment, etc, are becoming prevalent to add on the trouble of the job. Incoming nurses will have to hope that changes will be made by the hospitals to either better accommodate workers with pay and staffing or that it suddenly becomes a more attractive career to be in to increase numbers in the state of Illinois. As previously shown, the history of nursing is filled with its fair share of issues but changes have been made over the years for the benefit of the staff. Even though nurses are always needed, one has to consider if either this situation will be resolved or the issues have become too much.

Citations

Egenes, Karen J., and Wendy Burgess. Faithfully Yours: A History of Nursing in Illinois.
Illinois Nurses鈥� Association, 2001.

French, Rachel, et al. , Accessed 25 Oct. 2023.

Counts as of December 31,, Accessed 4 Dec. 2023.

Counts as of December 31,, Accessed 4 Dec. 2023.

, Accessed 2 Oct. 2023.

Pathieu, Diane, and Michelle Gallardo. 鈥� ABC7 Chicago, 23 Aug. 2023.

ABC7 Chicago, 23 Aug. 2023.

鈥� NBC Chicago, NBC Chicago, 24 June 2021 .

McMahon, Emily. ANA Illinois, 4 Apr. 2022.

ANA, 28 Feb. 2022.

. Illinois 2022 RN Workforce Survey Report (2023).