The impact of staffing ratios, magnet recognition, and institutional characteristics on risk adjusted mortality, risk adjusted complications, and risk adjusted resource utilization for pediatric cardiac surgery programs in California before and after enactment of the California Safe Staffing Law and relative to other states combined.

摘要

Objective: To examine the impact of staffing ratios, Magnet Recognition, and institutional characteristics on risk adjusted outcomes for pediatric cardiac surgery programs in California before and after enactment of the California Safe Staffing Law and relative to other states combined.;Background: The Conceptual Model of Nursing and Health Policy guided this study California performs 20% of the nation's pediatric cardiac surgery and is the only state with a nurse ratio law. Understanding the imposition of mandated ratios on pediatric outcomes is necessary to inform the debate about nurse staffing.;Data Sources: Patient variables were extracted from the Healthcare Cost and Utilization Project (HCUP) KID database. The American Hospital Association (AHA) Annual Survey database and the American Nurse Credentialing Center (ANCC) website were used for institutional variables.;Methods: Descriptive analyses identified and described patient, nursing and hospital characteristics. Changes in nursing ratios and FTEs between 2003 and 2006 were examined. Associations between nursing characteristics, Magnet Recognition and each outcome variable were examined using GEE models. Risk adjustment was performed using the RACHS-1 method for mortality, the Complication Screening Method for Congenital Heart Surgery Admissions, and Connor's Cardiovascular Resource Utilization model The California Safe Staffing Law was examined to determine whether it influenced changes in these outcomes in California relative to other states combined. Results: Hospitals in California significantly increased RN FTEs (p-0.025) and RN ratios (p=0.036) after enactment of AB394 in 2006. Neither RN FTEs nor RN ratios were associated with mortality, complications or resource utilization after risk adjustment. After the law; California's SMR decreased more (33%) than in all other states combined (29%). SCR increased by 5% but decreased by 5% for all other states combined, and the increase in charge differential (;Conclusion: Hospitals in California made upward adjustments in nursing FTEs and ratios after enactment of AB394. There was a substantial increase in California's charge differential, a decrease in SMR and an increase in SCR after enactment of the legislation. The findings did not reveal a relation between these changes and individual hospital nursing FTEs or ratios.