More nurses for hospital patients: Impact on quality questionable

September 12, 2012 by Stephanie Stephens
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 , 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 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 such as those related to intravenous lines and , 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 acquired infections.

"A substantial body of existing research shows that 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 , 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."

Explore further: California nurse staffing

More information: Mark, B.A., et al. (2012) California's Minimum Nurse Staffing Legislation:Results from a Natural Experiment, Health Services Research, In Press.

Related Stories

California nurse staffing

July 15, 2011
In a comprehensive analysis comparing nurse staffing in California hospitals to similar hospitals in the U.S. over nearly a decade, researchers at the University of Pennsylvania School of Nursing have found that controversial ...

New study reveals increasing nurse-to-patient ratios do not extend patient safety

February 27, 2012
(Medical Xpress) -- Hospitals are currently under pressure to control the cost of medical care, while at the same time improving patient health and reducing medical errors through appropriate nurse staffing levels. A study ...

Nurse staffing, burnout linked to hospital infections

July 30, 2012
Nurse burnout leads to higher healthcare-associated infection rates (HAIs) and costs hospitals millions of additional dollars annually, according to a study published in the August issue of the American Journal of Infection ...

RN staffing affects patient success after discharge

April 26, 2011
Higher non-overtime staffing levels of registered nurses lower the probability of patient readmissions to the hospital, a new study finds. However, higher levels of RN overtime increase the likelihood of unplanned visits ...

International research finds quality and safety problems in hospitals throughout 13 countries

March 20, 2012
In one of the largest studies of its kind, a consortium of investigators from 13 countries led the University of Pennsylvania School of Nursing in the U.S. and the Catholic University of Leuven, Belgium in Europe, found that ...

Recommended for you

Expert: Be concerned about how apps collect, share health data

October 20, 2017
As of 2016 there were more than 165,000 health and wellness apps available though the Apple App Store alone. According to Rice University medical media expert Kirsten Ostherr, the Food and Drug Administration (FDA) regulates ...

Three million Americans carry loaded handguns daily, study finds

October 19, 2017
An estimated 3 million adult American handgun owners carry a firearm loaded and on their person on a daily basis, and 9 million do so on a monthly basis, new research indicates. The vast majority cited protection as their ...

More teens than ever aren't getting enough sleep

October 19, 2017
If you're a young person who can't seem to get enough sleep, you're not alone: A new study led by San Diego State University Professor of Psychology Jean Twenge finds that adolescents today are sleeping fewer hours per night ...

Across Asia, liver cancer is linked to herbal remedies: study

October 18, 2017
Researchers have uncovered widespread evidence of a link between traditional Chinese herbal remedies and liver cancer across Asia, a study said Wednesday.

Eating better throughout adult years improves physical fitness in old age, suggests study

October 18, 2017
People who have a healthier diet throughout their adult lives are more likely to be stronger and fitter in older age than those who don't, according to a new study led by the University of Southampton.

Global calcium consumption appears low, especially in Asia

October 18, 2017
Daily calcium intake among adults appears to vary quite widely around the world in distinct regional patterns, according to a new systematic review of research data ahead of World Osteoporosis Day on Friday, Oct. 20.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.