Embargoed Until:
February 10, 2009
12:01 a.m. Eastern Time



Christopher Fleming

After California Implemented Minimum Nurse-Staffing Regulations, Wages For RNs Grew Faster In California Than In Other States

Bethesda, MD -- Wages for registered nurses (RNs) increased faster in California than elsewhere after California began implementing landmark legislation mandating minimum nurse-to-patient staffing ratios in acute care hospitals, according to a study published today in Health Affairs. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w326

The study's findings suggest that implementing nurse-staffing standards in California could cost more than some anticipated. Two previous major studies of the potential impact of the Golden State's staffing requirements assumed that RNs' wages would not change, despite also forecasting large increases in demand for nurses as a result of the requirements.

The findings in the new Health Affairs study, by Barbara Mark, a professor in the School of Nursing at the University of North Carolina, and coauthors could also mean higher costs for other localities that implement nurse-staffing regulations. However, Mark and her colleagues stress that the effect of nurse-staffing regulations on wages might vary from place to place, depending on local variables such as the demographic makeup of the nurse workforce and the availability of alternative job opportunities for RNs.

In 1999, Gov. Gray Davis (D) signed legislation making California the first state in the nation to require its acute care hospitals to have a minimum number of nurses per patient. The California State Department of Health Services (DHS), charged with setting specific staffing ratios, issued draft regulations in 2002. Amidst much public debate, the nurse-to-patient ratio for medical and surgical areas was set at 1:6 beginning January 1, 2004. In March, 2005, it was strengthened to 1:5. Hospitals were allowed to meet these requirements using licensed vocational nurses (LVNs) as well as RNs, as long as LVNs did not account for more than 50 percent of nursing hours. However, the scope of practice for LVNs is very restricted in California, so hospitals turned primarily to RNs to meet the new staffing requirements.

Mark's team looked at the effect of California's staffing requirements on wage growth for RNs in California metropolitan areas, as compared to metropolitan areas in other states. They excluded rural nurses because wage data for them were unavailable and because many rural hospitals received waivers from the nurse-staffing regulations from the DHS. The researchers used data from four national surveys: the National Sample Survey of Registered Nurses (NSSRN), the Current Population Survey (CPS), the National Compensation Survey (NSC), and the Occupational Employment Statistics (OES) survey.

The four surveys rely on different samples and use different methodologies, and the results obtained varied somewhat across surveys. However, "the estimates from the four data sources provide reasonably consistent evidence of higher wage growth in California metropolitan areas after the staffing regulations were implemented," Mark and coauthors write. For instance, from 2000 to 2006, wage growth for RNs in California metropolitan areas exceeded wage growth in metropolitan areas elsewhere by 12.2 percentage points according to the NCS, by 12.1 percentage points according to the CPS, and by 4.9 percentage points according to the OES. The NSSRN is conducted every four years, and data from this survey show wage increases in California metro areas of 7.8 percentage points more than in metro areas outside of California between 2000 and 2004.

The increase in wages for California RNs is not surprising, particularly because the increased demand from the state's staffing legislation came against the background of an existing shortage of RNs, in California and across the United States, say Mark and her colleagues. An important question for the future is whether these wage increases will attract new people into the nurse workforce. Ultimately, the most important issue is whether the legislation results in improved quality of care for patients, the researchers say.

After the embargo lifts, the article by Mark and coauthors will be available at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w326


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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