By Robert Scally, NurseZone assistant editor
California has released final regulations for its nurse staffing law, which
is set to take effect on January 1, 2004.
The law, first of its kind in the nation, sets minimum ratios for the number
of nurses to patients in a number of major nursing specialties and for various
work shifts in hospitals. The nurse staffing regulations are currently in a
final public comment period ending July 17.
Originally signed into law in 1999, the nurse staffing regulations have been
hailed by many nursing organizations as a major improvement in patient safety
and reviled by the hospital industry for being too costly.
Under the new regulations, nurses will care for no more than eight patients
at a time, four mother and baby couplets in postpartum units. In emergency
departments only one critical care patient will be assigned to a registered
nurse. In most areas of the hospital, including intensive care units, the
regulation refers to licensed nurses and does not specify and RN.
Many of the provisions of the nurse staffing regulations will be phased in
during the next five years to allow hospitals time to comply with the law, said
Gina Henning, a manager specialist with the California Department of Health
In medical-surgical units, for example, the new nurse staffing ratios will
require one nurse for every six patients in 2004 and every five patients by
2005. Currently about half of California hospitals meets the proposed ratio for
medical-surgical units, Henning said.
"A new era is dawning in which all California families should expect safer
standards in California hospitals," Kay McVay, RN, president of the California
Nurses Association, said in a statement. "Every patient should be able to demand
and count on receiving the registered nursing care they need, when they need
The California Healthcare Association, which represents health care
providers, contends that the nurse staffing regulations are too costly and
unreasonable, especially when the nursing shortage and other state-mandated
demands on hospitals, such as earthquake safety requirements, are taken into
"Whether we will be able to successfully meet these regulations remains to be
determined," said Susan Olsen-Nakada, RN, MSN, chief nursing officer and chief
operating officer of the 204-bed Sharp Coronado Hospital in Coronado,
California’s severe nurse shortage, which is expected to worsen in the coming
years, may make it difficult for many hospitals to hire sufficient numbers of
nurses to meet the new requirements, she said.
"The Department of Health Services is projecting that when we get about four
years out that this will cost hospitals about a billion dollars a year," said
Dorel Harms, RN, MHA, vice president of professional services for the California
Healthcare Association. "The other side of the coin is that we don’t have the
nurses to do this."
The California Employment Development Department estimates the state will
have 97,500 job openings for registered nurses in the state between 2000 and
The California Department of Health Services estimated that the fiscal impact
of the new nurse staffing regulations will cost the state’s hospitals $422
million in 2004, $652 million in 2005 and more than $956 million in 2008 when
all of the staffing ratios will be phased in.
The expense of hiring more nurses is also expected to grow substantially in
the next few years. Nurse salaries in California have been rising at an annual
rate of about 7 percent during the past two years and are expected to continue
increasing at about that rate for the next few years, Henning said.
Hospitals are also concerned about two recently introduced bills in the
California legislature that would create stiff fines for hospitals that fail to
meet the requirements of the nurse staffing law, said Jan Emerson, the
California Healthcare Association’s vice president of external affairs.
The new nurse staffing ratios, combined with the threat of fines could create
an issue over access to health care.
If California hospitals cannot hire enough nurses to meet the new staffing
ratio requirements and are confronted with the threat of severe fines, hospitals
would then have no choice but to close units or refuse care to some patients,
Not all health care providers are opposed to California’s new nurse staffing
Kaiser Permanente, the state’s largest health maintenance organization,
announced that its 11 hospitals in Southern California already meet the new
regulations and that several of its facilities currently exceed the mandated
nurse staffing ratios for medical surgical units.
During the past two years Kaiser Permanente has added more than 1,000 nurses
in California and is implementing nurse retention programs along with
initiatives to improve nurses’ work environments, foster career growth and
provide for better balance between nurses professional and personal lives.
Kaiser’s initiatives are part of an "effort to be the best place to work for
nurses," the company, which employs 10 percent of the nurses in California,
announced in a statement released July 1.
California Long-Awaited Nurse Ratios Unveiled
Legislation Introduced to Set Minimum Nurse-to-Patient Ratios In Pennsylvania
California Long-Awaited Nurse Ratios Unveiled
No Nurse Staffing Ratios for California Yet
Nurse-to-Patient Ratio Still Undecided, Comment Period Ahead
Nurse Staffing Ratios: California Nears Deadline for Mandate
Nurse Staffing Ratios: Will Other States Follow California's Lead?
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