RNs Required Under Proposed Federal Standards per 1,000 Decedents, by Interval Before Death
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    RNs Required Under Proposed Federal Standards per 1,000 Decedents, by Interval Before Death
    (Interval Before Death: Last Two Years of Life; Year: 2014; Region Levels: State)
    Alabama 36.4
    Alaska 29.7
    Arizona 32.0
    Arkansas 33.5
    California 38.6
    Colorado 26.6
    Connecticut 41.1
    Delaware 36.8
    District of Columbia 44.0
    Florida 41.9
    Georgia 33.9
    Hawaii 37.0
    Idaho 21.2
    Illinois 38.2
    Indiana 32.9
    Iowa 27.4
    Kansas 30.6
    Kentucky 37.9
    Louisiana 35.0
    Maine 27.8
    Maryland 39.2
    Massachusetts 34.5
    Michigan 36.1
    Minnesota 26.4
    Mississippi 36.9
    Missouri 33.5
    Montana 24.8
    Nebraska 29.3
    Nevada 36.5
    New Hampshire 29.6
    New Jersey 47.3
    New Mexico 30.8
    New York 48.5
    North Carolina 33.3
    North Dakota 26.3
    Ohio 34.2
    Oklahoma 33.0
    Oregon 22.9
    Pennsylvania 37.3
    Rhode Island 33.0
    South Carolina 35.4
    South Dakota 27.4
    Tennessee 34.6
    Texas 36.4
    Utah 20.2
    Vermont 27.0
    Virginia 36.6
    Washington 27.1
    West Virginia 38.8
    Wisconsin 26.8
    Wyoming 27.1
    National Average 36.2
    90th Percentile 41.1
    50th Percentile 33.5
    10th Percentile 26.3
        • FOOTNOTES:
        • Our estimate is based on proposed federal staffing requirements set out in legislation considered by Congress (“Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007” H.R. 2123). The bill sets out minimum staffing requirements based on the ratio of patients in hospital to the number of FTE registered nurses. The requirements differ according to the intensity of the care setting. For high-intensity ICUs and cardiac care units (CCUs), the standard is no more than two patients for every nurse; for “step-down,” or intermediate ICUs, the standard is no more than three patients per nurse; and for medical and surgical units, the minimum standard is four patients per registered nurse. The rate was calculated by multiplying high-intensity ICU bed inputs by 1.5 (3 eight-hour shifts ÷ 2 patients per nurse), intermediate-intensity ICU bed inputs by 1 (3 eight -hour shifts ÷ 3 patients per nurse), and medical and surgical bed inputs by .75 (3 eight -hour shifts ÷ 4 patients per nurse). The results were then added together.

        • Click here to read about changes in methods between the 2001-05 and 2003-07 analyses. The study population includes beneficiaries with one of nine chronic conditions who were enrolled in traditional (fee-for-service) Medicare and died during the measurement period. To allow for two years of follow-back for all patients, the population is restricted to those whose age on the date of death was 67 to 99 years, and to those having full Part A and Part B entitlement throughout the last two years of life. Persons enrolled in managed care organizations were excluded from the analysis. For the hospital-specific analyses, patients had to be hospitalized for chronic illness at least once during their last two years of life to be included. For regional analyses, all patients diagnosed with a chronic illness were included.

        • ADJUSTMENTS:
        • Rates are adjusted for age, sex, race, primary chronic condition, and the presence of more than one chronic condition using ordinary least squares regression.


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    The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.