Published Jun 20, 2003
Forwarded by PSNA.org:
The California Department of Health Services (DHS) announced this week that its revised nurse-to-patient staffing regulations will be published on June 30 or July 1.
The comment period will begin the same date and end on July 17. Comments will be accepted only on the revisions, and there will be no public forum for comments. Instead, all comments should be sent to DHS at the address
published with the revisions.
The California Healthcare Association (CHA) and the Association of California Nurse Leaders (ACNL) are planning a series
of educational programs throughout the state in September that will focus on the final nurse-to-patient regulations. (SOURCE: CHA News, June 20, 2003)
Couldn't find it. Plan to take a class 1st day off when available.
For true geeks who like to read. Even so more interesting to CA nurses:
NRSKarenRN, BSN, RN
forwarded by psna.org to me. karen
for immediate release july 1, 2003
california nurses assn. applauds final rn ratios plan
hospital industry proposals to erode ratios rejected by state
the california nurses association today welcomed the release of the final regulations to establish new minimum registered nurse staffing ratios that all hospitals must meet by january 1, 2004 as a significant step towards improving patient care conditions in california hospitals and protecting patient safety.
"a new era is dawning in which all california families should expect safer standards in california hospitals," said kay mcvay, rn, president of the 50,000-member cna which sponsored the safe staffing law and worked for 10 years to enact it. "the finish line is finally near. every patient should be able to demand and count on receiving the registered nursing care they need, when they need it."
in the package approved by gov. gray davis and the department of health services, state officials made critical decisions on some hotly contested issues regarding implementation of the cna-sponsored law, the first such law in the nation which has been a model for rns and legislators in other states. among key decisions in the plan:
proposals by the hospital industry to erode the ratios in emergency rooms, post-surgical recovery units, and for evening, night, and weekend shifts, were all rejected. state officials also rebuffed hospital efforts for further delays in implementation.
phased-in, improved ratios (fewer patients to nurses) in three hospital areas. as of 2008, ratios will be lowered in step down units, typically housing patients just transferred from critical or intensive care, telemetry, where patients are on monitors, and other specialty care units, such as oncology and rehab. cna was the only organization to present scientific data - based on 22 million patient discharge records, the drg designations and patient acuity - along with thousands of rn testimonials to make the case for these reductions.
assurances that hospitals must adhere to scope of practice laws to protect patient safety. no rn may be assigned, or be responsible for more patients than the specified ratios. the regulations clarify the respective roles of rns and lvns, make it apparent that rns and lvns are not inter-changeable, and require that additional nurses must be assigned, as needed, by severity of patient illness.
hospitals are required to document staffing assignments, including the licensure of the direct caregiver for every patient for every unit for every shift, and keep the records for one year, steps that will help the state monitor and assure compliance with the law.
mcvay noted that many cna-represented hospitals have already hired hundreds of additional rns in preparation for implementing the law, and as a result of unprecedented cna gains in compensation, retirement security, and workplace improvements intended to enhance retention of current experienced rns and recruitment of new rns.
cna, which has campaigned since 1992 to enact safe rn staffing ratios, will work with rns across the state to monitor enforcement of the law and encourage hospital compliance. cna has also sponsored a new bill, ab 253, to help assure compliance.
introduced by assembly introduced by assembly member darrell steinberg (d-sacramento), the bill authorizes state health officials to conduct unannounced inspections, and provides for fines of up to $5,000 a day, on hospitals that continue to maintain unsafe rn staffing after final implementation of the ratio law.
the specific ratios by hospital unit, and more background on the law, are available on the cna website, http://www.calnurse.org http://www.calnurse.org/>.
Intensive/Critical Care ..........1:2
Neo-natal Intensive Care......1:2
Labor and Delivery................1:2
Postpartum women only.........1:6
ICU patients in the ER..........1:2
Trauma patients in the ER....1:1
Step Down Initial..................1:4
Step Down in 2008...............1:3
Telemetry in 2008.................1:4
Medical/Surgical in 2005........1:5
Other Specialty Care Initial....1:5
Other Specialty Care in 2008...1:4
All ratios are minimums. Hospitals
must increase staffing as needed by
1 Charge RNs and managers are not counted in
2 RN license only.
3 Triage or Base Radio RNs shall not be included in
the ratios. Every ER must have an RN, with
experience in emergency care, on duty at all times.
4 Such as Oncology and Rehab.
This is really amazing, when you think how dark everything looked 5 years ago. I got tears in my eyes. Hope floats!
These ratios specify that the charge RN is not to be counted in the staffing ratio, but what about other ancillary personnel? Our small ICU has a great pt/RN ratio, but we are it. No CNAs, no secretaries...We answer phones, take off orders, do traffic control with visitors...the whole nine yards. You can imagine the HIPPA nightmares when you and your only co-worker are doing patient care, leaving the station unguarded.
Our administrators say the California idea (and hospitals locally who advertise good nurse/patient ratios) are actually making the RN do more work because they are getting rid of CNAs and secretaries. Who can clarify this for me?
rebelwaclause, ASN, RN
I still ask...If an RN is "covering" (Yeah...right) an LVN, and the LVN has 8 patients...What will the RN's ratio be then?
STATE HEALTH DEPARTMENT RELEASES REVISED
NURSE-TO-PATIENT RATIOS FOR PUBLIC COMMENT
SACRAMENTO - The California Department of Health Services
(CDHS) today released for public comment revised nurse-to-patient
ratio regulations for general acute care hospitals. The ratios will be the
first of their kind in the nation.
"The high interest in this issue is reflected in the fact that CDHS
received more than 24,000 letters from organizations and individuals
across the state during the initial public comment period," noted State
Health Director Diana M. Bontá, R.N., Dr.P.H. "In signing the
legislation that led to the development of these ratios, Gov. Gray Davis
demonstrated his commitment to quality patient care and recognition
of the key role nurses play in providing that care."
While most of the revisions are technical in nature or clarifications to
make the regulations more clear, ratios for step-down, step-down
telemetry, telemetry and specialty care units were changed in
response to comments received during the initial public comment
period in late 2002 (chart attached). The ratios would be implemented
in stages beginning in 2005 to enable hospitals, especially those in
rural areas, to develop strategies to meet the new ratios.
In 1999, Gov. Gray Davis signed AB 394, which required CDHS to
establish minimum nurse-to-patient ratios by licensed nurse
classification and by hospital unit for the state's general acute care
The proposed ratios are based on a complex number of factors,
including information collected by state regulators during
unannounced visits to 80 acute care hospitals and 10 state-operated
hospitals that began in May 2001. CDHS used data from the on-site
hospital visits to determine the licensed nurse-to-patient ratios in the
nursing units at the hospitals.
The proposed ratios also reflect the results of a literature search, an
analysis of data from the state Office of Statewide Health Planning
and Development, comments from professional organizations and over
24,000 letters received from individuals across the state.
Only intensive and critical care, acute respiratory care, coronary care,
well-baby nursery, neonatal intensive care unit and operating rooms
currently have minimum ratios. The proposed ratios cover all other
areas of a hospital, including medical/surgical units. The proposed
ratios vary from 1:1 for trauma patients to 1:6 (reduced one year later
to 1:5) in medical/surgical units.
The regulations are expected to take effect Jan. 1, 2004. Five years
after their adoption, CDHS will evaluate the regulations and provide a
report to the Legislature, as required by law.
The draft regulations, research findings and information about the
process for submitting comments are available on CDHS' Web site at
CDHS will summarize all comments received and provide a formal
response to each one. The regulatory package, including the
responses, will be submitted to the Office of Administrative Law for
approval. After approval, the regulatory package, including the
responses, will be published on the CDHS Web site.
The deadline for public comments is 5 p.m. July 17. Written
comments can be submitted via fax at (916) 440-7714, e-mail at
mailto:[email protected] or
through the "Making Comments" link on the CDHS' Web site at
http://www.dhs.ca.gov/regulation. Comments can also be mailed to the
Office of Regulations, Department of Health Services, MS 0015, P.O.
Box 942732, Sacramento CA 94234-7320. (Please note that CDHS
has moved to a new location in the East End Complex in Sacramento
and that the U.S. Postal Service requires the use of a post office box
for the delivery of mailed items.
Intensive/Critical Care Unit
(When multiple births, the number of
newborns plus the number of mothers shall
never exceed 8 per nurse)
1:8 (1:4 couplets)
1:6 (mothers only)
Labor and Delivery
Post Anesthesia Care Unit
(Triage, Base Radio, and other specialty
nurses are to be added as additional workforce
and not included in the ratio)
Critical Care Patients
Burn Units (considered a CCU)
Behavioral Health Psychiatric Units
Step-Down and Step-Down/Telemetry Units
1:3 on 01/01/08
Specialty Care (Oncology) Units
1:4 on 01/01/08
Medical, Surgical and Medical/Surgical Units
1:5 on 01/01/05
Sounds good on paper, but I agree with rebel..so you are covering for LVN/SNT etc, what is your ratio then? Are they really going to cut out other staff to keep the licensed ratio?
Originally posted by Desert Rat Sounds good on paper, but I agree with rebel..so you are covering for LVN/SNT etc, what is your ratio then? Are they really going to cut out other staff to keep the licensed ratio?
Sounds good on paper, but I agree with rebel..so you are covering for LVN/SNT etc, what is your ratio then? Are they really going to cut out other staff to keep the licensed ratio?
Simple answer is NO!
Complex answer is that the RNs, other hospital staff, and the public (patients & visitors) will have to help enforce the ratios. U dom't expect most facilities to comply unless forced by their staff or the DHS. Who would stay at a poorly staffed hospital when a safely staffed one is nearby?
For answers to many questions soch as why laying off other workers will not be acceptable click the PDF files on the links:
California Nurses Assn. Applauds Final RN Ratios Plan
Hospital Industry Proposals to Erode Ratios Rejected by State
The California Nurses Association today welcomed the release of the final regulations to establish new
minimum registered nurse staffing ratios that all hospitals must meet by January 1, 2004 as a
significant step towards improving patient care conditions in California hospitals and protecting patient
"A new era is dawning in which all California families should expect safer standards in California
hospitals," said Kay McVay, RN, president of the 50,000-member CNA which sponsored the Safe
Staffing Law and worked for 10 years to enact it. "The finish line is finally near. Every patient should be
able to demand and count on receiving the registered nursing care they need, when they need it."
In the package approved by Gov. Gray Davis and the Department of Health Services, state officials
made critical decisions on some hotly contested issues regarding implementation of the
CNA-sponsored law, the first such law in the nation which has been a model for RNs and legislators in
other states. Among key decisions in the plan:
Proposals by the hospital industry to erode the ratios in Emergency Rooms, Post-Surgical
Recovery units, and for evening, night, and weekend shifts, were all rejected. State officials also
rebuffed hospital efforts for further delays in implementation.
Phased-in, improved ratios (fewer patients to nurses) in three hospital areas. As of 2008, ratios
will be lowered in Step Down units, typically housing patients just transferred from critical or
intensive care, Telemetry, where patients are on monitors, and other specialty care units, such
as Oncology and Rehab. CNA was the only organization to present scientific data - based on
22 million patient discharge records, the DRG designations and patient acuity - along with
thousands of RN testimonials to make the case for these reductions.
Assurances that hospitals must adhere to scope of practice laws to protect patient safety. No
RN may be assigned, or be responsible for more patients than the specified ratios. The
regulations clarify the respective roles of RNs and LVNs, make it apparent that RNs and LVNs
are not inter-changeable, and require that additional nurses must be assigned, as needed, by
severity of patient illness.
Hospitals are required to document staffing assignments, including the licensure of the direct
caregiver for every patient for every unit for every shift, and keep the records for one year, steps
that will help the state monitor and assure compliance with the law.
McVay noted that many CNA-represented hospitals have already hired hundreds of additional RNs in
preparation for implementing the law, and as a result of unprecedented CNA gains in compensation,
retirement security, and workplace improvements intended to enhance retention of current experienced
RNs and recruitment of new RNs.
CNA, which has campaigned since 1992 to enact safe RN staffing ratios, will work with RNs across
the state to monitor enforcement of the law and encourage hospital compliance. CNA has also
sponsored a new bill, AB 253, to help assure compliance.
Introduced by Assembly introduced by Assembly member Darrell Steinberg (D-Sacramento), the bill
authorizes state health officials to conduct unannounced inspections, and provides for fines of up to
$5,000 a day, on hospitals that continue to maintain unsafe RN staffing after final implementation of
the ratio law.
For the specific ratios by hospital unit Click here.
For the specific ratios by hospital unit and more background on the law, Click Here
Fact Sheet on RN Staffing Ratio Law
California is the first state in the U.S. to establish minimum RN-to-patient ratios for hospitals. The
ratios are based on AB 394, sponsored by the California Nurses Association and signed by Gov. Gray
Davis in October, 1999.
Today's announcement of the final regulations to implement AB 394 culminates a 10-year campaign
by CNA to improve RN staffing in California hospitals to protect patient safety, and reverse the effects
of a decade of hospital restructuring that eroded patient care conditions and produced a hospital
All hospitals must be staffing with the minimum ratios as of January 1, 2004. Many CNA represented
hospitals have already hired hundreds of additional RNs in preparation for implementing the law, and
as a result of unprecedented CNA gains in compensation, retirement security, and workplace
improvements intended to enhance retention of current experienced RNs and recruitment of new RNs.
What the Law Does
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 judgment.
AB 394 also restricts the unsafe assignment of unlicensed staff and the unsafe assignment of nursing
staff to hospital clinical areas where they do not have demonstrated competency, training, and
The specific ratios:
AB 394 required the state Department of Health Services to establish the specific ratios for specific
hospital units. In 2002, the DHS issued the proposed regulation to implement AB 394, including the
specific ratios for every hospital unit, and held public hearings.
On July 1, 2003, Gov. Davis and the DHS issued the final regulations incorporating extensive
testimony presented during the hearings and public comment, including from 500 CNA RNs who
testified in the hearings, and nearly 25,000 RNs whose letters were submitted by CNA to the DHS.
Why the Law was needed
The purpose of the law was to address the growing crisis in patient care in California hospitals caused
by managed care and market based decisions on hospital care that resulted in California having
among the worst RN staffing in the nation and a growing exodus of RNs out of hospitals creating a
serious nursing shortage.
CNA campaigned for 10 years to get the law enacted, including the largest gatherings of RNs in
California history, major rallies drawing thousands of RNs to the Capitol.
California's law was the first (and still only) ratio law in the nation. It is the single most effective
response to protecting patient safety in hospitals and reducing the nursing shortage. The California law
is considered a national, even international model, and has generated extensive attention from the
national media and RN organizations around the world.
How the ratios will protect patients
Safe RN staffing is the single most essential element to safe patient care in hospitals. In the last year
JCAHO, the Joint Commission on Accreditation of Hospital Organizations, announced that
inadequate staffing precipitated one-fourth of all sentinel events - unexpected occurrences that
led to patient deaths, injuries, or permanent loss of function - reported to JCAHO the past five
A New England Journal of Medicine study documented that improved RN-to-patient ratios
reduces rates of pneumonia, urinary infections, shock, cardiac arrest, gastrointestinal bleeding,
and other adverse outcomes. No similar links were found for LVNs or other nursing staff.
Research in the Journal of the American Medical Association found that up to 20,000 patient
deaths each year can be linked to preventable patient deaths. For each additional patient
assigned to an RN the likelihood of death within 30 days increased by 7 percent. Four
additional patients increased the risk of death by 31%. No similar findings were associated with
improved ratios for LVNs or other staff.
Where will the RNs come from to meet the ratios?
DHS has projected that California will need 5,000 RNs to meet the ratios that go into effect in
January. That is the same number of RNs who graduate every year from California's 72 schools
The approach of the ratios is already having an effect on overcoming the nursing shortage. In
the past fiscal year, the number of RNs increased by 4% -- the largest increase since 1989,
reports the Board of Registered Nurses. The number of exam applicants increased by 18% and
the ratio of RNs entering and exiting the state continues to make a dramatic change with 1,664
more RNs coming into the state than leaving.
In the three years since the law was signed, according to BRN data, applications for RN
licenses from new graduates and from RNs outside California, has grown from 22,372
applications in fiscal year 1999-2000 to 27,551 in fiscal year 2000-2001 to 32,368 in fiscal year
In Victoria, Australia, ratios were enacted in 2001. By February 2002, the full-time RN
workforce had increased by 16.5 percent.
The real key to meeting the ratios is for hospitals to hang on to the RNs they already have.
Many CNA-represented hospitals have taken big strides by enacting significant improvements,
though collective bargaining with CNA, in retirement security, compensation, and improved
patient care conditions.
More background information is available at http://www.calnurse.org
July 1, 2003
That's great. Too bad I'm in Arizona. We've got a long way to go.
You have a way to go as do we. We do have a head start but some Arizona nurses have begun. California nurses will help our neighbors (at least some of us)!
Southern Arizona Nurses Coalition - California Nurses
For Justice in Health Care
The Southern Arizona Nurses Coalition is a grassroots, community-based
organization of direct-care nurses and supporters seeking justice in
healthcare. Founded in August 2001, the coalition promotes the
organization and representation of direct-care nurses to improve working
conditions, patient care, nurse retention and healthcare justice in the
The coalition recently affiliated with the California Nurses Association, a
professional organization and union with an outstanding record of
advocacy for nurses and patients.
SAZNC-CNA promotes and protects the legal and human right to organize
and bargain collectively. Without contract protection, nurses are unable
to vigorously advocate for themselves or their patients without
jeopardizing their job security.
The membership-based coalition currently comprises nurses from many
Tucson-area hospital facility, including the following:
Northwest Medical Center
University Medical Center
St. Mary's Hospital
St. Joseph's Hospital
El Dorado Hospital
Tucson Heart Hospital
Tucson Medical Center
Kino Community Hospital.
Members also include nursing students and nurses in public health,
long-term care, and behavioral and home health.
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