A research arm of the Department of Health and Human Services (HHS) is touting the benefits of increased nurse-to-patient ratios – long a bargaining and legislative objective of health care unions – based on a theoretical “simulation” study published nine months ago. It is unclear whether a June 2010 post on the website of the federal Agency for Healthcare Research and Quality (AHRQ) signals support by the Department, or renewed life for proposed federal legislation that would regulate nurse-patient ratios. The post, titled “Higher Nurse-Patient Ratios Result in Societal Cost Benefits for Some Hospital Areas,” proclaims that“[i]ncreasing nurse-to-patient staffing is recommended to improve patient safety and reduce adverse [events],” citing a University of Minnesota study that AHRQ says it partly supported.  The AHRQ website states that the study “shows that increased registered nurse (RN) staffing was associated with lower hospital-related mortality and adverse patient events,” resulting in “societal net savings.”  The AHRQ post does not mention, however, that the study was based on a presumption that increased RN staffing would lead to such results, and was not designed to test whether that conclusion is true.

The study, “Cost Savings Associated with Increased RN Staffing in Acute Care Hospitals:  Simulation Exercise,”  used a theoretical economic modeling approach to estimate the number of avoided adverse events corresponding to an increased nurse-patient ratio “assuming causality of the association.”  The authors of the study expressly acknowledged that their conclusions were not based on randomized controlled clinical trials, and that “there is no direct evidence from randomized trials that increasing staffing can lead to better outcomes.”  In contrast to the statements on the AHRQ website, the study itself indicated that it was exclusively focused on costs and savings, and simply presumed a causal relationship between increased nurse-patient ratios and improved patient outcomes.  

The  Minnesota study was published in September 2009.  Earlier in 2009, the California Healthcare Foundation, an independent non-profit organization, published a study of the impact of California’s 2004 legislation establishing minimum nurse-to-patient ratios in acute care hospitals.  That study, “Assessing the Impact of California’s Nursing Staffing Ratios on Hospitals and Patient Care,”  reviewed data from 1999 - 2006 on patient outcomes in five key “nursing-sensitive” areas, and found that “while the legislation has increased the use of registered nurses, the ratios have had no clear impact on the quality measures that are associated with nursing care.” 

AHRQ’s decision to endorse the 2009 Minnesota study on its website in June 2010 follows  the National Nurses Union’s push for legislation mandating minimum nurse-patient ratios, exemplified in several bills on the issue that were introduced in Congress last year.  As Littler previously reported on its Washington DC Employment Law Update, on May 6, 2009, Rep. Janice Schakowsky (D-IL), introduced the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009 (H.R. 2273), which would “establish direct care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes.”  The bill has languished in the House committees to which it was referred.  A similar bill, National Nursing Shortage Reform and Patient Advocacy Act (S. 1031), was introduced in the Senate by Senator Barbara Boxer (D-Cal) on May 13, 2009.  That bill was referred to the Senate Committee on Health, Education, Labor, and Pensions, and no action has been taken.  

Stay tuned as we continue to monitor this issue for any new developments impacting hospitals and other healthcare employers. 

This entry was written by George O’Brien