A comparison of the nursing costs associated with the implementation of the mandated nurse-to-patient ratios in California

Abstract

<p>Nurse executives are challenged to provide adequate nurse staffing to prevent adverse patient outcomes, promote patient satisfaction and enhance nurses' job satisfaction. Historically, nurse staffing strategies have involved the use of patient classification systems, the use of time studies to predict staffing numbers and the best guesses of the nurse administrators. Collective bargaining units moved to include staffing ceilings or nurse-to-patient ratios to address staffing needs in hospitals. In 1999, the state of California signed AB394 into law requiring the implementation of mandated minimum nurse-to-patient ratios. The California Department of Health Services estimated that the mandated nurse-to-patient ratios would cost California hospitals $956 million annually after implementation given adequate recruiting sources (CHA, 2004). While this estimate was made prior to the known fiscal impact of the ratios, no study has been published addressing the actual costs differences to the hospitals of the mandated nurse-to-patient ratios that were implemented in 2004. As other states consider introducing legislation to implement the staffing ratios as California has done, the impact of these costs should be revealed. The aim of this study was to examine the impact on nursing costs expressed as a percentage of hospital operating costs from before the staffing ratios in California were implemented (2002) and after the staffing ratios were implemented (2006). Two hundred eighty-two hospitals were included in this study. Financial and productivity data were obtained from the Office of Statewide Health Planning and Development in California. Examination of the percentage of total hospital operating costs attributed to nursing costs shed light on the fiscal impact of the mandated nurse-to-patient ratios in California. Results demonstrated that there was significant difference in the percentage of total hospital operating costs attributed to Registered Nurse costs and to overall nursing costs. There was no significant difference in the percentage of total hospital operating costs attributed to the costs for the licensed vocational nurse. In addition, there were no significant differences noted in the level of unit support staff (aides/orderlies, technicians, clerical) after the implementation of the ratios.</p>