We describe the influence of electron-impact multiple ionization (EIMI) on the ionization balance of collisionally ionized plasmas. Previous ionization balance calculations have largely neglected EIMI. Here, EIMI cross-section data are incorporated into calculations of both equilibrium and non-equilibrium charge-state distributions (CSDs). For equilibrium CSDs, we find that EIMI has only a small effect and can usually be ignored. However, for nonequilibrium plasmas the influence of EIMI can be important. In particular, we find that for plasmas in which the temperature oscillates there are significant differences in the CSD when including versus neglecting EIMI. These results have implications for modeling and spectroscopy of impulsively heated plasmas, such as nanoflare heating of the solar corona.