Mandating nurse staffing ratios

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The cookies contain no personally identifiable information and have no effect once you leave the Medscape site.With passage of AB 394 in 1999, California became the first state to establish minimum registered nurse (RN)–to-patient ratios for hospitals.In the 1990s, the idea of setting standard staffing ratios in other areas gained momentum, as the scope of the current nursing shortage started becoming apparent.Since then, many states have considered mandated ratios as well as some alternative staffing solutions for all healthcare facilities.In intensive care units (ICUs), staffing ratios—the ratio of one nurse-care provider to patients—have been standardized for 30 years.In almost any ICU, one registered nurse (RN) cares for two patients.Hospital officials also would have to post staffing ratios inside facilities.It's not the first time such a bill has been introduced in Congress.

(See Staffing solutions: State by state in pdf format by clicking the download now button.) Thirteen states plus the District of Columbia have either enacted legislation mandating nurse-patient ratios, created regulations requiring written staffing plans, or developed an approach using a combination of the two.By the turn of the 21st century, momentum for mandated ratios had grown.Then, the New York legislative focus shifted from mandated ratios to staffing plans that allow ratio adjustments with input from direct-care nurses.While the language differs across the states, at the heart of all these bills is a minimum nurse-to-patient ratio — a fixed number of nurses per patient.The bills call for a different ratio in different parts of a hospital. Legislatures in at least seven states and the District of Columbia are trying to answer that question as they debate bills that would require hospitals to have a minimum number of nurses on staff at all times. California is the only state that has a minimum nurse staffing law, but at least seven other states are considering adopting their own versions (Photo by Joe Raedle/Getty Images). California’s state legislature passed a minimum nurse staffing law in 1999.

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