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Impact of Mandatory Nursing Staffing Levels on Patient Outcomes

  • Past research has demonstrated a positive link between nurse staffing levels and measures of patient outcomes and nurse retention.
  • In 2004, California implemented minimum nurse-to-patient staffing requirements in acute care hospitals in an effort to improve the quality of patient care and nurse job satisfaction.
  • This study compared patient and nurse outcomes from hospitals in California versus two states without legislatively mandated staffing ratios, Pennsylvania and New Jersey. The study used data obtained in 2006 from over 22,000 staff nurses from among the three states, as well as hospital discharge databases.
  • Among the study findings, the researchers reported that hospital nurses on medical and surgical units in California cared for fewer patients on average than nurses in the other two states. These lower patient-to-nurse ratios were associated with significantly lower patient mortality.
  • The study also found that nurses in California reported higher job satisfaction, less burnout, and better ability to care for patients.
  • The authors estimated that, had patient-to-nurse ratios in Pennsylvania and New Jersey been consistent with those in California during the period of the study, 486 fewer surgical deaths would have occurred in those two states combined.
  • The study presents important policy implications for policymakers in other states that are currently considering health care workforce legislation.

Aiken LH, Sloane DM, Cimiotti JP, Clarke SP, Flynn L, Seago JA, Spetz J, Smith HL. “Implications of the California Nurse Staffing Mandate for Other States.” Health Serv. Res. 2010, April 9 . Epub.

Funding Source: R01-NR004513 (PI: Aiken)