Unbiased Analysis of Today's Healthcare Issues

Mandatory Nurse Staffing Ratios and Hospital Quality

Written By: Jason Shafrin - Mar• 10•09

At the turn of the century, California passed laws mandating minimum nurse-to-patient ratios.  These laws went into effect in 2004.   Initially, the nurse patient ratio was 1:6, but those ratios were decreased to 1:5 in 2005.  Do minimum nurse staffing laws increase the quality of medical care or do they simply increase costs and drive up nurse employment?

A paper by the California HealthCare Foundation attempts to answer this question.  The authors use data from the  Office of Statewide Health Planning (OSHPD) and the California Employment Development Department (EDD) to measure hours of work for registered nurses, licensed vocational nurses, aides and orderlies.  AHRQ data is employed to identify hospital-specific quality measures which could be affected by changes in nurse staffing patterns.  

“… nurse staffing legislation resulted in higher use of registered nurses in most California hospitals. Implementation of the staffing regulations could not be tied to changes in hospital finances; rather, changes in Medicare and Medi-Cal payment rates and demands to address seismic building requirements had far greater effects on finances. Hospital administrators found that it was challenge to meet the staffing requirements, particularly in ensuring that staff were available at all times, including during breaks and meals. Finally, many of the health care leaders interviewed for the study expressed an expectation that the minimum staffing ratios would increase the quality of care due to increased interaction with patients; however, there was no evident change in patient length of stay or adverse patient safety events. None of these findings were affected by hospital ownership, financial position, or patient mix.”

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