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c) Using all of these references, develop your plan for influencing votes of legislators on nurse-patient ratios. As of September 2009, 14 states and the District of Columbia had enac- ted nurse staffing legislation and/or adopted regulations addressing nurse staffing and another 17 states had introduced legislation (American Nurses Association 2009). Researchers were unable to detect an impact Address correspondence to Linda H. RESEARCH ARTICLE Implications of the California Nurse Staffing Mandate for Other States Linda H. When nurses’ workloads were in line with California-mandated ratios in all three states, nurses’ burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur. Nurse staffing, California nurse ratios In 2004, California became the first state to implement minimum nurse- to-patient staffing requirements in acute care hospitals (Coffman, Seago, and Spetz 2002; Spetz 2004). Whether the increase in nurses is associated with improved outcomes has been more difficult to determine. A recent ANA survey of nearly 220,000 RNs reported that 54% of nurses do not have sufficient time with patients, 43% have been working extra hours because of short staffing, and 20% found that inadequate staffing affected admissions, transfers, and discharges.Legislation to aid in staffing plans and ratios has been discussed on both the state and federal levels.Currently, 15 states (CA, CT, IL, ME, MN, NV, NY, NJ, NC, OH, OR, RI, TX, VT, and WA) plus the District of Columbia have enacted legislation or adopted regulations to address nurse staffing.
The law addresses minimum staffing requirements for nursing homes and requires a registered nurse (RN) in the operating room during all surgical procedures. “To determine whether nurse staffing in California hospitals, where state-mandated minimum nurse-to-patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes.” This study comes from 2006 survey data of 22,366 hospital staff nurses in California, Pennsylvania, New Jersey, and state hospital discharge databases from those states. New Jersey and Pennsylvania were chosen because these states lacked nurse staffing standards at the time of the study. DPE-affiliated unions represent: teachers, college professors, and school administrators; library workers; nurses, doctors, and other health care professionals; engineers, scientists and IT workers; journalists, and writers, broadcast technicians and communications specialists; performing and visual artists; professional athletes; professional firefighters; psychologists, social workers, and many others.But Jan Emerson, spokeswoman for the California Hospital Association, which fought implementation of the ratios with an unsuccessful court challenge, says they are tough for hospitals to enforce."The most onerous aspect to the ratios is the requirement that hospitals be in 'continuous compliance'—that means in compliance every minute of every shift on every unit every day," Emerson says.We reported in 2002 that each patient added to nurses’ workloads was associated with a 7 percent increase in mortality following common surgeries, and that nurse burnout and job dissatisfaction, precursors of voluntary turnover, also in- creased significantly as nurses’ workloads increased (Aiken et al. Rep- lications in Canada, England, and Belgium produced similar findings as did other studies in the United States (Aiken, Clarke, and Sloane 2002; Needle- man et al. N., Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104-4217; e-mail: [email protected]
Aiken examined how patient mortality and failure-to-rescue (FTR), incidents where hospital doctors, nurses, or caregivers fail to notice symptoms or respond adequately to signs that a patient is dying of preventable complications, are affected by differences in nurse workloads.