Study: Nurse-to-patient ratio saves lives

By Kathy Robertson
Sacramento Business Journal
April 20, 2010

California’s nurse-to-patient staffing law reduces deaths from common surgeries, allows nurses to spend more time with patients and helps hospitals retain nurses, a study by researchers at the University of Pennsylvania concludes.

California’s landmark law requires minimum nurse-to-patient ratios for specific units in all general acute-care hospitals. It was signed in 1999, but ratios were phased in from 2004 through 2008.

Researchers compared deaths from common surgeries in California from 2005 to 2006 to surgical deaths in two states without legally mandated ratios, New Jersey and Pennsylvania. There would have been 13.9 percent fewer patient deaths on surgical units in New Jersey hospitals in 2006 if they adopted California’s ratio of one nurse to every five patients, researchers concluded. There would have been 10.6 fewer deaths in Pennsylvania hospitals.

“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,” Linda Aiken, a registered nurse, lead author of the study and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, said in a news release.

The study surveyed 22,336 nurses in California, New Jersey and Pennsylvania. It was funded by the National Institute of Nursing Research and the Robert Wood Johnson Foundation. It is published online in the policy journal, Health Services Research.

California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units, according to the study. They also reported more job satisfaction, less burnout and higher quality of care.

“This research documents what California RNs have long known — safe staffing saves lives,” said Malinda Markowitz, a registered nurse who is copresident of the California Nurses Association/National Nurses United. The union sponsored the California law.

“It absolutely makes a difference,” said Kathy Dennis, a registered nurse who works at Mercy General Hospital in Sacramento. “Asking nurses here what it was like before ratios, they say, ‘Oh, I can’t even imagine.’”

With ratios, nurses are able to spend more time on patient education, Dennis said, and nurse retention at Mercy General has improved considerably.

Efforts to reach the California Hospital Association were unsuccessful. The trade group has criticized the law because it removed hospital flexibility to staff according to fluctuating patient need.