Volume 47 | Number 3pt1 | June 2012

Abstract List

Kristin L. Reiter Ph.D., David W. Harless, George H. Pink Ph.D., Barbara A. Mark


To estimate the effect of minimum nurse staffing ratios on alifornia acute care hospitals’ financial performance.

Data Sources/Study Setting

Secondary data from edicare cost reports, the merican ospital ssociation's () nnual urvey, and the alifornia ffice of tatewide ealth lanning and evelopment () are combined from 2000 to 2006 for 203 hospitals in alifornia and 407 hospitals in 12 comparison states.

Study Design

The study employs a difference‐in‐difference analytical approach. Hospitals are grouped into quartiles based on pre‐regulation nurse staffing levels in adult medical‐surgical and pediatric units (quartile 1 = lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for alifornia hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period.

Data Collection/Extraction Methods

Hospital data from edicare cost reports are merged with nurse staffing measures obtained from and from .

Principal Findings

Relative to hospitals in comparison states, operating margins declined significantly for alifornia hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3.


Implementation of minimum nurse staffing legislation in alifornia put substantial financial pressure on some hospitals.