Assessing the Impact of California’s Nurse Staffing Ratios on Hospitals and Patient Care


Joanne Spetz, Susan A. Chapman, Carolina Herrera, Jennifer Kaiser, Jean Ann Seago, Catherine Dower

February 1, 2009

In 2004, California began requiring that acute-care hospitals maintain certain minimum ratios between nurses and patients, making it the first state in the nation to do so. However, little is known about what effects the staffing ratios have had, either on the hospitals themselves or the quality of care they provide. This issue brief examines how California's nurse staffing regulations affected different types of hospitals in order to probe what strategies were used to meet the ratio requirements; whether the ratios influenced hospitals' financial performance; and what effect they had on improving patient care. The research combined quantitative and qualitative analysis, including interviews with executives and other management staff at 12 acute-care hospitals. The results show that while the legislation has increased the use of registered nurses, the ratios have had no clear impact on the quality measures that are associated with nursing care. The study also found no relationship between the staffing regulations and the overall decline in hospital operating margins that occurred after the law went into effect.

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