Higher Nurse-To-Patient Ratios Reveal Mixed Result on Quality of Patient Care

B. Mark Dr. Barbara Mark

In 2004, California legislation increased nurse-to-patient ratios in the state’s hospitals, providing a rare opportunity to examine how increasing nurse staffing affects patient care and hospital economics. A new study from the School of Nursing found that the mandate had mixed results on quality of care for patients. Barbara Mark, PhD., RN, FAAN, who is the Sarah Frances Russell Distinguished Professor at the School of Nursing, led the study, which appeared recently in Health Services Research, a bimonthly journal.

The new results on patient care add to her previous findings, which show that after the legislation, wages increased for nurses but hospital financial performance and charity care decreased in some California hospitals.

“There is a measurable cost to the increase in staffing,” said Mark. “Before implementing similar nurse staffing requirements elsewhere, more studies should examine the effects of minimum nurse staffing requirements on all aspects of patient care and whether staffing increases are worth the cost.”

The new study compared quality of care and staffing in California hospitals before and after implementation of the legislation, with hospitals in 12 other states without staffing legislation. Mark and colleagues divided California hospitals into four groups based on their staffing levels prior to the legislation. To measure the quality of patient care, they analyzed data on patient deaths and patient safety indicators that were collected from 2000 to 2006. The patient safety indicators provided information on patient complications after surgeries and procedures.

After the mandate, California hospitals, for the most part, increased nurse-staffing levels significantly more than the comparison state hospitals. The study showed that California hospitals with the lowest (Group 1) and highest (Group 4) pre-legislation staffing levels had a significant decrease in the number of deaths resulting from complications, also known as failure to rescue. Group 3 hospitals showed an increase in the number of infections after the legislation, which could result from the increased number of nurses being better able to detect infections. The analysis showed no significant changes in respiratory failure and in infections following surgery.

“The study didn’t tell us the best nurse-to-patient ratio,” Mark said. “Patients vary widely in the amount of care they need from nurses, and as of yet we don’t have a way to quantify that from the nursing point of view.”

The study was funded through a grant from the Agency for Healthcare Research and Quality. Authors include David W. Harless, Ph.D., Virginia Commonwealth University; Joanne Spetz, Ph.D., University of California, San Francisco; and Kristin L. Reiter, Ph.D., and George H. Pink, Ph.D., from the University of North Carolina at Chapel Hill.

UNC press release: http://uncnews.unc.edu/content/view/5586/71/