Does Nurse-to-Patient Ratio Legislation Help Patients or Harm Hospitals in the United States?

California’s law was passed in 1999 under Governor Gray Davis.  The implementation of ratios began January 1, 2004 and was considered a great success by California nursing groups.  The implementation of planned increased standards (lower ratios), scheduled for 2005, was frozen until 2008 by Governor Schwarzenegger as an emergency action due to the predicted high costs to hospitals and severe nursing shortage. Several California courts, however, upheld the legislation and the tougher standards were enforced. According to the Department of Health Services nursing ratios had an estimated cost of $442 million in 2004, and $652 million for 2005 once stricter standards were in place. The estimate for 2008 and beyond is $956 million annually. An estimated 5,000 additional nurses are required statewide to meet the guidelines; a difficult proposition in the midst of a nationwide nursing shortage.

The California Nurses Association (CNA) claims that ratios have been successful in creating a safer working environment in hospitals. They believe that creating a safer and more pleasant work environment for nurses will attract trained nurses who have left the profession to go back to work. They also assert that nursing ratios are necessary to protect patient safety and eliminate the dangers associated with patient overload. They suggest a strong link between improved nurse-to-patient staffing and lower rates of medical errors and patient deaths. The CNA heavily criticized Schwarzenegger’s freeze on tougher standards suggesting he is showing a “disregard for patient safety” and accused him of pandering to the multibillion-dollar hospital industry. The CNA filed the lawsuit that ultimately enforced the higher standards.