A 2004 California law mandating specific nurse-to-patient staffing standards in acute care hospitals significantly lowered job-related injuries and illnesses for both RNs and LPNs, according to UC Davis research published online in the International Archives of Occupational and Environmental Health.
The study, whose authors include Carrie Markis, MSN, RN, is believed to be the first to evaluate the effect of the law on occupational health, according to a news release.
Study lead author J. Paul Leigh, a professor of public health sciences and investigator with the Center for Healthcare Policy and Research at UC Davis, Sacramento, said in the release that the researchers were surprised to discover such a large reduction in injuries as a result of the law, and that the findings should contribute to a national debate about enacting similar laws in other states.
The study is titled “California’s Nurse-to-Patient Ratio Law and Occupational Injury.” All study authors were from UC Davis, including Markis, a master’s graduate from the Betty Irene Moore School of Nursing at UC Davis.
California is the only state in the U.S. with mandated minimum nurse-to-patient staffing ratios, according to the release. The ratios are based on the type of service such as pediatrics, surgery, or labor and delivery, and allow for flexibility in cases of healthcare emergencies.
Some hospitals have argued against extending the law to other states because of the increased costs of additional nursing staff, according to the release. There is no consensus that the law has improved patient outcomes, which was its primary intent. Some studies show improvement, while others do not, according to the release.
Leigh said the study measures the lower workers’ compensation costs, improved job satisfaction and increased safety that comes with linking essential nursing staff levels to patient volumes.
Using data from the U.S. Bureau of Labor Statistics, Leigh and his colleagues compared occupational illness and injury rates for nurses during several years before and after implementation of the new law. They also compared injury and illness rates in California to rates for all other states combined.
For California, they estimated the law resulted in an average yearly change from 176 injuries and illnesses per 10,000 RNs to 120 per 10,000, representing a 32% reduction. For LPNs, the average yearly change went from 244 injuries per 10,000 to 161 per 10,000, representing a 34% reduction.
Leigh said in the release that the lower rates of injuries and illnesses to nurses could come about in a number of ways as a result of improved staffing ratios. Back and shoulder injuries could be prevented, for instance, if more nurses are available to help with repositioning patients in bed. Likewise, fewer needle-stick injuries may occur if nurses conduct blood draws and other procedures in a less time-pressured manner.
The research team recommended additional research with more recent data to see if the reductions in injury and illness rates held up over time.