Nurse Labor Effects of Residency Work Hour Limits

Results
...On average, hospitals with larger programs employed 319 residents and 1,002 RNs and they hired 49.6 extra RNs as a result of the residency work hour limitations, a 5% increase. We found no evidence of differential changes in the number of LPNs or residents after the regulation.....

Discussion
Our results showed that hospitals employing large numbers of residents increased their hiring of RNs (including NPs, nurse anesthetists, and other RNs with greater training) significantly more than hospitals with smaller numbers of residents as a result of the ACGME work hours reforms. This finding agrees with the literature which confirmed reductions in the average number of hours worked by residents, specifically in the fields of general surgery and surgical subspecialties (Ferguson et al., 2005; Zuckerman et al., 2005). We found that hospitals with larger programs, employing 272.4 more residents on average than hospitals with smaller programs, added 49.6 more nurses after the ACGME resident work hours restriction. If average resident hours were the same, prior to the regulation, then the differential increase in nurses at hospitals with large residency programs can be attributed to the ACGME guidelines. We estimate that about one new nurse was hired for every 5.5 residents. This labor response suggests that to some extent, residency programs complied with the mandate, concurring with both ACGME data and survey data (ACGME, 2004; Landrigan et al., 2006).