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New Study Adds to Evidence—California’s RN-Patient Ratios Law Improves Nursing, Patient Care

Press Release Press Release, 7/14/11

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For Immediate Release
July 14, 2011
 
Health Affairs study on achievements of California safe staffing law


Another major study has reinforced a growing body of evidence that California’s landmark law requiring minimum, specific nurse-to-patient staffing ratios enhances registered nurse staffing and the quality of patient care.

The latest study, conducted by eminent University of Pennsylvania and Arizona State University researchers, appears in the July 2011 issue of Health Affairs.

Titled, “Contradicting Fears, California’s Nurse-To-Patient Mandate Did Not Reduce The Skill Level Of The Nursing Workforce In Hospitals,” the report <http://content.healthaffairs.org/content/30/7/1299.abstract>  refutes worries promoted by healthcare industry opponents of the 1999 California law that hospitals might respond by disproportionately hiring lower-skill licensed vocational nurses.

In fact, following implementation of the law in 2004, the results have gone in exactly the opposite direction, the study concludes. California hospitals have added registered nurses, dramatically increasing patient access to professional RN care, a factor long associated with positive patient outcomes in a broad range of care barometers.

“This study brings home once again what California nurses could readily tell you. The safe staffing law has improved the quality of care in California hospitals, ensured that RNs have more time to spend with patients, respond to patient care incidents, and reduced the nursing shortage by keeping experienced, professional RNs where they belong, at the bedside,” said Deborah Burger, RN, a co-president of National Nurses United and the California Nurses Association.

CNA, an affiliate of NNU, the largest union and professional association of RNs in the U.S., sponsored the California law and fought off efforts by the hospital industry and former Gov. Arnold Schwarzenegger to roll back the law.

Overall, the authors write, “we found that the staffing mandate resulted in roughly an additional half-hour of nursing per adjusted patient day beyond what would have been expected in the absence of the policy.”

The study directly compared California hospitals to institutions in New York, Texas, Florida, and Pennsylvania – the five states with the most hospitals. While many states nationally saw increases in nurse staffing the past decade, in the period following implementation of the law, California readily surpassed the national average, and California had  five times as many registered nursing care hours as New York hospitals and twice as many as Texas hospitals.

Authors of the new study include Matthew McHugh and Douglas Sloane of the University of Pennsylvania’s Center for Health Outcomes and Policy Research in Philadelphia, UPenn nursing professor and well known RN researcher Linda Aiken, and Lesly Kelly, RN assistant professor at Arizona State University in Phoenix.

Aiken in particular is one of the nation’s foremost RN researchers and just last year led a study comparing California hospitals to facilities in Pennsylvania and New Jersey which documented that New Jersey hospitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California’s 1:5 ratios in surgical units.

In the new study, McHugh, Aiken, and the others note that the intent of the California Legislature in passing the CNA/NNU-backed law was to “improve quality of care and patient safety, and to retain nurses in employment in hospitals. Another primary goal of the law was to avoid high patient-to-nurse ratios, especially for registered nurses.”

Poor ratios, they note, are widely associated with “a number of negative patient outcomes, such as higher surgical mortality and higher complication rates due to errors” as well as to “job dissatisfaction and burnout” that drive nurses away from the patient bedside.

“The California law has clearly met all the goals, a major reason why safe RN ratios is considered the gold standard by direct care RNs across the nation,” says Burger.

Nurses throughout the U.S. continue to campaign for similar state and federal legislation, usually against the opposition of hospital corporate lobbyists.

NNU is sponsoring federal legislation, S 992, the National Nursing Shortage Reform and Patient Advocacy Act, in the Senate, and a companion House bill, HR 2187.

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