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health care quality. Another aspect is examining two key reasons why inadequate nurse staffing exists and the lack of incentives for hospitals to remedy the issue. In 1999, California’s governor signed a bill into law mandating minimum nurse-to-patient ratios for hospitals. California is the first, and currently only, state to have mandated minimum nurse-to-patient ratios. The maximum number of patients a hospital may assign a nurse are 1:5. Since the law was passed, it is reported that nurses feel the quality of care in California has improved, and their accounts are buttressed by a study that compared patient outcomes to two other states (Pennsylvania and New Jersey) which did not have nurse staffing legislation. Research supports that strengthening nurse staffing can improve quality of care, yet many hospitals have not implemented lower nurse-to-patient ratios because there is no law requiring them to, and the cost is shown to be not conducive to their bottom line (Kuwata, 2017). This article provides research to support the success of California’s law regarding mandated minimum nurse-patient ratios. It also sheds light on why many hospitals have eluded minimum nurse-to-patient ratios. Running head: MILESTONE THREE 5
Livanos, N. (2018). A broadening coalition: Patient safety enters the nurse-to-patient ratio debate. Journal of nursing regulations. (18)30056-5According to Livanos (201) a 2010 study showed that nurse job satisfaction rose in California after the implementation of mandated ratio legislation. Also, higher nurse-to-patient ratios had significant effect on nurses including turnover, burnout, job dissatisfaction, and intent to leave. It is important to note the main opponents of mandated nurse-to-patient ratios are health care facilities. Many hospitals contend they address staffing issues on their own, while professional and labor organizations claim lower nurse-to-patient ratios would reverse negative effects (Livanos, 2018). Serratt, T., Harrington, C., Spetz, J., & Blegen, M. (2011). Staffing changes before and after mandated nurse-to-patient ratios in California’s hospitals. Policy, Politics, & Nursing Practice, 12(3), 133–140. According to Serratt et al. (2011), California was the first state to mandate specific nurse-to-patient ratios which took full effect in 2004. This study looks at staff changes made at hospitals as a result of the implementation of mandated ratios. The findings suggest that most hospitals did make an upward adjustment to registered nurse (RN) staffing in response to the mandated ratios by increasing use of employee RNs, although this adjustment did not decrease use of nonnurse staff who could have been vulnerable to hospital cost reductions. Another result Running head: MILESTONE THREE 6