Using Minimum Nurse Staffing Regulations to Measure the Relationship Between Nursing and Hospital Quality of Care

This study tests whether changes in licensed nurse staffing led to changes in patient safety, using the natural experiment of 2004 California implementation of minimum staffing ratios. We calculated counts of six patient safety outcomes from California Patient Discharge Data from 2000 through 2006,...

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Bibliographic Details
Published in:Medical care research and review 2013-08, Vol.70 (4), p.380-399
Main Authors: Spetz, Joanne, Harless, David W., Herrera, Carolina-Nicole, Mark, Barbara A.
Format: Article
Language:English
Subjects:
California
Clinical outcomes
Government Regulation
Hospitals
Humans
Length of stay
Nurses
Nursing
Nursing Staff, Hospital - organization & administration
Patient care
Patient Safety
Personnel Staffing and Scheduling - legislation & jurisprudence
Poisson Distribution
Quality of care
Quality of Health Care - standards
Safety measures
Staffing
State regulation
Workforce planning
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Summary:This study tests whether changes in licensed nurse staffing led to changes in patient safety, using the natural experiment of 2004 California implementation of minimum staffing ratios. We calculated counts of six patient safety outcomes from California Patient Discharge Data from 2000 through 2006, using the Agency for Healthcare Research and Quality Patient Safety Indicators (PSI) software. For patients experiencing nonmortality-related PSIs, we measured mean lengths of stay. We estimated difference-in-difference equations of changes in PSIs using Poisson models and calculated the marginal impact of nurse staffing on outcomes from fixed-effect Poisson regressions. Licensed nurse staffing increased in the postregulation period, except for hospitals in the highest quartile of preregulation staffing. Growth in registered nurse staffing was associated with improvement for only one PSI and reduced length of stay for one PSI. Higher registered nurse staffing per patient day had a limited impact on adverse events in California hospitals.
ISSN:1077-5587
1552-6801
DOI:10.1177/1077558713475715