Staffing changes before and after mandated nurse-to-patient ratios in California's hospitals.
ABSTRACT California is the first state to mandate specific nurse-to-patient ratios in general acute care hospitals. These ratios went into effect January 1, 2004 and apply "at all times". Little is known about the changes in staffing that occurred subsequent to the implementation of this legislation. This study identifies and describes changes in nurse and non-nursing staffing that may have occurred as a result of the enactment of these nurse-to-patient ratios. The results of this study indicate that most hospitals made upward adjustments in their RN and registry nurse staff but decreases in support staff and other non-nurse staff were not evident. These findings suggest that these mandated ratios had the desired effect of increasing the number of nurses caring for acutely ill patients.
- SourceAvailable from: Aled Jones
Technical Report: Research into nurse staffing levels in Wales.[Show abstract] [Hide abstract]
ABSTRACT: This report presents a review of the evidence associated with setting and monitoring safe nurse staffing levels. It also includes analysis of findings related to developing a better understanding of the availability and accessibility of nurse staffing data in medical and surgical wards in Wales. The review of evidence on safe nurse staffing levels includes, for example, nurse-to-patient ratios and skill mix, the role played by nurse staffing levels in influencing patient safety, unintended consequences of mandatory nurse staffing levels and the use of staffing level tools. Availability and accessibility of relevant data focuses on the Electronic Staff Record (ESR), public availability of Welsh NHS staff data, data quality in the ESR database system and possible other sources of data. In addition, a data acquisition exercise with Local Health Boards is outlined, setting out methods, data quality, findings from an initial analysis of the data returned and lessons for future practice.
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ABSTRACT: Objective To determine whether state-mandated minimum nurse-to-patient staffing ratios in California hospitals had an effect on reported occupational injury and illness rates. Methods The difference-in-differences method was applied: The change in injury rates among hospital nurses after implementation of the law in California was compared to the change in 49 other states and the District of Columbia combined. Data were drawn from the US Bureau of Labor Statistics and the California Employment Development Department, including numerator estimates of injury and illness cases and denominator estimates of the number of registered nurses (RNs) and licensed practical nurses (LPNs) employed in hospitals. Confidence intervals (CIs) for rates were constructed based on assumptions that favored the null hypothesis. Results The most probable difference-in-differences estimate indicated that the California law was associated with 55.57 fewer occupational injuries and illnesses per 10,000 RNs per year, a value 31.6 % lower than the expected rate without the law. The most probable reduction for LPNs was 33.6 %. Analyses of CIs suggested that these reductions were unlikely to be due to chance. Conclusions Despite significant data restrictions and corresponding methodological limitations, the evidence suggests that the law was effective in reducing occupational injury and illness rates for both RNs and LPNs. Whether these 31.6 and 33.6 % reductions are maintained over time remains to be seen.International Archives of Occupational and Environmental Health 09/2014; 88(4). DOI:10.1007/s00420-014-0977-y · 2.20 Impact Factor
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ABSTRACT: In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets. Copyright © 2013 John Wiley & Sons, Ltd.Health Economics 08/2014; 23(8). DOI:10.1002/hec.2966 · 2.14 Impact Factor