Lower Burnout Among Hospital Nurses in California Attributed to Better Nurse Staffing Ratios

Hospital nurses report that improving patient-to-nurse staffing ratios is a priority intervention to improve their well-being. In 2004, California became the first state to implement a hospital-wide policy mandating safe staffing ratios. This cross-sectional study determined whether nurses in California hospitals exposed to a staffing policy ("California advantage") experienced lower nurse burnout compared to those in hospitals not exposed, and whether part of the differences in burnout can be attributed to better hospital staffing. Nurse job outcomes (burnout [primary], job dissatisfaction, and intent to leave [secondary]), and nurse staffing variables were derived from the RN4CAST-US 2016 survey of 14,518 registered nurses in California, Florida, New Jersey, and Pennsylvania in 463 hospitals. Nurses in California had lower burnout, job dissatisfaction, and intentions to leave their employer, as compared to nurses in other states (<i>p</i> < .001). Mean patient-to-nurse staffing ratios were lower in California compared to non-California hospitals (3.8 vs. 4.7, <i>p</i> < .001). In bivariate logistic regression models, the California advantage was associated with lower odds of all nurse job outcomes (e.g., burnout <i>OR</i> = 0.81; 95% CI [0.74, 0.89]; <i>p</i> < .001). The California advantage, while smaller, remained statistically significant with the addition of nurse staffing in the model. Every patient added to a nurse's workload was associated with higher odds of nurse burnout (aOR = 1.12; 95% CI [1.06, 1.19]; <i>p</i> < .001), job dissatisfaction, and intent to leave. Better hospital nurse staffing partially mediated the California advantage on all job outcomes. California nurses experience better job outcomes, attributed in part to safer staffing due to a policy.