Implications of the California nurse staffing mandate for other states.
OBJECTIVE
To determine whether nurse staffing in California hospitals, where state-mandated minimum nurse-to-patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes.


METHODS
Primary survey data from 22,336 hospital staff nurses in California, Pennsylvania, and New Jersey in 2006 and state hospital discharge databases.


METHODS
Nurse workloads are compared across the three states and we examine how nurse and patient outcomes, including patient mortality and failure-to-rescue, are affected by the differences in nurse workloads across the hospitals in these states.


RESULTS
California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care.


CONCLUSIONS
Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.
Aiken
Linda H
LH
Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104-4217, USA. laiken@nursing.upenn.edu
Sloane
Douglas M
DM
Cimiotti
Jeannie P
JP
Clarke
Sean P
SP
Flynn
Linda
L
Seago
Jean Ann
JA
Spetz
Joanne
J
Smith
Herbert L
HL
D019985:Benchmarking / Q000592:standards / Q000706:statistics & numerical data; D002055:Burnout, Professional; D002140:California; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D033161:Government Regulation; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007588:Job Satisfaction; D016015:Logistic Models; D009026:Mortality / Q000639:trends; D009515:New Jersey; D009741:Nursing Staff, Hospital / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010414:Pennsylvania; D011787:Quality of Health Care / Q000331:legislation & jurisprudence* / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data
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