Nurse Staffing Regulations Increase Wages, Improve Working Conditions for Nurses, Study Finds

Working conditions and wages have improved for nurses in the state since nurse staffing regulations were enacted, according to a study published in the Journal of Nursing Administration, the Sacramento Bee reports. However, the study "raises more questions than answers" because it is unclear whether the ratios have improved the safety or health of patients, according to the Bee.

For the study, Joanne Spetz of the Center for Health Workforce Studies at the University of California-San Francisco conducted "anecdotal surveys" of hospital executives around the state.

In the study, Spetz questioned whether higher-quality care could be attributed to the ratios and whether an "enriched nursing staff" is the most effective way to improve patient care, the Bee reports.

According to the study, hospitals have raised nurses' wages, improved health and pension benefits, increased signing bonuses for new recruits and developed programs to train current employees to work as nurses in an effort to help mitigate the current nursing shortage in the state and comply with ratios.

From 1999 to 2003, the number of nurses in the state increased 11% to 299,000 registered nurses. However, federal labor statistics show that the state continues to have a shortage of about 18,000 nurses. By 2010, the state will have a shortage of more than 42,000 nurses, and by 2015, that shortage could increase to more than 78,000 nurses.

Brenda Klutz, deputy director of licensing and certification for the Department of Health Services, said that an unintended effect of the ratios has been that they have contributed to a shortage of nurses in long-term care facilities, nursing homes and assisted-living facilities, in part because hospitals have attracted more nurses away from such jobs.

Many hospitals also have eliminated support staff positions to reserve budget funds to hire additional nurses.

According to the study, some hospital executives said they have had to accept fewer transfer patients from rural communities and have redirected "complex patients" to trauma centers, the Bee reports.

Spetz said, "It's fair to say it will take many years of research before we know how much ratios directly improve patient care. Once we know that, we may still find that money spent hiring nurses might have been better spent on technology or other services that might have improved care even more."

Klutz said, "I think it's fair to say one component of evaluating the effectiveness of the ratios would be determining what long-term effects the law has on the labor market, given the nursing shortage."

Rose Ann DeMoro -- executive director of the California Nurses Association, which supports the ratios -- said, "This law has without a question attracted more people to the profession of nursing and prompted many retired nurses to return to the work force again."

Bob Chason, CEO of the University of California-Davis Medical Center, said, "We can agree that more registered nurses generally result in better outcomes for patients. But we can also say we believe other investments in technology over the long run will prove far more effective in raising the bar for quality care than nurse staffing ratios" (Rapaport, Sacramento Bee, 12/10).