Despite rising hospital admissions under the state’s health insurance reform law, nurse staffing in Massachusetts hospitals has remained flat. That portends possible trends under federal health care reform, according to an analysis by Associate Professor Judith Shindul-Rothschild and Senior Research Statistician Matt Gregas.

In a paper published in Policy, Politics, & Nursing Practice in March, the researchers examined patient turnover and RN employment in Massachusetts, New York, and California nonfederal hospitals between 2000 and 2011—both before and after Massachusetts passed its landmark health insurance law in 2006.

Massachusetts had significantly more admissions per bed than California and New York in 2009 and 2011, signaling that health care reform increased access to hospital services for previously uninsured residents—and foreshadowing rising demand under the federal Patient Protection and Affordable Care Act. It was modeled after the Massachusetts law, Shindul-Rothschild and Gregas note.

They found, however, that the number of RNs employed in Massachusetts has not kept pace with the intensity of patient turnover and demand for hospital services. With hospitals everywhere facing pressure to curb costs and improve efficiency of care, the researchers say their findings “are a reminder that the cost-containment provisions that also accompany health insurance reform may restrain hospitals from increasing RN staffing even in the face of rising admissions.”

—Research summary by Debra Bradley Ruder