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Nurse Staffing Mandates Are Not a Silver Bullet

Alexandra Wilson Pecci, for HealthLeaders Media, February 12, 2013

Fed up with inadequate staffing that exhausts staff and puts patients at risk, Washington, DC, nurses flooded their city hall earlier this month, clad in red scrubs and demanding specific nurse-to-patient ratios that would protect themselves and patients.

In response to their calls for action, D.C. Council Chairman Phil Mendelson said he plans to introduce legislation that would require the city's hospitals to increase nursing staff levels, according to The Washington Post.

Mandating nurse staffing levels is a move that seems like a good idea, but carries with it a lot of controversy and questions about its effectiveness.

There's plenty of research showing that inadequate staffing levels negatively impact patient care, and that makes sense. It's a simple question of manpower. One nurse on a 12-hour shift couldn't possibly take care of 10 patients as effectively as two nurses could.

Yet legislative mandates—which require minimum staffing levels at all hospitals within a jurisdiction—may not be the solution to this problem. The best example is California, where a nurse staffing mandate that's been in place since 2004 has been billed a national experiment. So far, the experiment has had mixed results.

For example, a study published in the journal Health Services Research, found that although the California law succeeded in boosting nurse staffing, the staffing increase had only "mixed effects on quality." Researchers couldn't be certain whether any recorded quality improvements were actually caused by staffing changes.

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