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The Effect of a Hospital Nurse Staffing Mandate on Patient Health Outcomes: Evidence from California’s Minimum Staffing Regulation

Author

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  • Andrew Cook
  • Martin Gaynor
  • Melvin Stephens, Jr.
  • Lowell Taylor

Abstract

We evaluate the impact of California Assembly Bill 394, which mandated maximum levels of patients per nurse in the hospital setting. When the law was passed, some hospitals already met the requirements, while others did not. Thus changes in staffing ratios from the pre- to post-mandate periods are driven in part by the legislation. We find persuasive evidence that AB394 had the intended effect of decreasing patient/nurse ratios in hospitals that previously did not meet mandated standards. However, these improvements in staffing ratios do not appear to be associated with relative improvements in measured patient safety in affected hospitals.

Suggested Citation

  • Andrew Cook & Martin Gaynor & Melvin Stephens, Jr. & Lowell Taylor, 2012. "The Effect of a Hospital Nurse Staffing Mandate on Patient Health Outcomes: Evidence from California’s Minimum Staffing Regulation," The Centre for Market and Public Organisation 12/283, The Centre for Market and Public Organisation, University of Bristol, UK.
  • Handle: RePEc:bri:cmpowp:12/283
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    Cited by:

    1. 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.
    2. Jean-Baptiste Combes & Eric Delattre & Bob Elliott & Diane Skåtun, 2015. "Hospital staffing and local pay: an investigation into the impact of local variations in the competitiveness of nurses’ pay on the staffing of hospitals in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(7), pages 763-780, September.
    3. Nick Krachler & Jennie Auffenberg & Luigi Wolf, 2021. "The Role of Organizational Factors in Mobilizing Professionals: Evidence from Nurse Unions in the United States and Germany," British Journal of Industrial Relations, London School of Economics, vol. 59(3), pages 643-668, September.
    4. Karina Dietermann & Vera Winter & Udo Schneider & Jonas Schreyögg, 2021. "The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 833-846, July.
    5. Nan Jiang & Gail Pacheco, 2014. "Demand in New Zealand hospitals: expect the unexpected?," Applied Economics, Taylor & Francis Journals, vol. 46(36), pages 4475-4489, December.
    6. John R. Bowblis & Andrew Ghattas, 2017. "The Impact of Minimum Quality Standard Regulations on Nursing Home Staffing, Quality, and Exit Decisions," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 50(1), pages 43-68, February.
    7. Yaa Akosa Antwi & John R. Bowblis, 2018. "The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession," American Journal of Health Economics, University of Chicago Press, vol. 4(2), pages 131-163, Spring.
    8. Traczynski, Jeffrey & Udalova, Victoria, 2018. "Nurse practitioner independence, health care utilization, and health outcomes," Journal of Health Economics, Elsevier, vol. 58(C), pages 90-109.
    9. Maibom, Jonas & Sievertsen, Hans H. & Simonsen, Marianne & Wüst, Miriam, 2021. "Maternity ward crowding, procedure use, and child health," Journal of Health Economics, Elsevier, vol. 75(C).
    10. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    11. 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.
    12. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2020. "Capacity constraints and time allocation in public health clinics," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 324-336, March.
    13. Mareike Heimeshoff & Jonas Schreyögg & Oliver Tiemann, 2014. "Employment effects of hospital privatization in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 747-757, September.
    14. David, Guy & Kim, Kunhee Lucy, 2018. "The effect of workforce assignment on performance: Evidence from home health care," Journal of Health Economics, Elsevier, vol. 59(C), pages 26-45.
    15. Augurzky, Boris & Bünnings, Christian & Wübker, Ansgar, 2017. "The relationship between nurse staffing levels and objective and subjective quality of care: A panel data approach for Germany," Ruhr Economic Papers 724, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    16. Haizhen Lin, 2014. "Revisiting the relationship between nurse staffing and quality of care in nursing homes: An instrumental variables approach," Working Papers 2014-01, Indiana University, Kelley School of Business, Department of Business Economics and Public Policy.
    17. Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.
    18. Lin, Haizhen, 2014. "Revisiting the relationship between nurse staffing and quality of care in nursing homes: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 37(C), pages 13-24.
    19. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2019. "Capacity Constraints and the Provision of Public Services: The Case of Workers in Public Health Clinics," NBER Working Papers 25706, National Bureau of Economic Research, Inc.
    20. Arindrajit Dube & Ethan Kaplan & Owen Thompson, 2016. "Nurse Unions and Patient Outcomes," ILR Review, Cornell University, ILR School, vol. 69(4), pages 803-833, August.
    21. Michael DiNardi, 2017. "Affordable Care Act Medicaid Expansions and the Impact on Nurses," 2017 Papers pdi509, Job Market Papers.

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    More about this item

    Keywords

    Nursing; Staffing; Regulation; Outcomes; Hospitals; patient safety;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • K2 - Law and Economics - - Regulation and Business Law

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