The California experiment: alternatives for minimum nurse-to-patient ratios

In making policy, it is ideal to study a problem, test solutions, and then implement the best solution. In California there is legislation regarding nurse staffing that requires implementation of a solution before the problem has been accurately stated and before alternative solutions have been tested. Assembly Bill 394 directs the California Department of Health Services to establish "minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit" and have these ratios in place January 1, 2002. This law is scheduled for implementation before there is specific evidence of optimal staffing levels for various patient populations. The author presents a comprehensive literature review of activities related to nurse staffing in the United States, provides data related to existing patient classification systems in California, and suggests an alternative to staffing ratios to protect consumers.