Highlights
- •California is the only state with a minimum hospital nurse staffing mandate.
- •Postmandate, staffing improved faster in California than in other states.
- •During the Great Recession, nurse staffing was stable in California hospitals.
- •Hospital nurse staffing declined in other states during the Great Recession.
- •Entropy balancing helped account for systematic differences in California hospitals.
Abstract
Background
Despite the importance of adequate hospital nurse staffing, California is the only
state with minimum nurse-to-patient ratio mandates. The health care workforce is historically
“countercyclical”—exhibiting growth during economic recessions when employment in
other sectors is shrinking.
Purpose
This study was to examine how staffing mandates impact hospital nurse staffing during
economic recessions.
Method
We compared hospital nurse staffing in California and in other states over 20 years
to examine differences before and after the California mandate and, within the postmandate
period, before, during, and after the Great Recession of 2008.
Findings
Staffing differences increased during the postmandate period due to faster growth
in California staffing compared to other states, except during the Great Recession,
when staffing remained stable in California but declined in other states.
Discussion
State legislators deliberating staffing mandates should consider the protective factor
such policies provide during economic recessions and the implications for the quality
and safety of care.
Keywords
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Article info
Publication history
Published online: December 15, 2021
Accepted:
September 15,
2021
Received in revised form:
September 3,
2021
Received:
May 27,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc.
