Implementation of nurse-to-patient ratios laws in California is successful, says American Society of Registered Nurses

In a national online survey conducted by the American Society of Registered Nurses (ASRN.org), 56% of the 761 Registered Nurses surveyed on March 26 that worked under nurse-to-patient ratios said that due to the implementation of the ratios, they had more time for breaks. In a separate survey, 69% said they had more time for personal care of their patients.

California's historic staffing law for registered nurse staffing ratios, achieved through years of advocacy by California's Registered Nurses, completed its phase-in period this year.

Over the five-year course of the phase-in, these ratios have revolutionized hospital care and improved patient safety by mandating hospitals maintain minimum, specific nurse-to-patient staffing ratios for all hospital units at all times.

Ratios differ by hospital area, such as a minimum of no less than 1 RN for every 5 patients in general medical or post-surgical care units, 1:4 in pediatrics, and 1:4 in emergency rooms. The ratios are a floor, not a ceiling, with hospitals also required to increase registered nurse staffing as needed based on individual patient illness or acuity.

As of January 1, 2008, new ratios went in effect for three units. They improve to 1:3 in Step Down (transitional units between intensive care and general medical-surgical floors, reduced from 1:4), 1:4 in Telemetry (where patients are on monitors, improved from 1:5) and 1:4 in Other Specialty Care units such as cancer care (upgraded from 1:5).

California's ratios are a spectacular success story. Under California's ratio law, lives are being saved, the ability to be effective advocates for patients is stronger, and more RNs are entering the work force and staying at the bedside longer mitigating the nursing shortage.

Since the law was signed, 80,000 more licensed RNs have come into the state's workforce. In contrast to the years before the law was signed in 1999, more RNs are entering the state than leaving, and more are staying at the bedside.

Because of their achievements, the ratios have sparked a brush fire around the country by nurses demanding similar laws in 13 other states including: Arizona, Florida, Illinois, Maine, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania and Texas.

In many other workplace settings like for instance, day-care centers, public school classrooms, local fire stations and on commercial aircraft, minimum staffing levels are well established and clearly work for the benefit of the public. Why not in hospitals?

Today, it's still perfectly legal for nurses in 49 states to be assigned to 10 or even 15 patients at a time, far more than can be safely handled. It is hoped that by Nurses' Week next year, more states will have joined California in regulating hospital workloads, so nurses can properly meet their professional responsibilities.

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This article is republished with kind permission from our friends at the American Society of Registered Nurses. Get ASRN journals delivered to you via email. Copyright 2008 - American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved.