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California’s Nurse-to-Patient Ratios, Part 3: Eight Years Later, What Do We Know About Patient Level Outcomes?

Serratt, Teresa PhD, RN

Journal of Nursing Administration: November 2013 - Volume 43 - Issue 11 - p 581–585
doi: 10.1097/01.NNA.0000434505.69428.eb

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

BACKGROUND: While implemented in 2004, questions remain about the effects the ratios have had on patients.

METHODS: A comprehensive literature review was conducted.

RESULTS: Patient outcome results are mixed in the 8 identified studies, with 3 studies finding both positive and negative outcomes and 5 studies reporting no significant changes in patient outcomes.

CONCLUSIONS: Findings from this review suggest some improvements have resulted from the implementation of staffing ratios, but the positives have not been as significant and widespread as predicted. Further studies are needed to explore the relationship between patient outcomes and mandated staffing levels in this state and other settings.

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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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