California’s nurse-to-patient ratio cuts nurse injuries by one-third

Thinkstock | Fuse

Thinkstock | Fuse

California’s mandatory nurse-to-patient ratio has reduced LPN injuries and illnesses by more than 33 percent a year since the law was enacted in 2004, according to a new study. The numbers were similar for RNs, with injuries and illnesses reduced by an average of 32 percent over the same time period.

“We were surprised to discover such a large reduction in injuries as a result of the California law,” said the study’s lead author, J. Paul Leigh, according to a press release. “These findings should contribute to the national debate about enacting similar laws in other states.”

California is currently the only state with a mandatory minimum staffing ratio. However, other states have some staffing laws and some are considering enacting a minimum.

The study was done by researchers at the University of California, Davis, and published in the journal International Archives of Occupational and Environmental Health. It looked at the injury and illness rates before and after the law was enacted, also comparing California’s rates to those of all other states combined.

The study’s authors found that the minimum staffing ratio also resulted in other benefits, including increased nurse job satisfaction.

“Our study links the ratios to something just as important—the lower workers’ compensation costs, improved job satisfaction and increased safety that comes with linking essential nursing staff levels to patient volumes,” said Leigh.

California nurses, do these findings seem similar to what you’ve noticed on the job? And for nurses who don’t live in California, do you think that a mandatory minimum staffing ratio would have a positive impact on your job satisfaction and safety? Weigh in below.

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3 Responses to California’s nurse-to-patient ratio cuts nurse injuries by one-third

  1. beoff2

    I would’nt know about reduction of injury’s but better staffing would increase better patient care and reduce staff turn over

  2. Gene Hunter

    When I took over Coral Ridge Psych hospital as DON, we had a 21% fall rate with state # staffing and restrictive restraints. After implementing a less restrictive method and improved assessment skills; decrease the ration of patients to nurses and other staffing, all monthly injuries to staff and patients decrease in 3 months to 0-1%/ months and this continued for 5 years the time all implementation stayed in place. Hunter

  3. Corinne MacEgan

    While California’s ratio laws make sense, and I’m happy they’ve been implemented, there are improvements that are needed.

    The RN Safe Staffing Act of 2003 was intended to include “intensity”, or acuity, of the patient with each assignment, as mentioned here in one of the standards: “Be based on the number of patients and level and intensity of care to be provided, with consideration given to admissions, discharges and transfers that nurses must handle each shift” (American Association of Critical Care Nurses, 2015). The Act was also intended to include consideration of nurse opinions with each assignment.

    While we fill out the Acuity Checklist for each patient, it is rare (at least on my unit) that these numbers are considered. Nurses may choose different statuses based on their assessment, so it’s a highly subjective field. The charge nurses often assign rooms based on location, and will usually only assign a nurse four patients if there is one who is receiving chemotherapy.

    Recently I have put forth the idea that comfort care patients, chemotherapy patients, and those patients who require sitters or extensive attention be part of a 1:4 ratio, or 1:3 if staffing allows. While we are licensed as a medical-surgical unit, and therefore make the 1:5 ratio law, I agree that this is a maximum, and doesn’t always allow for safe or effective care.

    As nurses, we have the ability to write to our legislators and nursing organizations suggesting amendments to legislation. I have already presented this to my board at ANA\C and it will be placed on our “To-Do” list. This idea may also be presented to individual hospitals by nursing, with the foundation of safer care for the patients. If we are not staffed to provide efficient care, there is a chance for increased falls, lowered patient satisfaction scores, etc. Personally, I have heard patients and family members verbalize that they never see their nurse, or they always see staff running around.

    American Association of Critical Care Nurses. (2015). Nurse-to-Patient Ratios. Retrieved from