Warm Southern Breeze

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Good News! California’s Nurse:Patient Ratio Law Saves Lives!

Posted by Warm Southern Breeze on Tuesday, April 20, 2010

Extra! Extra!

Read all about it!

Should that, or

“Told ‘ya so!”

be the cry?

California and her residents, often maligned within and without, on occasion do come up with some good ideas.

Here’s one of the better ones.

In 1999, California became the first state in the nation to enact a mandatory Nurse:Patient ratio law. The law became fully effective in 2004.

During the past decade, there have been naysayers, and attempts by lawmakers – including the “Governator,” Governor Arnold Schwarzenegger (R) – within California to suspend or even gut the law, citing costs, as a predominate factor. In 2005, the California Nurse’s Association even sued the Governor over the matter, and won!

But the news is in: Mandatory Nurse-to-Patient Ratio laws work and save lives. (‘Course now, we nurses knew that all along. It just took us some time to prove it to hard-headed administrators whom snuggle up with pencil-necked geeks wearing funny green visors.) As of today – Tuesday, 20 April 2010 – there are 14 states and the District of Columbia that “had enacted nurse staffing legislation and/or adopted regulations addressing nurse staffing and another 17 states had introduced legislation,” while California is the solitary state to have enacted laws regulating minimum Nurse-to-Patient ratios.

What does this mean?

The long and short of it is, that you or a loved one might actually LIVE after an in-hospital admission for a procedure! (Like one old-timer told me, “any day above ground beats the alternative.”)

Researchers examined deaths resulting from common surgeries in California in 2006, and compared them to deaths in New Jersey and Pennsylvania for the same procedures. They found that 14% FEWER deaths would have occurred from those general surgeries in New Jersey, and 10.6% FEWER deaths in Pennsylvania if hospitals in NJ & PA had staffed at CA’s levels of 1 Registered Nurse for 5 Patients.

California’s Patient : Nurse Ratios

Units    _______ Patient:Nurse ratio

Medical/Surgical                    5:1
Pediatric                               4:1
Intensive Care Units              2:1
Telemetry                             5:1
Oncology                              5:1
Psychiatric                            6:1
Labor/Delivery                      3:1

The research was published today (Tuesday, 20 April 2010) in Health Services Research, a policy journal, and performed by the University of Pennsylvania School of Nursing.

(The University of Pennsylvania is sometimes known as Penn or UPenn, and is a private, research-based university in Philadelphia, PA, whose founder was Benjamin Franklin. It is NOT to be confused with “Penn State,” The Pennsylvania State University, in University Park, PA.)

In part, the study found that “… the higher the percentage compliance with benchmark based on California ratios, regardless of the hospital state location, the less likely nurses are to report complaints from patients or families, verbal abuse of nurses by staff or patients, [that] quality of care that is poor or only fair, and [express] lack of confidence that their patients can manage after discharge.

Bottom line?

“Improved nurse staffing, however it is achieved, is associated with better outcomes for nurses and patients.”

Read more:

California Code of Regulations, Title 22, Section 70217, 2005.

22 California Code of Regulations § 70217
Cal. Admin. Code tit. 22, § 70217
This database is current through 4/9/10 Register 2010, No. 15
§ 70217. Nursing Service Staff.

Implications of the California Nurse Staffing Mandate for Other States

Alternate download of “Implications of the California Nurse…research pdf is here.

Pioneering law on nurses found to save lives,
by Victoria Colliver, Chronicle Staff Writer

Just in the case the news story link may be lost, here it is from the above mentioned URL for your perusal.

Pioneering law on nurses found to save lives

Victoria Colliver, Chronicle Staff Writer

Tuesday, April 20, 2010

(04-20) 11:35 PDT SAN FRANCISCO — California’s law limiting the number of patients that can be assigned to a nurse has resulted in fewer deaths and a belief among the state’s nurses that they were able to provide better care, according to the first comprehensive evaluation of the landmark legislation.

The study by the University of Pennsylvania, published today in the policy journal Health Services Research, compared deaths from common surgeries in California in 2006, two years after the law was enacted, to surgical deaths in Pennsylvania and New Jersey.

The study concluded there would have been nearly 14 percent fewer deaths from general surgeries in New Jersey and 10.6 percent fewer surgical deaths in Pennsylvania if hospitals in those states had been staffed at California’s level of 1 nurse to every 5 patients. California is the only state in the nation with legally mandated patient-to-nurse ratios.

Researchers also surveyed more than 22,000 nurses in all three states and found California nurses consistently reported higher job satisfaction than nurses in the other states. The study attributed the finding to the California nurses’ ability to provide better care to their patients and spend more time with them.

“The differences between California and the other states are striking,” said Linda Aiken, lead author and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania’s School of Nursing. “Nurses in California take care of two fewer patients on average than nurses in Pennsylvania and New Jersey in general surgery. These differences lead to the prevention of literally thousands of deaths.”

California’s nurse-to-patient staffing law, implemented in 2004, required hospitals to meet minimum staffing levels that varied by the demands of each unit. For example, the law limits nurses to no more than five patients on a medical-surgical unit, three in labor and delivery and just two in the intensive care unit.

About 18 states are evaluating whether to adopt nurse-to-patient ratios. “It’s important to know what the impact on California is because the whole country is looking at this legislation,” Aiken said.

The ratios have been controversial, with some critics noting the lack of evidence to support the ratios. In late 2004, Gov. Arnold Schwarzenegger unsuccessfully sought to suspend the law, arguing it was too hard on financially strapped hospitals.

“What this study doesn’t do is compare California before the ratios to California after the ratios,” said Joanne Spetz, faculty researcher at UCSF’s Center for the Health Professions and one of the study’s authors. She said funding for the study was secured after the ratios were enacted.

But she said the findings on how nurses perceive their workload and ability to be more attentive to their patients is important in evaluating the success of the law because nursing satisfaction rates have a direct impact on quality of care.

“It really tells us what difference that (the law) makes in the ability of nurses to do their work,” said Jack Needleman, a professor at UCLA School of Public Health who researches nursing workloads, but who was not involved in the study. Needleman is critical of the ratio law, preferring instead a system in which nurse staffing would be based on the specific needs of each hospital.

Since the law was signed in 1999, California has increased the number of actively licensed registered nurses by more than 110,000, according to the California Nurses Association/National Nurses United, a strong proponent of the law.

Findings of the nurses-to-patients ratio study

— California nurses cared for two fewer patients on average than nurses in New Jersey and 1.7 fewer than in Pennsylvania,

— 468 more Californians would have died in 2006 from general surgical deaths if the state had the same nursing ratios as Pennsylvania and New Jersey.

— Adding one patient to nurses’ workloads increased patients’ odds of dying by 13 percent in California, 10 percent in New Jersey and 6 percent in Pennsylvania.

Source: University of Pennsylvania School of Nursing’s “Implications of the California Nurse Staffing Mandate for Other States.”

E-mail Victoria Colliver at vcolliver@sfchronicle.com.


This article appeared on page C – 5 of the San Francisco Chronicle

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