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The Labor Market Effects Of California'S Minimum Nurse Staffing Law

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  • Elizabeth L. Munnich

Abstract

In 2004, California became the first state to implement statewide minimum nurse‐to‐patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse‐to‐patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets. Copyright © 2013 John Wiley & Sons, Ltd.

Suggested Citation

  • Elizabeth L. Munnich, 2014. "The Labor Market Effects Of California'S Minimum Nurse Staffing Law," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 935-950, August.
    • Handle: RePEc:wly:hlthec:v:23:y:2014:i:8:p:935-950
    DOI: 10.1002/hec.2966
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    References listed on IDEAS

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    1. Cook, Andrew & Gaynor, Martin & Stephens Jr, Melvin & Taylor, Lowell, 2012. "The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California's minimum staffing regulation," Journal of Health Economics, Elsevier, vol. 31(2), pages 340-348.
    2. Patricia K. Tong, 2011. "The effects of California minimum nurse staffing laws on nurse labor and patient mortality in skilled nursing facilities," Health Economics, John Wiley & Sons, Ltd., vol. 20(7), pages 802-816, July.
    3. A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller, 2008. "Bootstrap-Based Improvements for Inference with Clustered Errors," The Review of Economics and Statistics, MIT Press, vol. 90(3), pages 414-427, August.
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    1. David W. Harless, 2019. "Reassessing the labor market effects of California's minimum nurse staffing regulations," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1226-1231, October.
    2. Falch, Torberg & Strøm, Bjarne, 2025. "Teacher shortages, the business cycle, and teacher demand: A long-run perspective," Explorations in Economic History, Elsevier, vol. 98(C).
    3. Elizabeth Munnich & Abigail Wozniak, 2020. "What Explains the Rising Share of US Men in Registered Nursing?," ILR Review, Cornell University, ILR School, vol. 73(1), pages 91-123, January.
    4. Raja, Chandni, 2023. "How do hospitals respond to input regulation? Evidence from the California nurse staffing mandate," Journal of Health Economics, Elsevier, vol. 92(C).
    5. Milstein, Ricarda & Schreyoegg, Jonas, 2020. "The relationship between nurse staffing levels and nursing-sensitive outcomes in hospitals: Assessing heterogeneity among unit and outcome types," Health Policy, Elsevier, vol. 124(10), pages 1056-1063.

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