California’s nurse-to-patient ratio law and occupational injury
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To determine whether state-mandated minimum nurse-to-patient staffing ratios in California hospitals had an effect on reported occupational injury and illness rates.
The difference-in-differences method was applied: The change in injury rates among hospital nurses after implementation of the law in California was compared to the change in 49 other states and the District of Columbia combined. Data were drawn from the US Bureau of Labor Statistics and the California Employment Development Department, including numerator estimates of injury and illness cases and denominator estimates of the number of registered nurses (RNs) and licensed practical nurses (LPNs) employed in hospitals. Confidence intervals (CIs) for rates were constructed based on assumptions that favored the null hypothesis.
The most probable difference-in-differences estimate indicated that the California law was associated with 55.57 fewer occupational injuries and illnesses per 10,000 RNs per year, a value 31.6 % lower than the expected rate without the law. The most probable reduction for LPNs was 33.6 %. Analyses of CIs suggested that these reductions were unlikely to be due to chance.
Despite significant data restrictions and corresponding methodological limitations, the evidence suggests that the law was effective in reducing occupational injury and illness rates for both RNs and LPNs. Whether these 31.6 and 33.6 % reductions are maintained over time remains to be seen.
KeywordsLegislation Job-related injury Illness Ratios
- American Nurses Association (2013) Safe nurse staffing laws in state legislatures. http://www.safestaffingsaveslives.org/WhatisANADoing/StateLegislation.aspx. Accessed 1 Feb 2013
- Angrist JD, Pischke J-S (2009) Mostly harmless econometrics: an empiricist’s companion. Princeton University Press, PrincetonGoogle Scholar
- Bureau of Labor Statistics (2012) Employer-reported workplace injuries and illnesses. http://www.bls.gov/news.release/archives/osh_11072013.pdf. Accessed 15 April 2014
- Bureau of Labor Statistics (2013) Chapter 9: Occupational safety and health statistics. http://www.bls.gov/opub/hom/pdf/homch9.pdf. Accessed 27 Feb 2013
- California Department of Health Services (2003) Final statement of reasons R-37-01, pp 1–42. http://www.cdph.ca.gov/services/DPOPP/regs/Documents/R-37-01_FSOR.pdf. Accessed 10 Sep 2014
- California Healthline (2011) Nurses group pursues stringent penalties for staffing violations. http://www.californiahealthline.org/articles/2011/3/3/nurses-group-pursues-stringent-penalties-for-staffing-violations. March 3, 2011. Accessed 11 May 2014
- Casella G, Berger RL (2002) Statistical inference, 2nd edn. Duxbury, New YorkGoogle Scholar
- Charney W, Schirmer J (2007) Nursing injury rates and negative patient outcomes-connecting the dots. AAOHN J 55(11):470–475Google Scholar
- Jofre J (2008) New RN staffing regulations. LawyersandSettlements.com. January 11, 2008. http://www.lawyersandsettlements.com/features/employment/nurse-staffing-regulations.html#.U1q9aT-1e3I. Accessed 25 April 2014
- Occupational Safety and Health Administration (2013) Caring for our caregivers: facts about hospital worker safety. US. Department of Labor, Washington DC, September, 2013. https://www.osha.gov/dsg/hospitals/documents/1.2_Factbook_508.pdf. Accessed 17 April 2014
- Reville RT, Seabury SA, Neuhauser FW, Burton JF, Greenberg MD (2005) An evaluation of California’s permanent disability rating system. Rand Corporation, Santa Monica, California. http://www.rand.org/pubs/monographs/MG258.html. Accessed 29 April 2014
- Ruser JW (2008) Examining evidence on whether BLS undercounts workplace injuries and illnesses. Mon Lab Rev 131(8):20–32Google Scholar
- Schultz D (2013) Nurses fighting state by state for minimum staffing laws. Kais Health News April 24, 2013. http://www.kaiserhealthnews.org/stories/2013/april/24/nurse-staffing-laws.aspx. Accessed 25 April 2014
- Serratt T, Spetz J, Harrington C (2012) Are staffing changes in California’s hospitals sensitive to individual hospital characteristics? Nurs Econ 30(6):339–346Google Scholar
- Spetz J (2004) California’s minimum nurse-to-patient ratios: the first few months. J Nurs Adm 34:571–578Google Scholar
- Stock JH, Watson MW (2003) Introduction to econometrics. Addison-Wesley, New YorkGoogle Scholar