National Nurses United

NewsBriefs.REV_April 5/8/10 12:04 AM Page 6 NEWS BRIEFS Study: Sta∞ng Ratios Save Lives our hundred and sixty-eight. That's how many more general surgery patients might be alive today if New Jersey and Pennsylvania had the same nurse-topatient ratio law as California from 2004 to 2006. It's just one of the findings of a major study on California's safe staffing law released this month by researchers from the University of Pennsylvania. The most farreaching examination of the law to date, the study found that staffing ratios have improved nurses' ability to provide quality care, reduced patient mortality, and increased nurse job satisfaction. "Thousands of deaths could be prevented if we improved nurse-to-patient staffing," said lead researcher Linda Aiken, RN, PhD, director of the Center for Health Outcomes and Policy Research at the F 6 N AT I O N A L N U R S E NEW JERSEY PENNSYLVANIA CALIFORNIA Eighty-eight percent of the medical–surgical nurses in California cared for five patients or less on their last shift. The same was true of only 19 and 33 percent of medical–surgical nurses in New Jersey and Pennsylvania, respectively. University of Pennsylvania. "In every single outcome we looked at for both patients and nurses, mandated ratios led to better results." The study, published in the journal Health Services Research, compared nurse staffing and patient mortality rates at hospitals in New Jersey and Pennsylvania—two states without safe staffing laws—to those in California. Researchers surveyed more than 22,000 nurses in 2006, asking them questions about workload, job satisfaction and burnout. What they found wouldn't surprise any nurse on a hospital floor. California RNs were able to spend more time at the bedside, detect changes in condition sooner and send patients home with a better ability to manage their care than their counterparts in the other states, according to the survey results. W W W. N A T I O N A L N U R S E S U N I T E D . O R G The study found that New Jersey hospitals would experience 14 percent fewer patient deaths in surgical units and Pennsylvania 11 percent fewer if they applied the same safe staffing ratios as California. That remained true even after researchers controlled for 130 confounding factors, including the severity of patient illness. "We knew when the study was done it would show what we've been saying all along," said Malinda Markowitz, RN, Copresident of the California Nurses Association. "Finally, hospitals can't dispute it and other state nursing associations can't dispute it." Sponsored by CNA, the first-in-thenation safe staffing law was passed in 1999 and implemented in 2004. Nurses beat back several attempts by the hospital industry and Governor Arnold Schwarzenegger to weaken or repeal it. It set minimum nurseto-patient ratios by hospital unit—from 1:2 in intensive care to 1:5 for surgical patients—that must be adjusted upward based on how sick patients are. The study comes as National Nurses United is working to pass similar laws in several states, including Pennsylvania, Florida and Illinois. NNU is also lobbying for S. 1031/H.R. 2273, the National Nursing Shortage Reform and Patient Advocacy Act, which would mandate safe staffing ratios at the national level. Hospital industry executives have argued that there was no real science to back up the effectiveness of ratios, and some previous research found only a weak relationship. But this study, led by one of the most prominent researchers in the field and published in a journal with a reputation for stringent peer review, puts the burden on the industry to justify their opposition, said Jack Needleman, a professor of public health at the University of California, Los Angeles who studies nurse workloads. "The weight of evidence is that the association between nurse staffing and patient care quality is real and causal," he said. "Those that make the counter argument need to put data on the table and not just offer theoreticals now." —Heather Boerner APRIL 2010

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