Center for Policy Alternatives
CPA - Header Photo
Related Resources
AFL-CIO
SEIU

Safe Staffing for Hospital Care

Over the past decade, hospitals have reduced per-patient staffing levels by 13 percent.1
As hospitals cut staffing levels to reduce their costs, nurses began to leave hospitals for more rewarding and less demanding jobs. The proportion of registered nurses employed in hospitals decreased from 59 percent in 2000 to 56.2 percent in 2004. Only 2.4 million of the 2.9 million registered nurses in America are practicing in the profession, and only 1.3 million of those are working in hospitals.2
Reduced hospital staffing levels burden nurses with greater workloads.
Hospital managers fill gaps by requiring nurses to work mandatory overtime. A national survey found that nurses worked an average of 8½ weeks of overtime in 2000.3 Mandatory overtime may ensure that a nurse is on duty, but it does not ensure that quality health care is provided.
Substandard working conditions have exacerbated the staffing problem.
Nurses who work in hospitals have been stretched to the limit. As a result, they experience high levels of stress, chronic fatigue, and work-related injuries. A 2002 study of 168 Pennsylvania hospitals, for example, found that nurses with heavier workloads are more likely to report burnout and job dissatisfaction.4 One study found that hospitals with nurse-to-patient ratios of 1:7 have double the turnover of hospitals with 1:4 ratios.5
As nurse staffing levels decline, hospital patients needlessly die.
Understaffing is a contributing factor in 24 percent of all accidental patient deaths and injuries, according to data reported to the Joint Commission on Accreditation of Healthcare Organizations.6 A large-scale study published in the fall 2002 edition of the Journal of the American Medical Association found that every general surgery patient added to a hospital nurse’s workload increases the patient’s risk of death within 30 days by an average of seven percent.7 A nationwide study by the Chicago Tribune found that tens of thousands of hospital patients die each year from hospital-acquired infections, largely because low staffing levels have made it difficult for hospital staff to execute proper infection control procedures.8 A 2006 study found that an increase in nurse staffing levels could avoid about 7,000 in-hospital deaths a year at a short-term cost savings of at least $242 million.9
California has established comprehensive standards for nurse staffing.
In order to guarantee adequate nurse staffing levels, California enacted legislation in 1999 to mandate a series of specific patient-to-nurse ratios in all hospital nursing units. A judge upheld the law in 2005. A few other states now require specific ratios in specialty areas such as intensive care or labor and delivery units, but none require ratios in every patient care unit in every hospital as California has done.
In recent years, eight states have prohibited mandatory overtime for hospital nurses.
Illinois prohibited mandatory overtime for nurses in 2005. West Virginia enacted a similar law in 2003. Six other states (ME, MD, MN, NJ, OR, WA) have done the same. Some of these laws apply only to licensed nurses while others apply to all healthcare staff who directly serve patients. In each of the eight states, voluntary overtime is permitted and healthcare workers are protected from retaliation if they refuse overtime assignments.

This policy summary is based in large part on information from the Service Employees International Union.

Endnotes
  1. HCIA-Sachs, “The Comparative Performance of U.S. Hospitals: The Sourcebook,” 2001.
  2. U.S. Department of Health and Human Services, “2004 National Sample Survey of Registered Nurses,” 2005.
  3. The Feldman Group and the SEIU Nurse Alliance national poll of registered nurses, 2001.
  4. Linda Aiken et al., “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction,” Journal of the American Medical Association, Fall 2002.
  5. Jean Seago et al., “Minimum Nurse to Patient Ratios,” Nursing Economics, 2003.
  6. Joint Commission on Accreditation of Healthcare Organizations, “Health Care at the Crossroads,” August 7, 2002.
  7. Linda Aiken et al., “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction,” Journal of the American Medical Association, Fall 2002.
  8. Michael Berens, “Infection Epidemic Carves Deadly Path; Poor Hygiene, Overwhelmed Workers Contribute to Thousands of Deaths,” Chicago Tribune, July 21, 2002.
  9. Jack Needleman et al., “Nurse Staffing in Hospitals: Is There a Business Case for Quality?” Health Affairs, January/February 2006.
Updates