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California’s Nurse-to-Patient Ratios, Part 2: 8 Years Later, What Do We Know About Hospital Level Outcomes?

Serratt, Teresa PhD, RN

Journal of Nursing Administration: October 2013 - Volume 43 - Issue 10 - p 549–553
doi: 10.1097/NNA.0b013e3182a3e906

OBJECTIVE: The aim of the study was to identify and describe the impact of California’s nurse-to-patient ratios on hospital level outcomes from a comprehensive literature review.

BACKGROUND: While implemented in 2004, questions remain about the effects ratios have had on hospitals’ financial status and access to care.

METHODS: A comprehensive literature review was conducted.

RESULTS: Findings suggest labor costs increased, and some reductions in services were made after the implementation of staffing ratios.

CONCLUSIONS: Implementing staffing ratios had a negative financial impact on selected outcomes of California hospitals.

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Author Affiliation: Assistant Professor, Orvis School of Nursing, University of Nevada, Reno.

The author declares no conflicts of interest.

Correspondence: Dr Serratt, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557 (

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