The effect of a hospital nurse staffing mandate on patient health outcomes: evidence from California's minimum staffing regulation.

We evaluate the impact of California Assembly Bill 394, which mandated maximum levels of patients per nurse in the hospital setting. When the law was passed, some hospitals already met the requirements, while others did not. Thus changes in staffing ratios from the pre- to post-mandate periods are driven in part by the legislation. We find persuasive evidence that AB394 had the intended effect of decreasing patient/nurse ratios in hospitals that previously did not meet mandated standards. However, these improvements in staffing ratios do not appear to be associated with relative improvements in measured patient safety in affected hospitals.

Cook A ，Gaynor M ，Stephens M Jr ，Taylor L ... -  《-》

Impact of California's licensed nurse-patient ratios on unit-level nurse staffing and patient outcomes.

Donaldson N ，Bolton LB ，Aydin C ，Brown D ，Elashoff JD ，Sandhu M ... -  《-》

Impact of California mandated acute care hospital nurse staffing ratios: a literature synthesis.

Donaldson N ，Shapiro S 《-》

Staffing changes before and after mandated nurse-to-patient ratios in California's hospitals.

Serratt T ，Harrington C ，Spetz J ，Blegen M ... -  《-》

The labor market effects of California's minimum nurse staffing law.

In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets.

Munnich EL 《-》