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CA Nurse Staffing Law Generates More Debate

Rebecca Hendren, for HealthLeaders Media, July 26, 2011

Nursing unions are angling for mandatory nurse staffing laws, which they say ensure safe patient care. It's a potent message. Studies show better patient outcomes for everything from mortality to healthcare-acquired infections when RN-to-patient ratios are higher.

The debate continues as to whether mandating staffing actually makes patients safer. Allowing hospitals flexibility to staff according to patient need is more effective than legislating blanket rates, say many patient safety advocates because the rates don't account for patient acuity or staff skill mix and experience. Unions use safe patient staffing arguments as a powerful mobilizer and recruiting tool.

A recent study in Health Affairs examined the effects of staffing laws on patient care in California, the first state to pass mandatory staffing laws.

Patients in California hospitals receive 30 minutes more nursing care per day due to the state's mandatory nurse staffing laws than they would have received without the laws, according to the study. That equals a rise from 6.44 hours per adjusted day in 2004 to 7.1 hours per adjusted day in 2008.

For patients, that extra half hour of hands-on care from an RN makes a big difference. It's a significant amount more face time each day between patient and RN, allowing more communication, assessment, and education.

Before the law took effect, there were concerns that hospitals would hire lower-skilled staff—licensed practical nurses or licensed vocational nurses—to meet the ratios. But the study showed that skill mix actually increased following the law's implementation and California hospitals hired more RNs.

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2 comments on "CA Nurse Staffing Law Generates More Debate"


Linda Gusch, RN, BSN (8/1/2011 at 8:35 PM)
Teachers have had classroom ratios for YEARS!! Teachers count a disabled student twice in their classroom numbers because they take more of a teachers' time. Yet, no one has ever died because they could not do long division, or diagram a sentence. THOUSANDS of patients die or are maimed due to the effects of deliberate short staffing in hospitals and nursing homes. Your child is safer in a day care center than a hospital pediatric unit because DSHS STRICLTY enforces staffing ratios in day care center, to the extent that they will close down a facility if the staffing ratios are not met. Are regular hospitalized patients not as important? Why have staffing ratios in hospitals been mandated? Because hospitals do not want to cut into their bottom line by providing adequate ataffing. There is no nursing shortage that is responsible for short staffing. There is now a gigantic nursing glut, with school turning up on every street corner. It is also a matter of control of the nursing profession. Nursing needs to take to the streets to let the public know how their safety has neen compromised where it should be a no brainer guarantee. Hospital will throw the nurse under the bus if there is a law suit due to short staffing, an issue that nurses have NO control over. And THAT is the sad fact that hospitals and nursing homes want to keep.

katrina howard (7/28/2011 at 10:32 AM)
With value-based purchasing, hospital reimbursement will improve dramatically if patient satisfaction and patient outcomes improve. Many of the outcomes or conditions associated with reimbursement reform, i.e.; medical errors and injuries that can reasonably be prevented, such as pressure ulcers, injuries related to inpatient falls, urinary catheter-associated urinary tract infection, vascular catheter-related infections, post-operative complications, readmission rates, length of stay, failure to rescue, etc., are outcomes which are FUNDAMENTALLY RELATED TO NURSE STAFFING LEVELS. The sheer volume of studies that equate safe staffing levels with improved patient outcomes is astounding. There is obviously a business case to improve RN staffing. Ratios must be mandated because hospitals cannot be counted on to staff appropriately. Staffing levels are often set by administrators who place economic goals ahead of quality care. Ratios have made a positive impact on patient care and nurse satisfaction in California, despite fierce and ongoing opposition from the hospital industry.