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The Evidence is In - California RN-to-Patient Ratios Save Lives

Press Release Press Release, 4/20/10

Contact Information | Media Center

For Immediate Release
April 20, 2010

With CA Ratios, NJ would have 14%, PA 11% Fewer Deaths Ratios also Boost RN Retention, Increase Time for Patient Care

A major new study led by one of the nation's most eminent nurse researchers provides compelling new evidence that California's landmark RN-to-patient staffing law reduces patient mortality, assures nurses more time to spend with patients, and substantially promotes retention of experienced RNs.

"This research documents what California RNs have long known - safe staffing saves lives. We see the effects every day at the bedside in improved patient care, an enhanced quality of life for patients, and nurses able to more safely practice the profession to which we have dedicated our lives," said Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses United.

CNA/NNU, Sponsor of Law, Cites Major Gains for Patient Safety, RN Shortage

CNA/NNU, the nation's largest organization of direct care RNs with 155,000 members, sponsored the California law and has fought off repeated hospital industry attempts to erode it, including a well-chronicled fight with Gov. Arnold Schwarzenegger who sought to roll back the law in late 2004.

The study, published today by the influential policy journal, Health Services Research, was conducted by University of Pennsylvania researchers led by Linda Aiken, RN, Ph.D. , director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

Surveying more than 22,000 RNs in California and two comparable states, Pennsylvania and New Jersey, the researches found striking results, including:

  • 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.
  • California RNs have far more time to spend with patients, and more of their hospitals have enough RNs on staff to provide quality patient care.
  • Fewer California RNs miss changes in patient conditions because of their workload than New Jersey or Pennsylvania RNs.
  • In California hospitals with better compliance with the ratios, RNs cite fewer complaints from patients and families and the nurses have more confidence that patients can manage their own care after discharge. 
  • California RNs are far more likely to stay at the bedside, and less likely to report burnout than nurses in New Jersey or Pennsylvania.

"In these two states alone, 468 lives might have been saved over the two year period just among general surgery patients if the California nurse staffing levels were adopted," said Aiken in a statement. "Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year."

Two years after implementation of the ratios - which mandate minimum staffing levels by hospital unit that must be increased as needed for patient illness - "nurse workloads in California were significantly lower" than Pennsylvania and New Jersey.

"Most California nurses, bedside nurses as well as managers, believe the ratio legislation achieved its goals of reducing nurse workloads, improving recruitment and retention of nurses, and having a favorable impact on quality of care," Aiken and team write in the study.

In the 10 years since the California ratio law was signed, the state has increased the number of actively licensed RNs by more than 110,000 RNs - tripling the average annual increase that was occurring prior to enactment of the law. 

Noting NNU members are working to pass similar laws in Congress, S 1031, and other states, Markowitz said, "Here's the proof. This is the future of safer patient care, and a solution to keeping nurses at the bedside. It works for patients, for their families, for our communities, and for our profession."

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