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)
    Wyoming 27.1
    Wisconsin 26.8
    West Virginia 38.8
    Washington 27.1
    Virginia 36.6
    Vermont 27.0
    Utah 20.2
    Texas 36.4
    Tennessee 34.6
    South Dakota 27.4
    South Carolina 35.4
    Rhode Island 33.0
    Pennsylvania 37.3
    Oregon 22.9
    Oklahoma 33.0
    Ohio 34.2
    North Dakota 26.3
    North Carolina 33.3
    New York 48.5
    New Mexico 30.8
    New Jersey 47.3
    New Hampshire 29.6
    Nevada 36.5
    Nebraska 29.3
    Montana 24.8
    Missouri 33.5
    Mississippi 36.9
    Minnesota 26.4
    Michigan 36.1
    Massachusetts 34.5
    Maryland 39.2
    Maine 27.8
    Louisiana 35.0
    Kentucky 37.9
    Kansas 30.6
    Iowa 27.4
    Indiana 32.9
    Illinois 38.2
    Idaho 21.2
    Hawaii 37.0
    Georgia 33.9
    Florida 41.9
    District of Columbia 44.0
    Delaware 36.8
    Connecticut 41.1
    Colorado 26.6
    California 38.6
    Arkansas 33.5
    Arizona 32.0
    Alaska 29.7
    Alabama 36.4
    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.