Helping Nurses or Hurting Patients: The Effect of Workplace Inspections in Nursing Facilities

This study examines the effect of workplace inspections on workplace safety, product quality, and worker productivity in nursing facilities. The identification strategy exploits the nationwide Site-Specific Targeting (SST) plan of the Occupational Safety and Health Administration (OSHA). The SST plan prioritized establishments for inspection if their injury case rates exceeded a threshold, generating a discontinuous increase in inspections at the SST threshold. The identification strategy exploits this discontinuous increase using a regression discontinuity design. The analysis sample is constructed by matching establishment-level data on injury case rates to OSHA inspection records and the quality measures and staffing levels from the Centers for Medicare and Medicaid Services (CMS). According to the data, the likelihood of inspections increases at the SST threshold by 32 percentage points. The discontinuous increase in inspections is associated with lower injury case rates of the nurses, but worse healthcare quality and lower nurse productivity. The results suggest improving occupational safety may come at the expense of service quality and worker productivity.