CA Nurse Staffing Law Generates More Debate

Rebecca Hendren, for HealthLeaders Media , July 26, 2011

The law effectively increased RN staffing in California hospitals, the study found, which supports proponents of staffing ratio laws. Those arguments, however, fail to address the number of travelers and temporary staff that hospitals must hire to meet requirements and that is expensive and inconvenient. 

The staffing ratio debate will heat up as hospitals feel the first effects of payments for quality and patient experience. To head off legislation, hospitals must demonstrate that existing staffing plans provide safe patient care. Top performing hospitals often staff better than the laws require, but they do so with the freedom to adjust as necessary, depending on patient need and the organization's resources.

Patient acuity systems can be invaluable for maximizing staffing and saving money. So can offering nurses scheduling options beyond the 12-hour shift, such as peak-time shifts, multi-task shifts, group sharing, or job sharing.

To provide a reasonable argument against legislating ratios, hospitals must demonstrate optimal nurse staffing and a commitment to high-quality patient care. Involving RNs in the staffing decisions is the best way to head off union action.

See Also:
Inpatient Mortality Linked to Nurse Understaffing

Does Mandating Nurse-Patient Ratios Improve Care?

Linking Medical Errors, Nurses' 12-Hour Shifts

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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2 comments on "CA Nurse Staffing Law Generates More Debate"

Linda Gusch, RN, BSN (8/1/2011 at 8:35 PM)
Teachers have had classroom ratios for YEARS!! Teachers count a disabled student twice in their classroom numbers because they take more of a teachers' time. Yet, no one has ever died because they could not do long division, or diagram a sentence. THOUSANDS of patients die or are maimed due to the effects of deliberate short staffing in hospitals and nursing homes. Your child is safer in a day care center than a hospital pediatric unit because DSHS STRICLTY enforces staffing ratios in day care center, to the extent that they will close down a facility if the staffing ratios are not met. Are regular hospitalized patients not as important? Why have staffing ratios in hospitals been mandated? Because hospitals do not want to cut into their bottom line by providing adequate ataffing. There is no nursing shortage that is responsible for short staffing. There is now a gigantic nursing glut, with school turning up on every street corner. It is also a matter of control of the nursing profession. Nursing needs to take to the streets to let the public know how their safety has neen compromised where it should be a no brainer guarantee. Hospital will throw the nurse under the bus if there is a law suit due to short staffing, an issue that nurses have NO control over. And THAT is the sad fact that hospitals and nursing homes want to keep.

katrina howard (7/28/2011 at 10:32 AM)
With value-based purchasing, hospital reimbursement will improve dramatically if patient satisfaction and patient outcomes improve. Many of the outcomes or conditions associated with reimbursement reform, i.e.; medical errors and injuries that can reasonably be prevented, such as pressure ulcers, injuries related to inpatient falls, urinary catheter-associated urinary tract infection, vascular catheter-related infections, post-operative complications, readmission rates, length of stay, failure to rescue, etc., are outcomes which are FUNDAMENTALLY RELATED TO NURSE STAFFING LEVELS. The sheer volume of studies that equate safe staffing levels with improved patient outcomes is astounding. There is obviously a business case to improve RN staffing. Ratios must be mandated because hospitals cannot be counted on to staff appropriately. Staffing levels are often set by administrators who place economic goals ahead of quality care. Ratios have made a positive impact on patient care and nurse satisfaction in California, despite fierce and ongoing opposition from the hospital industry.




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