California warns hospitals of tougher enforcement action for violating nurse staffing ratios

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Hospitals in California are being warned not to violate state law on staffing levels or face fines. New state policy narrows the circumstances under which hospitals can claim "unpredictable circumstances" for violating the mandate.

The California Department of Public Health this week, in a notice to hospitals, warned that noncompliance can result in a $15,000 fine for a first violation and $30,000 for a second. 

The state conducts periodic, unannounced inspections to enforce compliance. 

New policy by Governor Newsom narrows the circumstances under which hospitals will not be penalized for violations due to "unpredictable circumstances," requiring them to document efforts to maintain safe staffing and that such instances be truly unforeseen. 

In an advisory letter to hospitals, the public health department said, "Situations that are not considered unpredictable, unknown or uncontrollable include consistent, ongoing patterns of understaffing. Facilities are expected to maintain required nurse-to-patient ratios at all times, including but not limited to, weekends, holidays, leaves of absences, among others."  

WHY THIS MATTERS

Minimum staffing ratios have been law in California since nurses and healthcare workers fought to pass AB 394, the nation's first nurse-patient staffing ratio law in 1999.

In addition, SB 227, which passed in 2019, requires the state to assess administrative fines on hospitals that violate the safe staffing law. Law AB 1422 requires public comment before the public health department grants waivers to the critical care program flexibility requests. 

THE LARGER TREND

Nurse staffing ratios are controversial and California remains the only state to have enacted them.

Earlier this month, the Department of Health and Human Services proposed national minimum staffing standards for nursing homes.

A study reportedly commissioned by the Centers for Medicare and Medicaid Services said there was "no single staffing level that would guarantee quality care."

In 2010, the National Institutes of Health conducted a study comparing implications of the California staffing ratios with two other states that did not have the legislation. The NIH looked at survey data from 22,336 hospital staff nurses in California, Pennsylvania and New Jersey in 2006 and state hospital discharge databases.

California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients in medical and surgical units, the NIH research said. 

The study found that lower ratios were associated with significantly lower mortality. When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care, the NIH said.

Also, the hospital nurse staffing ratios in California were associated with better nurse retention than in the other states.

ON THE RECORD

"Patients in California are safer today because nurses and healthcare workers demanded that hospitals be held accountable for violating safe-staffing laws," said Leo Pérez, RN and president of SEIU 121RN. "The COVID-19 pandemic taught us that our state's health depends on supporting and listening to those who are on the front lines of patient care – a lesson we should never forget. Today's action is the result of SEIU's relentless vigilance. We applaud the step CDPH has taken to enforce laws that keep patients safe."
 

      
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org