California State Health Director Announces Proposed Changes to Nurse-to-Patient Ratio Regulations

SACRAMENTO -- Citing a need to protect patients and Californias fragile healthcare system, State Health Director Sandra Shewry today announced proposed changes to Californias regulations limiting the number of hospital patients under a nurses care.

"The Schwarzenegger Administration is committed to the fundamental principle embodied in California's first-in-the-nation hospital nurse-to-patient ratios--safe patient care," Shewry said. These changes provide commonsense flexibility for hospital emergency departments and clarify language in the current regulations."

On Jan. 1, 2004, California became the first state in the nation to set numerical limits in most areas of a hospital on the number of patients assigned to a nurse. The changes to the regulations are as follows:

-- Maintain until January 2008 the current limit of no more than six patients assigned to any one nurse for medical/surgical and mixed units. Previously, the maximum number of patients per nurse in those units was scheduled to drop to five in January 2005. Now, that change is scheduled for 2008.

-- Provide hospital emergency departments with temporary staffing flexibility to respond to an unforeseeable influx of patients with immediate needs. Hospitals will continue to be required to return to the specified staffing ratio as soon as possible. In addition, the documentation requirements for emergency departments will be simplified.

-- Clarify the requirement that the regulations be met "at all times" to include whenever the nurse is on the unit and available for patient care. Currently, a strict interpretation of the regulations requires that all patient assignments be given to another nurse during restroom breaks or phone calls.

Although the full effect of the nurse-to-patient ratios is not yet known, the following developments have occurred since the law took effect:

-- Eleven hospitals have identified nurse-to-patient staffing ratios as a cause for the closure of their respective hospital, emergency department or psychiatric unit.

-- Four hospitals have petitioned the California Department of Health Services (CDHS) to suspend the use of available beds because of the inability to provide enough nurses to care for the patients.

-- The shortage of nurses has worsened in other health facilities besides hospitals. Skilled nursing facilities, home health agencies and other healthcare facilities are reporting difficulties in filling nursing positions. California consistently ranks 49^th-50th nationwide in the number of registered nurses per capita, with 30 percent fewer nurses than the national average. The Federal Health Resources and Services Agency (HRSA) has projected by 2010 that California will need more than 42,000 additional nurses to meet the demand.

CDHS will begin a two-year study of the effect of the nurse-to-patient ratios next year.

"Because we do not yet understand the impact of these groundbreaking ratios on the states fragile healthcare delivery system, we must move forward cautiously," Shewry said. "Maintaining the current staffing ratios until 2008 for the medical/surgical and mixed units of a hospital will allow time to complete our study and evaluate the ratios."

The changes to the law are in emergency regulations filed today by CDHS with the state Office of Administrative Law (OAL). OAL has 10 days to reject or accept the regulations and file them with the Secretary of State, at which time the regulations become law. A notice of public hearing and comment will be published approximately three weeks after the regulations are approved.

Source: California Department of Health Services