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Researchers Say California Nurse Staffing Law Has Reduced Patient Mortality

By Jane Norman, CQ HealthBeat Associate Editor

April 21, 2010 -- A major new study by University of Pennsylvania researchers found that a California law mandating minimum nurse-to-patient ratios reduced patient deaths and allowed nurses to give more attention to their patients.

The study published in the journal Health Services Research looked at data from more than 22,000 nurses in California, New Jersey and Pennsylvania. California was the first state to require minimum nurse-to-patient ratios in acute care hospitals.

The study headed up by Linda Aiken, a registered nurse and director of the Center for Health Outcomes and Policy Research at the university, said that nurse workloads in California in 2006, two years after the law's enactment, were "significantly lower" compared to workloads in New Jersey and Pennsylvania.

"Nurses in California care for an average of one fewer patient each, and these lower ratios have sizable effects on surgical patient mortality," said the study. "In medical and surgical units, where nurse recruitment and retention has long been difficult nationally, nurses in California on average care for over two fewer patients than nurses in New Jersey and 1.7 fewer patients than nurses in Pennsylvania."

The researchers used predicted probabilities of dying from adjusted models to estimate how many fewer deaths would have occurred in New Jersey and Pennsylvania hospitals if the average patient-to-nurse ratios in those hospitals were the same as the average ratio across the California hospitals They said there would have been 13.9 percent fewer surgical deaths in New Jersey and 10.6 percent fewer surgical deaths in Pennsylvania.

"Most California nurses, bedside nurses as well as managers, believe the ratio legislation achieved its goals of reducing nurse workloads, improving recruitment and retention of nurses and having a favorable impact on quality of care," the study added.

It was praised by National Nurses United, an organization of registered nurses. "This research documents what California RNs have long known — safe staffing saves lives," said Malinda Markowitz, co-president of the California Nurses Association and National Nurses United.

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