The original Bill that put staffing ratios in place!

California A.B. 394 - Staffing Bill
Signed into law by Governor Gray Davis
October 10, 1999

California A.B. 394:

• Requires the State Department of Health Services (DHS) to adopt by January 1, 2001, regulations that establish minimum, specific and numerical licensed nurse-to-patient ratios by licensed nurse classification and hospital units for all general acute care hospitals, acute psychiatric hospitals and special hospitals. (While the legislation requires DHS to establish the regulations by 1/1/01, Governor Davis and the bill author, Assemblywoman Sheila Kuehl have tentatively agreed to extend the implementation deadline to 1/1/02.)
• Requires nurse staffing to be determined based on severity of illness, the need for specialized equipment and technology, the complexity of clinical judgement needed to design, implement and evaluate the patient care plan and the ability for self-care and the licensure of the personnel.
• Would prohibit a general acute hospital, an acute psychiatric hospital and special hospital, from assigning an unlicensed person to perform nursing functions in lieu of a registered nurse, or from allowing unlicensed personnel under the direct clinical supervision of a registered nurse to perform certain functions including:
  • medication administration;
  • venipuncture or intravenous therapy;
  • parenteral or tube feedings;
  • invasive procedures including inserting nasogastric tubes, inserting catheters or tracheal suctioning;
  • assessment of patient condition;
  • educating patients and their families concerning the patient's health care problems including post discharge care and
  • moderate complexity laboratory tests
• Requires a registered nurse assigned to a nursing unit or clinical area to first receive orientation in the area where practicing. All temporary personnel shall receive orientation and be subject to competency validation.

California Hospital Minimum Nurse to Patient ratios as required by AB 394 effective 1/1/05

Proposed Modifications (note: these were challenged in court, by interested groups and the court refused to allow the changes to take effect)

Fact Sheet

Citing 11 hospital emergency room closures; the fact that many others were turning away

ambulances because they could not meet the existing 1-to-6 nurse-patient ratio; and the

severe shortage of nurses in the state, Governor Schwarzenegger announced proposed

emergency regulations on November 4, 2004, making adjustments to the ratio

regulations. The emergency regulations were approved by the Office of Administration

Law (OAL) on November 14, 2004, and are in effect for a maximum of 120 days.

The modifications to the nurse-to-patient ratio regulations, as announced by Governor

Schwarzenegger, are as follows:

�� Maintain until January 2008 the current 1:6 ratio on hospital medical-surgical

units. The 1:6 ratio took effect on January 1, 2004. Previously, the ratio was

scheduled to drop to 1:5 on January 1. 2005.

�� Provide hospital emergency departments (EDs) with temporary staffing

flexibility to respond to an unforeseeable influx of patients. Hospitals are

required to return to the specified staffing ratio (1:4) as soon as possible.

�� Clarify the requirement that the ratio regulations be met “at all times” to mean

that nurses who are on the unit and available for patient care but step away

temporarily to use the restroom or take a phone call can be included in the ratios.

Previously, all patients had to be reassigned to another nurse during restroom

breaks or phone calls.

For the emergency regulations to become permanent, the Department of Health Services

(DHS) must follow the normal rule-making process. As part of this process, DHS has

scheduled a public hearing on the recommended modifications to the nurse-to-patient

ratio regulations for January 18, 2005. Written comments will be taken by DHS until

January 21, 2005. DHS then has 30 days to finalize the permanent regulations and

submit them to the Office of Administrative Law. Once OAL approves the regulation

package, the regulations will become permanent.