Implications of the California Nurse Staffing Mandate for Other States

Year in Research Nominee for 2010

In 2004, California became the first state to mandate minimum nurse staffing levels for various nursing units, specifying how many patients each nurse can care for at any one time. As other states look to enact nurse staffing legislation or regulations, California’s example provides some insight.

Nurse researchers, led by Linda Aiken, R.N., Ph.D., University of Pennsylvania School of Nursing, compared the outcomes for nurses and quality of care in California and two states without legislation—Pennsylvania and New Jersey. They surveyed 22,336 nurses in all three states and examined patient outcomes, including 30-day inpatient mortality and failure to rescue across hospitals according to whether the nurses cared for fewer or more patients each.

Key Findings:

  • Nurse workloads in New Jersey and Pennsylvania on all types of units were above California-mandated staffing levels.
  • If they matched California nurse staffing ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths, saving 486 lives over two years.
  • With lower workloads, California nurses reported more job satisfaction, less burnout and better quality of care.

When hospital nurse staffing levels are raised, nurse satisfaction and patient outcomes both benefit—and lives are saved.