Since New Jersey began requiring hospitals to publicly report nurse-to-patient ratios, the number of patients per nurse has decreased in most specialties in New Jersey hospitals.

Public reporting is a health policy strategy to help consumers and payers make choices by comparing data reported by hospitals. It also enables hospitals to make improvements to remain competitive. Five states-New Jersey, New York, Illinois, Rhode Island, and Vermont-now mandate that hospitals report the number of patients assigned to each RN on a unit for each shift. Complete data for New Jersey have been available since 2008.

Researchers analyzed New Jersey nurse staffing data from 2008 to 2015 from more than 70 hospitals for 13 specialties. By 2015, the number of patients per RN had decreased in all hospitals for 10 of the 13 specialties; for three specialties, the number of patients per RN either increased or remained the same. The greatest decreases were in the neonatal ICU, pediatrics, and the neonatal step-down unit. Medical-surgical units showed an almost 7% decrease in the number of patients assigned to RNs.

Higher levels of RN staffing have been shown to reduce adverse patient outcomes and decrease lengths of stay and readmission rates. "Public disclosure holds hospitals accountable," lead author Pamela B. de Cordova, assistant professor at Rutgers School of Nursing, told AJN. She added, "The rationale behind public disclosure mandates is to improve the quality of care while holding hospitals responsible for good outcomes and allowing consumers to make informed decisions."

"Public reporting may result in hospitals competing with one another," de Cordova said. Hospital administrators can utilize data to ensure their nurse staffing is equivalent to that of competitors, so as to not lose market share or receive criticism about nurse staffing.

Hospitals nationwide have been increasing nurse staffing. An influential factor, according to de Cordova, is the Affordable Care Act, which imposes financial penalties on hospitals with excessive readmissions. It's not possible to conclude that the public reporting mandate was solely responsible for the reduction in nurses' patient loads, the study authors acknowledged.

Regardless of the degree of effect on RN staffing levels, "public reporting is important because it helps patients become more knowledgeable about the quality of their health care," said de Cordova.-Joan Zolot, PA

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