Question 1 Prompts Comprehensive Analysis of Nurse Staffing Research

In an effort to provide clarity to the public confusion on the impact of nurse-to-patient staffing ratios as voters prepare to decide on Question 1, the Massachusetts Association of Colleges of Nursing (MACN) today released a white paper analysis that reviews a summary of over 100 studies related to nurse staffing.

 “Cutting through the clutter of conflicting claims, as an impartial nursing education group, we’ve conducted a comprehensive look at the myths versus the realities of nurse staffing research,” said Joan Vitello, RN, PhD, NEA-BC, FAHA, FAAN, Dean of the Graduate School of Nursing at UMass Medical School and MACN member. “We found that the scientific evidence argues against Question 1. There are no peer-reviewed studies that support the imposition of specific nurse-to-patient ratios, and in fact many of the studies point to unintended consequences of imposing inflexible nurse-to-patient ratios.”

The analysis (insert link to paper) provides a review of the existing scholarship on the topic of nurse staffing and highlights the many factors that impact or influence nurse staffing.  These factors include patient characteristics and patient outcomes, nurse education and experience, hospital characteristics and the work environment, the whole care team and the need for flexibility. Studies related to the minimum nurse-to-patient ratios experience in California, the only state in the nation to impose nurse staffing ratios, are highlighted.

MACN’s review led the organization to the following general conclusions:

  • Nurse staffing is related to some patient outcomes – under some circumstances
  • There are other factors that equally or more strongly influence patient outcomes, including:
    • The education level and experience level of nurses
    • The work environment
    • Collaboration and communication among the whole care team
  • Most researchers agree that while ‘adequate’ staffing levels are important, maintaining flexibility in staffing is crucial, and that widespread policy mandates are unlikely to yield the intended effects, but are highly likely to cause or result in significant unintended consequences, as observed in California.

MACN’s analysis led to the following specific conclusions regarding Question 1:

  • There is NO evidence to support specific nurse-to-patient ratios.
  • Patient care is complex and staffing levels should be determined within the context of local patient populations, nurse and other team member characteristics, and resource availability.
  • There were many unintended consequences of the nurse staffing mandate in California.

“MACN’s analysis dovetails with the recent conclusions of the Health Policy Commission, an independent watchdog group that reviewed the impacts of Question 1, and similarly found the cost of ratios – estimated to be up to $1 billion annually – will not yield substantial improvement in quality,” Vitello continued. “Our analysis goes one step further to explain to voters more fully why that’s the case.”  

About MACN:
The Massachusetts Association of Colleges of Nursing (MACN), comprised of Deans, Directors and Chairpersons of nursing programs of Baccalaureate and Higher Degree Nursing Programs in Massachusetts, serves as a leading voice and advocate for nursing education in the Commonwealth. As nurse leaders, educators and scholars, MACN members examine, assess and evaluate evidence in order to arrive at conclusions that then serve to direct improvement and change in nursing education and the nursing profession at large.