Travel Nursing in California Might Be Safest, Study Shows


By Debra Wood, RN, contributor

When considering a travel assignment, nurses might want to gravitate to California, the only state in the nation with mandatory minimum nurse-to-patient ratios. Not only are ratios good for patients, a new study from the University of California, Davis shows ratios have significantly lowered job-related injuries and illnesses for both registered nurses and licensed practical nurses in the state.

“We concluded the law did have an effect in reducing injuries more than what would have happened without the law,” said J. Paul Leigh, PhD, core faculty at the Center for Healthcare Policy and Research and a professor of health economics at UC Davis.

He conducted the study after a long-held interest in occupational health and curiosity about the difference in nurse safety and health after the law. He could not find any other data looking at the occupational health results of California’s ratios law.

The researchers used a difference-in-differences method to assess injury rates from U.S. Bureau of Labor Statistics data among hospital nurses; they studied before and after the ratio law went into effect in California and in 49 other states and the District of Columbia combined.

They found that nurse safety and health rates improved overall, but they were significantly better in California: a 32 percent reduction in injuries and illness for RNs and a 34 percent reduction for LPNs. Leigh indicated he did not expect the results the study delivered, saying that he and colleagues were surprised at the large reduction in injuries that resulted from the law.

Deborah Burger, RN, co-president of National Nurses United in California, on the other hand, was not surprised.

“It’s something most nurses could have told people,” Burger said. “When you have staffing that is adequate and allows you to slow down for a few minutes and not rush, it makes a huge difference in not only being able to provide good patient care but being able to prevent injuries.”

Burger added that the study validates what nurses have suspected and experienced. Plus having the data is helpful in convincing policymakers about the importance of staffing ratios. National Nurses United has worked extensively on trying to convince Congress at the federal level and state legislatures to pass similar nurse-to-patient ratios legislation.

“Even if the improvement was a temporary or ‘halo’ effect of the new law, it is important to consider our results in debates about enacting similar laws in other states,” Leigh said about the study, which was published online in the International Archives of Occupational and Environmental Health. “Nurses are the most recognizable faces of health care. Making their jobs safer should be a priority.”

Leigh pointed out that mandated nurse-to-patient ratios have led to improved nurse satisfaction and that in other industries, safer work environments have also been associated with improved job satisfaction. Reduced injury rates could lead to lower workers’ compensation costs, as well, resulting in a financial benefit to hospitals.

Additionally, many studies, including those by Linda Aiken at the University of Pennsylvania, have associated better nurse staffing after the ratios were mandated with improved patient care, Burger added.

“If the nurses are safer and healthier, it helps patients, and it’s better for the nurses themselves,” Leigh said. “Nursing is the most hazardous occupation for women.”

Leigh speculated that the lower rates of injuries and illnesses for nurses in California could result from more staff being available to lift and move patients and nurses having a few more minutes to ensure all sharps are collected and disposed of properly, among other things.

“It allows you more time to think carefully about monitoring the patient,” Leigh said. “You have fewer patients to think about and will make fewer errors.”

Burger, a diabetes educator, personally observed a difference in discharged patients’ abilities to manage their diabetes.

“Ratios have a ripple effect,” Burger said. “There are probably other benefits that have not been studied yet that would show that ratios in the hospital make a difference beyond that hospital stay.”

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