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Four Years After California Law's Passage, Nation's First Nurse Staffing Ratios Take Effect January 2004

  • October 31, 2003

Minimum nurse-to-patient staffing ratios for California hospitals are scheduled to go into effect on January 1, 2004. Four years after California enacted the law requiring the staffing ratios, the Department of Health Services issued the regulations in July 2003 after making changes to the proposed regulations based on comments received during public hearings around the state. DHS will administer the regulations.

Included in the final regulations is the central ratio requirement that medical and surgical units must staff one nurse to every six patients. Ratios for other areas, including intensive care, operating rooms, labor and delivery, pediatrics, emergency rooms, and behavioral health vary by department but were also unchanged from the original proposal. Among changes in the new version are tighter ratios beginning in 2008 for step-down telemetry and telemetry and specialty units. The later compliance date is to allow time for more nursing students to graduate and enter the workforce.

DHS received more than 24,000 comments on the regulations. In addition to its own staffing ratio study, the Department considered studies of other groups, including the California Nurses Association, Service Employees International Union, and California Hospital Association.

State officials have said the new regulations would require 5,000 new nurses in addition to the 264,000 that now work in California hospitals. The California Hospital Association warned that the ratios will intensify the nursing shortage in California, and some hospitals may be forced to close or reduce the capacity of patient services. CHA is conducting seminars around the state to help hospitals comply, but the association is not sure how widespread the reductions will be.

Enforcement legislation introduced in the 2003 session and backed by SEIU would impose fines of $50 per bed per day on noncomplying hospitals. The legislation passed the Senate in June and can be taken up in the Assembly when lawmakers reconvene in January 2004.

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