Assessing the Impact of California's Nurse Staffing Ratios on Hospitals and Patient Care

UCSF Center for California Health Workforce Studies

This issue brief examines California's establishment of minimum nurse-to-patient staffing ratios. It finds that while hospitals increased their use of nurses with the highest skills, the regulation has not led to a clear improvement in the quality of care.

February 2009

In 2004, California began requiring that acute care hospitals maintain certain minimum ratios of nurses to patients, making it the first state in the nation to do so. However, little is known about what effects the staffing ratios have had, either on the hospitals themselves or on the quality of care they provide.

This issue brief examines how California's nurse staffing regulations affected different types of hospitals in order to probe what strategies were used to meet the ratio requirements, whether the ratios influenced hospitals' financial performance, and what effect they had on improving patient care. The research combined quantitative and qualitative analyses, including interviews with executives and other management staff at 12 acute care hospitals.

The results show that while the legislation has increased the use of registered nurses, the ratios have had no clear impact on the quality measures that are associated with nursing care. The study also found no relationship between the staffing regulations and the overall decline in hospital operating margins that occurred after the law went into effect.

The full issue brief is available under Document Downloads.