More nurses for hospital patients: Impact on quality questionable
Passage of a bill in 1999 requiring minimum nurse-to-patient ratios in California hospitals increased the number of nurses but resulted in mixed quality of care, according to a new study in the journal Health Services Research.
"This was a wonderful opportunity to examine whether minimum staffing levels made any real difference in a variety of different outcomes that are of interest not only to researchers, but to health professionals, policy makers and the public," said lead author Barbara A. Mark, Ph.D., R.N, at the University of North Carolina School of Nursing.
Mark's research team studied changes in California hospitals' staffing from 2000 to 2006 and compared those changes to staffing changes in hospitals in states with no staffing ratio mandate.
"Ultimately, as we would have expected, those hospitals that had the largest staffing shortfalls increased staffing the most, and we were surprised that even hospitals that probably didn't have shortfalls also increased staffing—although not nearly as much," said Mark. "However, hospitals with the greatest shortfalls also relied more on licensed vocational nurses to meet the ratios than other hospitals did." Licensed practical or vocational nurses care for patients under the direction of a registered nurse or physician.
The researchers also found that staffing increases were associated with a decrease in the number of patients who died following a complication, known as "failure to rescue." This decrease was most apparent in those hospitals that had the largest staffing increase and those hospitals that were well-staffed when the legislation was implemented, she said.
Surprisingly, they also found that some rates of infections due to medical care such as those related to intravenous lines and catheters , increased more in California than in hospitals without nurse staffing regulations. The authors suspect that the staffing increases may have led to both better discovery and reporting of hospital acquired infections.
"A substantial body of existing research shows that nurse staffing matters in keeping care safe and delivering care reliably," said Jack Needleman, Ph.D., professor of health services and associate director of the UCLA Patient Safety Institute.
"The paper shows a trend toward growth in staffing has occurred across the country in hospitals with low levels of staffing, but the California legislation appears to have encouraged substantially greater growth. The impact on quality is less clear from this paper and I think reflects the fact that many factors influence quality. For example, when hospitals go about increasing staffing, particularly when they are required to by legislation, we don't know what changes they make in other operations that may decrease safety and reliability of care."
Mark agrees that more research is needed. "What we as researchers still don't know, and what this study doesn't answer is what is the best, most effective nurse-to-patient ratio and what factors play into determining that ratio?" she said. "Obviously, patients that are more or less sick need more or less time from nurses."
More information: Mark, B.A., et al. (2012) California's Minimum Nurse Staffing Legislation:Results from a Natural Experiment, Health Services Research, In Press.
Journal reference: Health Services Research
Provided by Health Behavior News Service
- California nurse staffing Jul 15, 2011 | not rated yet | 0
- New study reveals increasing nurse-to-patient ratios do not extend patient safety Feb 27, 2012 | not rated yet | 0
- Risk of hospital patient mortality increases with nurse staffing shortfalls, study finds Mar 17, 2011 | not rated yet | 0
- Nurse staffing, burnout linked to hospital infections Jul 30, 2012 | not rated yet | 0
- RN staffing affects patient success after discharge Apr 26, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
New mothers throughout Australia are needed to help QUT sleep researchers investigate whether the disrupted sleep experienced by mothers when caring for their new baby raises the risk of injury while driving.
Health 30 minutes ago | not rated yet | 0
(AP)—The mayor of Portland, Ore., has conceded defeat in an effort to add fluoride to the city's drinking water.
Health 1 hour ago | not rated yet | 0
The gap between life expectancy in patients with a mental illness and the general population has widened since 1985 and efforts to reduce this gap should focus on improving physical health, suggest researchers in a paper ...
Health 13 hours ago | not rated yet | 0
Failure to use linked electronic health records may lead to biased estimates of heart attack incidence and outcome, warn researchers in a paper published in BMJ today.
Health 13 hours ago | 5 / 5 (1) | 0
Dietary advice on added sugar is damaging our health, warns a cardiologist in BMJ today. Dr. Aseem Malhotra believes that "not only has this advice been manipulated by the food industry for profit but it is actually a risk ...
Health 13 hours ago | 5 / 5 (4) | 0
Medical researchers discover new ways to target, develop and design drugs to prevent and treat viral infection
Researchers at the University of Alberta have discovered a new drug target, developed a new drug and identified a new way to design drugs—all of which could be a winning combination in the battle against viruses.
12 minutes ago | not rated yet | 0 |
Italian lawmakers on Wednesday gave their final approval to a law that allows limited use of a controversial type of stem cell therapy which has been condemned by many scientists but has given hope to families of terminally-ill ...
52 minutes ago | 5 / 5 (1) | 0
Beta-blockers, normally used for high blood pressure, could enhance the effectiveness of chemotherapies in treating neuroblastoma, a type of children's cancer, according to a new study published in the British Jo ...
22 minutes ago | not rated yet | 0
Cancer survivors are no more likely to stop smoking, cut down on alcohol, or exercise more often than the general population, according to new research published in the British Journal of Cancer today (Wednesday)
12 minutes ago | not rated yet | 0
(Medical Xpress)—Do ethicists engage in better moral behavior than other professors? The answer is no. Nor are they more likely than nonethicists to act according to values they espouse, according to researchers from the ...
11 minutes ago | not rated yet | 0
A Japanese cancer specialist said Wednesday she has started the world's first clinical trial of a powerful, non-surgical, short-term radiation therapy for breast cancer.
32 minutes ago | not rated yet | 0