California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

California Hospitals Added RNs in Response to Nurse Staffing Law

Since the implementation of a state law mandating nurse-to-patient ratios, California hospitals have hired more registered nurses and expanded access to nursing care, according to a study published in the journal Health Affairs, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 7/18).

For the study, researchers from the University of Pennsylvania and Arizona State University examined nurse hiring practices from 1997 through 2008 (United Press International, 7/19).


Former Gov. Gray Davis (D) signed the nurse staffing measure (AB 394) in 1999, and the new nurse-to-patient ratios were rolled out between 2004 and 2008 (Sacramento Business Journal, 7/18).

The legislation established different mandatory nurse-to-patient ratios for specific hospital units. For example, the law calls for one nurse per patient in trauma units and one nurse per five patients in general medical-surgical units (California Healthline, 3/3).

Matthew McHugh -- lead researcher of the study and a nursing professor at the University of Pennsylvania -- said California was the first state to pass a law mandating nurse staffing levels (United Press International, 7/19).

Key Findings

According to the study, California's nurse staffing law resulted in an additional half-hour of nursing care per adjusted patient day above what would have been expected without the law.

In California hospitals, the amount of nursing care provided increased during the implementation of the staffing law, from 6.44 hours per adjusted patient day in 2004 to 7.11 hours per adjusted patient day in 2008.

In the control hospitals, the amount of nursing care provided during that time period increased from 5.75 hours per adjusted patient day to 6.22 hours per adjusted patient day (Sacramento Business Journal, 7/18).

Researchers noted that although California has faced a more severe nursing shortage than many other states, it has filled the gap by hiring more temporary nursing staff (United Press International, 7/19).


The study's findings ease concerns that hospitals are responding to the new nurse staffing mandates by hiring more lower-skilled licensed vocational nurses, according to the Business Journal.

Rather than reducing the skill level of the nursing work force, the study noted that California hospitals increased "their nursing skill mix, and they primarily used more highly skilled registered nurses to meet the staffing mandate" (Sacramento Business Journal, 7/18).

McHugh said the findings "demonstrate that the nurse-to-patient ratio mandate in California was effective in increasing registered nurse staffing in hospitals" (United Press International, 7/19).

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