Evaluating Proposed Federal Policy for Nurse-to-patient Staffing Ratios: Insights From State-level Data

Abstract

Approaches to nurse staffing in the Unted States is a highly debated topic. Mandated nurse-to-patient staffing ratios have been implemented at the state level and have been proposed at a federal level. The purpose of this dissertation study was to compare identified quality outcomes and workforce impact between states with and without mandated nurse-to-patient staffing ratios in Medicare-certified acute care hospitals and use these outcomes to evaluate a proposed policy to federally mandate nurse-to-patient staffing ratios in Medicare-certified acute care hospitals. A quantitative cross-sectional secondary data analysis of publicly available data from the American Hospital Directory, Bureau of Labor Statistics, Centers for Medicare and Medicaid Services, and the United States Census Bureau, followed by an analysis of federal policy mandating nurse-to-patient staffing, was conducted. No statistically significant difference was found between states with and without mandated nurse-to-patient staffing ratios for the identified outcomes and reporting period analyzed. The results of this study suggest that mandated nurse-to-patient staffing ratios may not impact 30-day mortality post CABG, nurse-sensitive HCAHPS indicators, the number of registered nurses working in hospitals, number of staffed beds, and number of discharges per staffed bed at the state level. These results informed a policy analysis that discussed the potential public health impact and political feasibility of the proposed federal policy that would mandate nurse-to-patient staffing ratios.