If California's mandatory nurse-patient ratios had been in effect in Pennsylvania and New Jersey hospitals in 2006, those states would have seen 10.6% and 13.9% fewer deaths among general surgical patients, according to a Pennsylvania researcher's analysis.
That equated to 468 lives that might have been saved, says Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and the study's lead author.
Her report was published in the journal Health Services Research, and is considered the first comprehensive evaluation of California's controversial 2004 nurse staffing ratio mandate and may inform decisions in 18 other states that are considering lowering their nurse-staff ratios, such as Massachusetts, Minnesota, and Illinois.
Aiken's study received funding support from the Robert Wood Johnson Foundation and the National Institute of Nursing Research at the National Institutes of Health.
Aiken, a registered nurse and a well-known nursing workforce investigator, says that the difference between staffing at hospitals in California versus New Jersey and Pennsylvania "is very large, about two more patients per nurse [in medical surgical units]. And that's very significant."
To explain the decline in California mortality that she attributes to better nurse-patient ratios, Aiken says, "Nurses are the main surveillance system in hospitals.
"Nurses detect the majority of complications; the majority of medication errors that are detected by anyone are detected by nurses first. And nurses can distinguish between patients who are shivering after surgery because the operating rooms are cold, or who are shivering because they are in shock and are going into multiple organ failure that can't be reversed if it isn't caught early enough."
"All hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients," Aiken says, adding that "the potential number of lives that could be saved by improving nurse staffing in hospitals is likely to be many thousands a year."
A spokeswoman for the California Hospital Association, which opposed the patient-nurse ratios and has criticized their effectiveness, said the organization was reviewing the report, but did not yet have a comment.
However, officials for the 155,000-member California Nurses Association were delighted with the report because it sponsored the law that mandated the lower ratios.
"This research documents what California RNs have long known–safe staffing saves lives," says Malinda Markowitz, CNA and National Nurses United co-president. "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."