Abstract
BACKGROUND: Despite the importance of adequate hospital nurse staffing, California is the only state with minimum nurse-to-patient ratio mandates. The health care workforce is historically "countercyclical"-exhibiting growth during economic recessions when employment in other sectors is shrinking. PURPOSE: This study was to examine how staffing mandates impact hospital nurse staffing during economic recessions. METHOD: We compared hospital nurse staffing in California and in other states over 20 years to examine differences before and after the California mandate and, within the postmandate period, before, during, and after the Great Recession of 2008. FINDINGS: Staffing differences increased during the postmandate period due to faster growth in California staffing compared to other states, except during the Great Recession, when staffing remained stable in California but declined in other states. DISCUSSION: State legislators deliberating staffing mandates should consider the protective factor such policies provide during economic recessions and the implications for the quality and safety of care.