For decades, nurses have raised concerns regarding inadequate staffing that threatens the health and safety of their patients.
Aiken and her colleagues investigated how nurse workloads compared in three states, California, New Jersey, and Pennsylvania.
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.
Of these states, seven (CT, IL, NV, OH, OR, TX, and WA) require hospitals to have staffing committees to address staffing plans and policies; one state (CA) requires the minimum nurse-patient ratio to be maintained at all time; and five states (IL, NJ, NY, RI, and VT) require public disclosure or reporting.
For two decades, nurses have reported that there are not enough nurses in hospitals to provide high-quality care (Aiken and Mullinix 1987; Aiken, Sochalski, and Anderson 1996; Aiken et al. In response to these con- cerns, Congress, in 1993, requested an Institute of Medicine (IOM) study of the adequacy of nurse staffing in hospitals and nursing homes.
Hayes (2010) Professional nursing practice: Concepts and perspectives (6th ed.). California remainstheonlystateto have enacted minimum nurse staffing requirements, and as the amount of legislative and regulatory r Health Research and Educational Trust DOI: 10.1111/j.1475-6773.2010.01114.x 1 Health Services Research activity suggests, there is widespread interest in what can be learned from California’s example. A meta-analysis of 90 studies commissioned by the Agency for Healthcare Research and Quality (AHRQ) subsequently concluded that there is an evident association between nurse staffing and patient outcomes (Kane et al. Registered nurse (RN) staffing in California hospitals increased sub- stantially following the passage of the legislation and implementation of the regulations (Donaldson et al.
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.
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.
In a statement on its website, ANA says that it “supports a legislative model in which nurses are empowered to create staffing plans specific to each unit.
This approach aides in establishing staffing levels that are flexible and account for changes; including intensity of patient’s needs, the number of admissions, discharges and transfers during a shift, level of experience of nursing staff, layout of the unit, and availability of resources (ancillary staff, technology etc.).” Rather than mandated fixed ratios or a one-size-fits-all approach, this type of model would give hospitals the flexibility to develop staffing plans that fit their particular institutional and patient needs.
In 2004, California became the first state to implement minimum nurse-to-patient staffing ratios. Dr.
Linda Aiken, Ph D, RN and her colleagues studied the effectiveness of the staffing ratios mandated in California. Aiken’s findings have important implications beyond California.