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Policy, Politics, & Nursing Practice
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Impact of California’s Licensed Nurse-Patient Ratios on Unit-Level Nurse Staffing and Patient Outcomes

Nancy Donaldson, DNSc, RN, FAAN

Center for Research and Innovation in Patient Care at the University of California, San Francisco School of Nursing

Linda Burnes Bolton, DrPH, RN, FAAN

Cedars-Sinai Medical Center in Los Angeles

Carolyn Aydin, PhD

Cedars-Sinai Medical Center in Los Angeles

Diane Brown, PhD, RN, FNAHQ

Northern California Region in Oakland California

Janet D. Elashoff, PhD

Biostatistics Core of Research Institute, Cedars-Sinai Medical Center in Los Angeles

Meenu Sandhu, MS

Biostatistics Core, Research Institute, Cedars-Sinai Medical Center in Los Angeles

This article presents the first analysis of the impact of mandated minimum-staffing ratios on nursing hours of care and skill mix in adult medical and surgical and definitive-observation units in a convenience sample of 68 acute hospitals participating in the California Nursing Outcomes Coalition project. Findings, stratified by unit type and hospital size, reveal expected changes as hospitals made observable efforts toward regulatory compliance. These data cannot affirm compliance with ratios per shift, per unit, at all times; however, they give evidence of overall compliance. Assessment of the impacts of the mandated ratios on two common indicators of patient care quality, the incidence of patient falls and the prevalence of pressure ulcers, did not reveal significant changes despite research linking nurse staffing with these measures. These findings contribute to understanding unit level impacts of regulatory staffing mandates and the preliminary effect of this legislation on core quality of care indicators.

Key Words: nurse-to-patient ratios • nursing sensitive indicators • patient safety and quality • falls • pressure ulcers • outcomes

Policy, Politics, & Nursing Practice, Vol. 6, No. 3, 198-210 (2005)
DOI: 10.1177/1527154405280107
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?