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LA Times: California announces new nurse-patient staffing ratios

July 2, 2003 -- An article by Steve Hymon in today's Los Angeles Times reported that California state regulators had issued rules setting specific new nurse-patient staffing ratios, which will take effect between 2004 and 2008, as mandated by a 1999 state statute that was the first of its kind in the United States.

The piece explains that the new ratios set by the state's Department of Health Services are designed to improve patient safety, noting that many nurses feel current short staffing leads to mistakes and burnout, exacerbating the nursing shortage.

The new rules reportedly mean that no nurse will have more than eight patients, and that the limit in many units will be four to six patients.

The article, though not lengthy, does a fairly good job surveying the range of opinions about the new rules, from bedside nurses and even the state's largest HMO who support them, to nursing unions who feel they constitute progress but don't go far enough, to the many hospitals who oppose the rules, arguing that they impose an unreasonable cost on them while they are struggling to cope with the nursing shortage.

With more space, the article might have discussed an important study published in 2002 in the Journal of the American Medical Association by Linda Aiken, RN, Ph.D. and colleagues which found that for each extra patient assigned to a nurse, that nurse was 23% more likely to report job burnout. This study also found that burned-out nurses are four times more likely to report that they will leave their jobs within the year. Conversely, a recent survey in Massachusetts found that 65% of RNs currently working away from the bedside would consider returning to provide direct patient care in a hospital if a law were passed to increase RN-to-patient ratios. These findings support many nurses' view that short-staffing by hospitals is a key factor in the current shortage, but that improving RN-to-patient ratios would bring RNs back to the bedside, thereby reducing the shortage.

There is also mounting evidence that improving nurse staffing will significantly improve patient health and actually reduce patient deaths. The recent Massachusetts survey found that nearly one in three nurses were aware of a patient death resulting from nurse short-staffing. And the Aiken study found that when a nurse's patient load is doubled from 4 patients to 8, his patients have a 31% greater chance of dying within a month; this suggests that even the California rules' 8-patient ceiling could result in far more patient deaths than lower ratios, depending on the setting.

See the LA Times article New rules will tighten nurse-patient ratios (free registration).