A response to California's mandated nursing ratios.
OBJECTIVE
To explore the need for evidence-based health policy, as illustrated by the mandatory staffing bill passed by the California state legislature in 1999.


METHODS
Prospective data were collected from a voluntary sample of California acute care hospital representatives to describe selected patient safety and clinical outcomes and nurse staffing variables at the patient-care unit level.


METHODS
Data for descriptive analysis were collected on hospital nurse staffing, patient falls, and pressure ulcers from 257 medical, surgical, medical-surgical combined, step-down, 24-hour observation units, and critical care patient care units in 38 California acute care hospitals from June 1998 to June 1999.


RESULTS
Nursing staffing ratios varied among the 257 units. RNs provided 91% of the nursing care in critical care units. Patients in medical-surgical units received 59% of their care from RNs, 11% from licensed vocational nurses, and 30% from other caregivers. Preliminary data showed no relationships between reported staffing ratios in these hospitals and the incidence of patient falls or hospital-acquired pressure ulcers.


CONCLUSIONS
California Nursing Outcomes Coalition (CalNOC) data showed wide variations in staffing ratios, patient falls, and hospital-acquired pressure ulcers among nursing units and hospitals. These early findings indicate the need for additional research before determining minimal RN staffing requirements. Analysis of multiple sources of data may be necessary to determine safe staffing ratios and to provide evidence-based data for public policy.
Bolton
L B
LB
Cedars-Sinai Health System/Burns & Allen Research Institute, Los Angeles, CA, USA. Bolton@cshs.org
Jones
D
D
Aydin
C E
CE
Donaldson
N
N
Brown
D S
DS
Lowe
M
M
McFarland
P L
PL
Harms
D
D
D000058:Accidental Falls / Q000706:statistics & numerical data; D000208:Acute Disease / Q000451:nursing; D002140:California / Q000453:epidemiology; D019317:Evidence-Based Medicine; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D020380:Needs Assessment; D015401:Nursing Administration Research; D009732:Nursing Care / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000331:legislation & jurisprudence* / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence* / Q000592:standards*; D003668:Pressure Ulcer / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012449:Safety; D016526:Workload