AbstractOne suggested approach to ensure safe and effective patient care has been to mandate nurse staffing ratios. In 1999 California became the first state to mandate minimum nurse-to-patient ratios in hospitals. California is not the only state to enact minimum nurse staffing ratios for hospitals, over the past four years at least eighteen other states have considered legislation regarding nurse staffing in hospitals. Policymakers are forced to consider alternatives to nurses ratios due to nurse shortages. Whether minimum staffing ratios will improve working conditions enough to increase nurse supply is unknown.
The United States healthcare system has changed significantly over the past two decades. Advances in technology and an aging population (baby boomers) have led to changes in the structure, organization, and delivery of health care services (Spetz, 2001). Low nurse staffing levels in acute care hospitals are jeopardizing the quality of patient care and is the leading cause for Registered Nurses (RNs) to leave the profession (Spetz, Seago, et al.,
2000). Apprehension for the nursing workforce and the safety of patients in the U.S. healthcare system now has the unprecedented attention of healthcare policy leaders at every level (Spetz, 2001). One suggested approach to ensure safe and effective patient care has been to mandate nurse staffing ratios (Donaldson, FAAN, Bolton, Janet, Meenu Sandhu, 2005).
In 1999 California did just that, it became the first state to enact legislation mandating minimum nurse-to-patient ratios in acute care hospitals (Donaldson, FAAN, Bolton, Janet, Meenu Sandhu, 2005). Assembly Bill 394 (1999), directed the California Department of Health Services (DHS) to establish specific nurse-to-patient ratios for inpatient units in acute care hospitals. This was done by creating a hospital Licensed nurses classification to include both RNs and licensed vocational nurses (LVNs) also referred to as licensed practical nurses (LPNs) (California, 2002 July).