California Nurse Ratio Law Saves Lives, Improves Nurse Morale, Study Finds

Hospital administrators could save thousands of lives if they followed California's model and put limits on nurse patient loads, according to RWJF-funded study.

    • May 26, 2010

A California law that caps patient loads for hospital nurses prevents deaths from common surgeries and improves nurse morale, a new study has found.

Because of the law, California nurses cared for fewer patients than hospital nurses in other states and reported lower rates of job burnout and dissatisfaction and better quality of care. The findings suggest that nurse staffing laws like California’s can help ease the projected shortage of nurses as well as save and improve patient lives.

“The potential number of lives that could be saved by improving nurse staffing in hospitals is likely to be many thousands a year,” said Linda Aiken, Ph.D., F.A.A.N., the lead author of the study. “Lightening the load on nurses also seems to have had the intended effect of improving the recruitment and retention of nurses in California, and that could help curb the projected shortage of nurses.” Read the full report.

For the study, Aiken and her research team compared deaths from common surgeries in California from 2005 to 2006 to surgical deaths in Pennsylvania and New Jersey, neither of which had enacted minimum nurse staffing requirements at the time. The team surveyed more than 22,000 hospital staff nurses in California, Pennsylvania and New Jersey and reviewed state hospital discharge bases.

Under California’s law, which went into effect in 2004, nurses may care for no more than six psychiatric patients; five patients on a medical-surgical unit; four pediatric patients; three patients in labor and delivery; and two patients in intensive care.

California Nurses Handled Fewer Patients than Nurses in New Jersey, Pennsylvania

On medical-surgical units, on average California nurses cared for two fewer patients than nurses in New Jersey and 1.7 fewer patients than nurses in Pennsylvania, the study found.

If California’s mandated minimum staffing levels had been implemented in New Jersey or Pennsylvania, there would have been 14 percent fewer surgical deaths in New Jersey and 11 percent fewer deaths in Pennsylvania during the study period, the study found.

That amounts to 468 lives that might have been saved in those states alone.

The study was funded by the Robert Wood Johnson Foundation (RWJF) and the National Institute of Nursing Research, a division of the National Institutes of Health. It was published online in April in the policy journal Health Services Research.

Aiken directs the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and is a beneficiary of Nurse Leaders in the Boardroom, a nursing initiative sponsored by RWJF that aims to increase the number of nurses on the executive boards of health care organizations, including hospital systems, insurers, accrediting organizations, journals and government agencies. She is the only registered nurse who sits on the editorial board of the health policy journal Health Affairs.

Aiken hopes the study will spur more attention to achieving safe nurse-staffing levels.

“Policy folks are looking at the California experience,” she said. “They want to know what knowledge we have gained from this experience and how that could inform their own policy decisions in the states or at the federal level.”

California is the only state that requires hospitals to adopt minimum nurse staffing requirements. As of last September, 14 states and the District of Columbia had adopted some kind of nurse staffing regulations. Legislation is pending in 18 additional states.

Many hospitals have voluntarily implemented nurse staffing rules and have continued to thrive even in the current economic climate, Aiken said. “Because so many hospitals are able to achieve safe levels of staffing in this environment, safe nurse staff levels should be possible for all hospitals.”

Most Requested