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There is no consensus that the law improves patient outcomes, which was its primary intent. "Our study links the ratios to something just as important," says J. Paul Leigh, "the lower workers' compensation costs, improved job satisfaction, and increased safety that comes with linking essential nursing staff levels to patient volumes." (Credit: "nurse" via Shutterstock)

health policy

Should states mandate nurse-to-patient ratios?

Standards that require higher nurse-to-patient ratios in acute care hospitals significantly lower job-related injuries and illnesses for both registered nurses and licensed practical nurses, a new study reports.

In 2004, California became the only state in the country with mandated minimum nurse-to-patient staffing ratios based on type of service (such as pediatrics, surgery, or labor and delivery) and allow for flexibility in cases of health-care emergencies.

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“We were surprised to discover such a large reduction in injuries as a result of the California law,” says study lead author J. Paul Leigh, professor of public health sciences and investigator with the Center for Healthcare Policy and Research at University of California, Davis.

“These findings should contribute to the national debate about enacting similar laws in other states.”

Some hospitals have argued against extending the law to other states because of the increased costs of additional nursing staff. There is also no consensus that the law has improved patient outcomes, which was its primary intent. Some studies show improvement, while others do not.

“Our study links the ratios to something just as important—the lower workers’ compensation costs, improved job satisfaction, and increased safety that comes with linking essential nursing staff levels to patient volumes,” Leigh says.

Fewer needle-sticks

Published online in the International Archives of Occupational and Environmental Health, the study uses data from the US Bureau of Labor Statistics. Researchers compared occupational illness and injury rates for nurses during several years before and after implementation of the new law. They also compared injury and illness rates in California to rates for all other states combined.

This approach—known as the “difference-in-differences” method—helped account for a nationwide downward trend in workplace injuries and separate the effects of California’s staffing mandates attributable to the new law.

For California, they estimated that the law resulted in an average yearly change from 176 injuries and illnesses per 10,000 registered nurses to 120 per 10,000, representing a 32 percent reduction. For licensed practical nurses, a position that involves less scope of practice than registered nurses, the average yearly change went from 244 injuries per 10,000 to 161 per 10,000, representing a 34 percent reduction.

The lower rates of injuries and illnesses to nurses could come about in a number of ways as a result of improved staffing ratios. Back and shoulder injuries could be prevented, for instance, if more nurses are available to help with repositioning patients in bed. Likewise, fewer needle-stick injuries may occur if nurses conduct blood draws and other procedures in a less time-pressured manner.

Halo effect?

Additional research with more recent data is recommended to see if the reductions in injury and illness rates held up over time, Leigh says.

“Even if the improvement was a temporary ‘halo’ effect of the new law, it is important to consider our results in debates about enacting similar laws in other states. Nurses are the most recognizable faces of health care. Making their jobs safer should be a priority.”

The National Institute for Occupational Safety and Health and the California Department of Public Health supported the research.

Source: UC Davis

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