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Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California

MCHUGH, MATTHEW D. ; BROOKS CARTHON, MARGO ; SLOANE, DOUGLAS M. ; WU, EVAN ; KELLY, LESLY ; AIKEN, LINDA H.

The Milbank quarterly, 2012-03, Vol.90 (1), p.160-186 [Peer Reviewed Journal]

Malden, USA: Blackwell Publishing Inc

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Title:
Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California
Author: MCHUGH, MATTHEW D. ; BROOKS CARTHON, MARGO ; SLOANE, DOUGLAS M. ; WU, EVAN ; KELLY, LESLY ; AIKEN, LINDA H.
Subjects: California ; Cost ; Disclosure ; Health care ; Health legislation ; Health outcomes ; Health planning ; Health services ; Hospital costs ; Hospitals ; Hospitals, County - economics ; Hospitals, County - legislation & jurisprudence ; Hospitals, County - organization & administration ; Hospitals, Urban - economics ; Hospitals, Urban - legislation & jurisprudence ; Hospitals, Urban - organization & administration ; Humans ; Legislation ; mandate ; Medicaid ; Medical personnel ; Nurse patient relationships ; nurse staffing ; Nurses ; Nursing ; Nursing Staff, Hospital - legislation & jurisprudence ; Nursing Staff, Hospital - organization & administration ; Nursing Staff, Hospital - statistics & numerical data ; Nursing Staff, Hospital - supply & distribution ; Original ; Patients ; Personnel Staffing and Scheduling - legislation & jurisprudence ; Practice Patterns, Nurses' - economics ; Practice Patterns, Nurses' - legislation & jurisprudence ; Professional Competence ; Psychiatric hospitals ; Ratios ; Registered nurses ; Regression Analysis ; Safety net ; Sociology ; Sociology of health and medicine ; Staffing ; Staffing levels ; State hospitals ; Time series ; U.S.A ; Uncompensated Care - statistics & numerical data
Is Part Of: The Milbank quarterly, 2012-03, Vol.90 (1), p.160-186
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Description: Context: California is the first and only state to implement a patient-to-nurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care—safety-net hospitals—remains unclear. One concern was that California's mandate would burden safety-net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety-net and non-safety-net hospitals. Methods: We used a time-series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety-net and non-safety-net hospitals. Findings: The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (-0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety-net and non-safety-net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety-net hospitals, although there was a small but significant difference in the effect on staffing levels of safety-net and non-safety-net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non-safety-net hospitals following the mandate, while the skill mix remained essentially unchanged for safety-net hospitals. The difference between the two groups of hospitals was not significant. Conclusions: California's mandate improved staffing for all hospitals, including safety-net hospitals. Furthermore, improvement did not come at the cost of a reduced skill mix, as was feared. Alternative and more targeted designs, however, might yield further improvement for safety-net hospitals and reduce potential disparities in the staffing and skill mix of safety-net and non-safety-net hospitals.
Publisher: Malden, USA: Blackwell Publishing Inc
Language: English

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Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California

MCHUGH, MATTHEW D. ; BROOKS CARTHON, MARGO ; SLOANE, DOUGLAS M. ; WU, EVAN ; KELLY, LESLY ; AIKEN, LINDA H.

Malden, USA: Blackwell Publishing Inc

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