Latest Study: Mandated Ratios in ICUs Don’t Improve Care

Did the Massachusetts law that mandated nurse staffing ratios in intensive care units result in any improvements to patient care in those units?


According to a new peer-reviewed study published in Critical Care Medicine, the costly, government-mandated ratios did not reduce mortality, and had no effect on nursing-sensitive measures relating to bloodstream and urinary tract infections, pressure ulcers, and falls.

The authors from Beth Israel Deaconess Medical Center wrote: “Given the excess costs of enacting and enforcing statewide legislation to implement acuity-guided ICU nurse staffing, future efforts to regulate patient-to-nurse ratios should carefully first consider the extent of the effects of the mandate on nurse staffing levels. In line with previous studies outside of the ICU, our study of ICU nurse staffing adds further evidence suggesting that statewide legislation to mandate nurse staffing strategies may not effectively improve patient outcomes.”

The Massachusetts ICU law was signed into law on June 30, 2014, setting a maximum patient-to-nurse assignment of 2:1 – but without any flexibility. That rigidity has resulted in Massachusetts hospitals reporting, since the law’s implementation, increased wait times and patients boarding in emergency departments; delayed transfers of patients into ICUs; clinically unnecessary patient transfers between hospitals; and, in neonatal ICUs, the splitting up of twins if one infant required a more intense level of critical care.

The Critical Care Medicine study adds a scientific foundation to the anecdotal problems hospitals have reported since the imposition of ICU ratios.  And the study adds yet another layer to the ever-increasing volume of studies that have found no direct link between a set ratio and improved patient outcomes.

As the authors note, only one state – California – has mandated ratios in its hospitals, adding, “Although California regulations were associated with an increase in nurse staffing, outcomes of hospitalized [patients] did not improve after the California law, findings similar to Massachusetts ICUs.”

The proposed Question 1 on the Massachusetts statewide ballot this November would extend the unproven ratio scheme from ICUs to all units in a hospital – a move that is opposed by the American Nurses Association – Massachusetts, MHA, and a growing coalition of health and community interests.

Learn more about No on Question 1 by visiting here.