California Registered Nurse Staffing Ratio Law PO

California Registered Nurse Staffing Ratio Law PO


Review of a Bill Assignment ( CALIFORNIA RN STAFFING RATIO LAW)

Select an active bill at the state or federal level( CALIFORNIA RN STAFFING RATIO LAW) that impacts the professional practice of nursing. In a 3-4 page paper (excluding the title and reference pages), summarize the provisions of the bill and clearly explain what the bill will accomplish. The paper should be no more than 4 pages, typed in Times New Roman using 12-point font, and double-spaced with 1″ margins.

Your review of a bill paper should:

Discuss the major provisions of the bill.
Demonstrate an in-depth understanding of the legislation by explaining the background and all relevant facts.
Discuss any relevant history related to the legislation, pertinent votes, and issues that are stalling the legislation, etc.
Use primary sources for this information.
Identify key supporters and those who do not support the bill. Explain why some of these individuals support the bill and why some do not.
Explore the positions of the key stakeholders in the bill, both pros and cons. Do not make assumptions about potential key stakeholders. Examine this area carefully so you are correctly reflecting the stakeholders positions.
Discuss how the bill would impact a nurse’s ability to provide safe and quality care or to practice to the highest scope of the nursing license.
Explain specific actions that nurses can take to assist with the passage or defeat of the legislation
Use Current APA Style, headings and references as appropriate.





California RN Staffing Ratio Law

 Major Provisions of The Bill

California registered nurses’ staffing ratio law was enacted in 1999. This law establishes that healthcare facilities should have a minimum number of registered nurses to patient ratios. Healthcare facilities operating in California are therefore required to meet specific staffing ratios depending on the demand for healthcare services that they experience frequently. California registered nurses staffing ratio law AB 394 provides a clear numerical nurse to patient ratios for acute psychiatric, acute care, and specialty hospitals across California. The ratios represent the maximum number of patients that registered nurses can be assigned to during their working shifts (Kasprak, 2017).  The AB 394 requires additional registered nurses to be hired and assigned in Healthcare facilities based on previously documented demands and patient classification systems that evaluate the need for nursing care. California registered nurses’ staffing ratio law also requires healthcare facilities to consider the complexity and severity of illness as they normally deal with in hiring extra nurses to ensure adequate nursing staffing ratios (Kasprak, 2017). AB 394 also restricts healthcare facilities from assigning nursing staff and unlicensed staff to two different areas where they do not have demonstrated training competency and orientation. An example of the different nurse-patient ratios provided in the California law includes one registered nurse for two patients in the critical care and intensive care unit, one registered nurse for two patients in the neonatal intensive care unit, one registered nurse to one patient in the operating room one registered nurse for two patients in the post-anesthesia recovery one registered nurses for two patients in the labor and delivery unit 1 registered nurse for four patients in the emergency room one registered nurse for four patients in the pediatric department one registered for six patients in the postpartum unit of a healthcare facility and one registered nurse  for1  in the trauma section and one registered nurse to four patients in the emergency room (Kasprak, 2017).

Background of Legislation

Before the adoption of the law governing registered nurse staffing ratios in California at the turn of the millennium, most of the existing laws and policies in the state regulated the registration licensing and the scope of practice for nurses. The California law to regulate the registered nurse staffing ratios was therefore adopted in a bid to prevent health care facilities, including acute psychiatric hospitals, acute care hospitals, and special hospitals, from assigning and unlicensed persons to perform registered nursing roles and to prevent unlicensed personnel from performing registered nurses roles even under the supervision of such nurses (Kasprak, 2017). The registered nursing staff ratio law was therefore adopted in the state of California to build on previous laws such as the laws prohibiting the operation of healthcare facilities without licenses issued by the state department health services and subsequent regulation of social care facilities. The law regulating the registered nurse staffing ratios in California required the state department for health services in California to adopt regulations that would establish a minimum nurse-to-patient ratio in acute care special hospitals and an acute psychiatric hospital. The law would also require healthcare facilities to adopt procedures and policies for the orientation and training of nursing staff (Kasprak, 2017).

Relevant History

The bill to regulate registered nursing staffing ratios in the state of California was first introduced in the state legislature of California on February 2, 1999. Eventually, the bill was referred to the committee on health on February 25, 1999. After numerous committee hearings, the bill was read for a second time on September 1, 1999, and read for that time on September 8, 1999. Senate amendments were introduced to the bill on September 9, 1999, with the Senate approving the bill (Kasprak, 2017). Finally, the bill was approved by the California governor on October 10, 1999. During the approval of the bill in the California senate, 46 representatives supported the bill, while 29 opposed the bill (Kasprak, 2017).

Proponents and Opponents of the Bill Positions

There are numerous proponents of the California nurse staffing ratios who include numerous representatives in the California State legislature, professional nursing organizations, and non-governmental organizations that advocate for better healthcare services among populations. The main reason that professional nursing organizations supported the California nursing ratio law was because of the long history of overworking among nurses in the state. Most nurses across California there were reported that they did not have adequate time to provide sufficient emotional support and comfort to their patients or family members (Livanos, 2018). Limiting the number of patients that nurses can attend to would therefore force healthcare facilities to hire more nurses and therefore improve the quality of care to patients. Different studies have therefore supported higher nursing staff ratios as a way of ensuring safety in healthcare facilities and helping to boost the number of positive outcomes among health care providers (Livanos, 2018).

On the other hand, the opponents of nursing staffing ratio laws argue that such laws can play a significant role in hindering access to healthcare services. The main opponents to nursing staffing ratio laws included the coalition to protect patient safety, healthcare owners associations, and some members of the California state legislature. Those opposing the nursing staffing laws argued that implementing such laws without providing the necessary funding to health care facilities would instigate significant cuts in critical programs such as mental health services and opioid treatment in healthcare facilities. Implementing nursing staff laws would also have a significant negative impact on community hospitals that would be forced to close because of not being able to absorb added costs (Livanos, 2018).

Positions of Key Stakeholders

The key stakeholders affected by the nursing ratio laws include the management of healthcare facilities, patients, and nurses. Nursing ratios with health nurses to provide all the necessary quality care to patients. On the other hand, nursing ratios would have a significant impact on the management of healthcare facilities due to the high costs required to hire extra nurses. Nursing staff ratios could have a significant impact on the delivery of quality services to patients, as some patients would receive quality care while others would not have any nurses to attend to them (McHugh et al., 2020).

Impact of the Bill or Nurse’s Ability to Provide Safe and Quality Care

The nurse staffing ratio law increases the ability of nurses to provide quality and safe care to patients. This is because the bill helps to manage the workload of nurses and therefore increases their ability to provide quality healthcare services (McHugh et al., 2020).

Action by Nurses to assist in Passage or Defeat of the Legislation

Nurses can play a significant role in introducing reforms that can make the California RN staffing ratio law that has already been adopted to be more effective. This would include lobbying set legislature representatives to make the necessary amendments to the law through various professional nursing organizations.



Kasprak, J. (2017). California Rn Staffing Ratio Law. Cga.Ct.Gov. Retrieved December 15, 2021, from

Livanos, N. (2018). A Broadening Coalition: Patient Safety Enters the Nurse-to-Patient Ratio Debate. Journal of Nursing Regulation, 9(1), 68–70.

McHugh, M. D., Aiken, L. H., Windsor, C., Douglas, C., & Yates, P. (2020). Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study. BMJ Open, 10(9), e036264.



Get 20% off your first purchase