Study: California’s Nurse-Patient Ratios Boost Patient Outcomes

California's mandatory nurse-patient ratios have contributed to a decline in adjusted 30-day inpatient mortality rates and improvements in nurse satisfaction, according to a study published in the journal Health Services Research, HealthLeaders Media reports.

The study received support from the Robert Wood Johnson Foundation and NIH's National Institute of Nursing Research.

Researchers say the study is the first to comprehensively examine the effects of California's 2004 minimum nurse-patient staff ratio mandate for acute care facilities. Under the law, a nurse must care for no more than:

• Six patients in a psychiatric unit;
• Five patients in a medical-surgical unit;
• Four pediatric patients;
• Three patients in a labor and delivery unit; or
• Two intensive care patients.

Study Details

Linda Aiken -- director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing -- conducted the study by comparing patient outcome data and hospital staffing information at hospitals in California, New Jersey and Pennsylvania. The study also surveyed 22,236 hospital nurses in the states.

According to the survey, the percentage of medical-surgical unit nurses who were overseeing only five patients -- as required under California law -- was:

• 88% among California nurses;
• 33% among Pennsylvania nurses; and
• 19% among New Jersey nurses.

Aiken's analysis suggests that if California's nurse-patient ratios had been instituted in Pennsylvania and New Jersey hospitals in 2006, the states could have achieved 10.6% and 13.9% fewer deaths respectively among general surgical patients.

Aiken said California's high nurse staffing levels contributed to the state's lower inpatient mortality rates because nurses serve as monitors who can catch complications and medical errors.

Nursing Satisfaction Levels

The survey also found that California nurses reported higher job satisfaction and said that they provided better quality of care than Pennsylvania and New Jersey nurses who responded to the survey (Clark, HealthLeaders Media, 4/20).