Wages for registered nurses (RNs) increased faster in California than elsewhere after California began implementing landmark legislation mandating minimum nurse-to-patient staffing ratios in acute care hospitals, according to a study published last week in Health Affairs (and free online through February 24).

In 1999, Gov. Gray Davis (D) signed legislation making California the first state in the nation to require its acute care hospitals to have a minimum number of nurses per patient. Amidst much public debate, the nurse-to-patient ratio for medical and surgical areas was set at 1:6 beginning January 1, 2004. In March, 2005, it was strengthened to 1:5. Hospitals were allowed to meet these requirements using licensed vocational nurses (LVNs) as well as RNs, as long as LVNs did not account for more than 50 percent of nursing hours. However, the scope of practice for LVNs is very restricted in California, so hospitals turned primarily to RNs to meet the new staffing requirements.

Barbara Mark, a professor in the School of Nursing at the University of North Carolina, and coauthors, say in their study that implementing nurse-staffing standards in California could cost more than some anticipated. The findings could also mean higher costs for other localities that implement nurse-staffing regulations. However, Mark and her colleagues stress that the effect of nurse-staffing regulations on wages might vary from place to place, depending on local variables such as the demographic makeup of the nurse workforce and the availability of alternative job opportunities for RNs.

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