The 2nd HPD report - Health Policy Monitor

California: First-in-nation rules on nurse-to-patient ratios
In 2002, the Joint Commission on Accreditation of Health Care
Organizations came to the conclusion that nearly one quarter of
unanticipated incidents resulting in death or injury of patients are
due to nursing shortage.
California’s implementation of nurse-to-patient ratio rules—the
first in the nation—marks an end to a lengthy administrative process.
In 1999, based on concerns about working conditions for
nurses, the quality of care patients receive and patients’ safety, the
California Association of Nurses drafted legislation on nurse-topatient
ratios that was signed into law that same year. It took
three more years for the California Department of Health Services
to release regulations and guidelines for implementation.
Idea
Pilot
Policy Paper
Legislation
Adoption
Evaluation
Change
The new rules stipulate that starting in January 2004, all general
wards in California must provide a ratio of one nurse for
every six patients. That ratio must decrease to one nurse for every
five patients in January 2005. The rules also set a deadline of
January 2008. Additionally, a deadline is set for increasing the
number of nurses in specialized health care units. These mandated
ratios are expected to have a significant impact on:
– Improving working conditions for nurses, by keeping the
number of patients manageable;
– Improving patients’ safety, by allowing nurses to pay more
attention to the individual patient; and on
– Increasing hospital costs, by forcing hospitals to increase their
staffing.
Although the rules are regarded as a clear-cut victory for labor
unions representing nurses, the unions themselves are divided
on the details. The Service Employees International Union
recommends different ratios (1:4) but also different qualification
standards (not just registered nurses).
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Public Visibility
Impact
Transferability
Better nursing
ratios—improved
patient safety
Victory for
nursing unions