Higher Nurse-to-Patient Ratios Make Hospitals Safer For Other Workers: Study

The findings of new research support the benefits of hospitals having more nurses, finding that mandated nurse-to-patient ratios in California have helped reduce occupational injuries among hospital workers by one-third.

In a study published in the International Archives of Occupational and Environmental Health, researchers from UC Davis found that state mandated hospital nursing levels decreased work injuries suffered in Registered Nurses (RNs) by nearly 32%. The new ratios also reduced injuries to Licensed Practical Nurses (LPN) by more than 33%.

The California law was enacted in 2004, mandating specific nurse-to-patient staffing ratio standards in acute care hospitals for RNs and LPNs. The ratios were specified based on the type of service, including pediatrics, surgery and labor and delivery.

J. Paul Leigh, lead researcher of the study and professor of public health sciences and investigator with the Center for Healthcare Policy and Research at UC Davis, said the California law was positively associated with 55 fewer occupational injuries and illnesses per 10,000 nurses, and those rates increase dependent on the type of nurse required in a specific situation.

The law resulted in an average yearly change from 244 injuries and illnesses per 10,000 LPNs, down to 161 per 10,000.

“We were surprised to discover such a large reduction in injuries as a result of the California law,” said Leigh.

Nurse-to-Patient Ratio Law Unique to California

California is the only state in the country to mandate minimum nurse-to-patient ratios, including a 1:2 ratio in critical care units, 1:2 in labor and delivery, 1:4 in postpartum mother-baby couplets, 1:2 in post-anesthesia recovery units, 1:4 in emergency rooms and 1:4 in pediatric units.

Researchers conducted a “difference-in-differences” study, where they compared injury rates in California before the law was enacted, rates for several years after it was enacted and injury rates to the other 49 states and District of Columbia, which do not have a nurse-to-patient ratio enforce.

The study used data from the U.S. Bureau of Labor Statistics and the California Employment Development Department.

Leigh said the reductions were unlikely due to chance, and were more likely a result of the mandate. Increasing nurse-to-patient staffing ratios would naturally help prevent injuries. For example, increasing the number of nurses to be available to help reposition patients in bed would help reduce the number of shoulder and back injuries.

This is the first study into the effects of the law on occupational health. Researchers have not reached consensus on whether this translates to better patient outcomes, which was the original intent of the mandate.

Some hospitals have argued against extending the law to other states, indicating that it will result in increased costs associated with maintaining additional nursing staff. However, the mandate did lower worker compensation costs, improved job satisfaction and increased workplace safety.

“Even if the improvement was a temporary ‘halo’ effect of the new law, it is important to consider our results in debates about enacting similar laws in other states,” said Leigh. “Nurses are the most recognizable faces of health care. Making their jobs safer should be a priority.”