A response to California's mandated nursing ratios

Purpose: To explore the need for evidence-based health policy, as illustrat ed by the mandatory staffing bill passed by the California state legislatur e in 1999. Design: Prospective data were collected from a voluntary sample of Californ ia acute care hospital representatives to describe selected patient safety and clinical outcomes and nurse staffing variables at the patient-care unit level. Methods: Data for descriptive analysis were collected on hospital nurse sta ffing, patient falls, and pressure ulcers from 257 medical, surgical, medic al-surgical combined, step-down, 24-hour observation units, and critical ca re patient care units in 38 California acute care hospitals from June 1998 to June 1999. Findings: Nursing staffing ratios varied among the 257 units. RNs provided 91% of the nursing care in critical care units. Patients in medical-surgica l units received 59% of their care from RNs, 11% from licensed vocational n urses, and 30% from other caregivers. Preliminary data showed no relationsh ips between reported staffing ratios in these hospitals and the incidence o f patient falls or hospital-acquired pressure ulcers. Conclusions: California Nursing Outcomes Coalition (CalNOC) data showed wid e variations in staffing ratios, patient falls, and hospital-acquired press ure ulcers among nursing units and hospitals. These early findings indicate the need for additional research before determining minimal RN staffing re quirements. Analysis of multiple sources of data may be necessary to determ ine safe staffing ratios and to provide evidence-based data for public poli cy.