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Reassessing the labor market effects of California’s minimum nurse staffing regulations (Harless 2019)

Absence of conflict of interest.

Citation

Harless, D. (2019). Reassessing the labor market effects of California’s minimum nurse staffing regulations. Health Economics, 28, 1226–1231. https://doi.org/10.1002/hec.3924

Highlights

  • The study’s objective was to examine the impact of California’s minimum staffing regulations for hospital nurses on wages and employment. 

  • The author used a non-experimental comparison group analysis to compare the outcomes of registered nurses (RNs) and workers in similar occupations in California and 15 other states from 2001 to 2008. Data from the National Sample Survey of Registered Nurses provided information on employment. Wage data came from the Occupational Employment Statistics program and the American Community Survey.  

  • The study found that the employment of RNs grew significantly faster in California than in other states following the regulations, and wages of RNs in California grew significantly faster relative to other occupations in other states following the regulations. 

  • The quality of causal evidence presented in this report is low because the author did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to California’s minimum staffing regulations for hospital nurses; other factors are likely to have contributed.  

Features of the Intervention

Starting in 2004, California became the first state to implement minimum staffing regulations for hospital nurses. The state implemented, for certain hospital units, a series of phased-in minimum licensed nurse-to-patient ratios that became progressively stricter in 2005 and 2008. As of 2011, 15 other states had introduced similar legislation. 

Features of the Study

The author used a non-experimental comparison group analysis to examine the outcomes of RNs in California before and after the state’s minimum nurse staffing regulations went into effect. The author compared changes in the RNs’ outcomes with those for workers in four occupations with similar wage growth, duties, and licensure requirements before the intervention—accountants and auditors, civil engineers, dental hygienists, and medical and health services managers—in California and 15 other states with similar pre-intervention growth in RN wages and hours. Data from the National Sample Survey of Registered Nurses provided information on employment from 2000 to 2008. Data from the Occupational Employment Statistics program provided key information on wages at the metropolitan statistical area level, and data from the American Community Survey provided supplementary wage information at the state level from 2001 to 2008. 

Findings

Employment 

  • The study found the growth in the RN workforce to be significantly larger in California than in comparison states for the four years following the intervention, for the total number of employed RNs (27.2 percent compared with 20.2 percent), full‐time equivalents (29.3 percent compared with 21.4 percent), and full‐time equivalents employed at hospitals (36.8 percent compared with 12.3 percent). 

Earnings and wages 

  • The study found that changes in RN wages relative to the comparison occupations were significantly larger following the intervention in California than in other states, by 7.5 to 10.8 percent.  

Considerations for Interpreting the Findings

The study did not account for preexisting differences between the groups on age, gender, and ethnicity nor show that the groups were similar in terms of employment for more than one year before the 2004 implementation of the regulations.  

Causal Evidence Rating

The quality of causal evidence presented in this report is low because the author did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to California’s minimum nurse staffing regulations; other factors are likely to have contributed.  

Reviewed by CLEAR

May 2021