Topic:
HOSPITALS; MEDICAL PERSONNEL;
Location:
NURSING;

OLR Research Report


February 10, 2004

 

2004-R-0212

CALIFORNIA RN STAFFING RATIO LAW

By: John Kasprak, Senior Attorney

You asked for information on California's nurse-to-patient ratio staffing law.

CALIFORNIA RN STAFFING RATIO LAW

Background

With passage of AB 394 in 1999, California became the first state to establish minimum registered nurse (RN)–to-patient ratios for hospitals. Final regulations to implement the law were issued in the summer of 2003, with hospitals required to meet the staffing ratios as of January 1, 2004.

AB 394 establishes specific numerical nurse-to-patient ratios for acute care, acute psychiatric, and specialty hospitals in California. The ratios are the maximum number of patients that may be assigned to an RN during one shift. The law requires additional RNs be assigned based on a documented patient classification system that measures patient needs and nursing care, including severity of illness and complexity of clinical need. The law also restricts assignment of unlicensed staff and nursing staff in hospital clinical areas where they do not have demonstrated competency, training, and orientation.

Specific Ratios

The law required the state Department of Health Services (DHS) to establish specific ratios for specific hospital units. In 2002, DHS issued proposed regulations to implement the law, including these specific ratios. Final regulations were issued on July 1, 2003 incorporating extensive testimony presented during numerous public hearings as well as public comment (i.e., letters submitted).

The final ratios are listed below in Table 1.

Table 1: California RN to Patient Staffing Ratios

Type of Care

RN to Patients

Intensive/Critical Care

1:2

Neo-natal Intensive Care

1:2

Operating Room

1:1

Post-anesthesia Recovery

1:2

Labor and Delivery

1:2

Antepartum

1:4

Postpartum couplets

1:4

Postpartum women only

1:6

Pediatrics

1:4

Emergency Room

1:4

ICU Patients in the ER

1:2

Trauma Patients in the ER

1:1

Step Down, Initial

1:4

Step Down, 2008

1:3

Telemetry, Initial

1:5

Telemetry, 2008

1:4

Medical/Surgical, Initial

1:6

Medical/Surgical, 2008

1:5

Other Specialty Care, Initial

1:5

Other Specialty Care, 2008

1:4

Psychiatric

1:6

Source: California Nurses Association

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