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Study Finds Lower Nurse-to-Patient Ratios Save Lives,Help Nurses

Are lower nurse-to-patient ratios a life saver or a money waster? That debate has been going on for years. Now, a new study of surgical patients in New Jersey and Pennsylvania has found that as many as 14 percent fewer patients would have died if hospitals in those states had required the same number of nurses as in California’s law.

If California’s mandatory nurse-patient ratios had been in effect in Pennsylvania and New Jersey hospitals in 2006, those states would have seen 10.6% and 13.9% fewer deaths among general surgical patients, according to a Pennsylvania researcher’s analysis.
That equated to 468 lives that might have been saved, says Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and the study’s lead author. Her report was published in the journal Health Services Research, and is considered the first comprehensive evaluation of California’s controversial 2004 nurse staffing ratio mandate and may inform decisions in 18 other states that are considering lowering their nurse-staff ratios, such as Massachusetts, Minnesota, and Illinois.

Here’s a very short summary of the results from the intro of the study:

Principal Findings.
California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units.
Lower ratios are associated with significantly lower mortality.When nurses’ workloads were in line with California-mandated ratios in all three states, nurses’ burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care.

Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.

Sandy Gomberg, interim CEO at Temple University Hospital, said the hospital will not agree to required ratios. She said staffing is too complex _ a mixture of patient needs, nurse skills, available technology and unit geography _ to reduce to one number. “Quality patient care cannot be boiled down to a math problem,” said Gomberg, who is a nurse.

The University of Pennsylvania’s Aiken said the new study follows decades of research showing that patient outcomes are better when nurses care for fewer patients.

She said many hospitals in Pennsylvania and New Jersey already meet California’s nursing requirements. “Some hospitals are quite good and some hospitals really have unsafe staffing by the standards of California,” she said. Her report did not identify specific hospitals.

Aline Holmes, senior vice president for clinical affairs for the New Jersey Hospital Association, said two-thirds of hospitals in New Jersey have medical-surgical unit nurse-to-patient ratios of one to 5.5 or less. She said previous studies have not shown that California’s mandates led to better patient outcomes. She thinks hospitals should determine staffing based on how sick patients are.

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