State Government Relations

California A.B. 394 - Staffing Bill
Signed into law by Governor Gray Davis
October 10, 1999

California A.B. 394:

• Requires the State Department of Health Services (DHS) to adopt by January 1, 2001, regulations that establish minimum, specific and numerical licensed nurse-to-patient ratios by licensed nurse classification and hospital units for all general acute care hospitals, acute psychiatric hospitals and special hospitals. (While the legislation requires DHS to establish the regulations by 1/1/01, Governor Davis and the bill author, Assemblywoman Sheila Kuehl have tentatively agreed to extend the implementation deadline to 1/1/02.)
• Requires nurse staffing to be determined based on severity of illness, the need for specialized equipment and technology, the complexity of clinical judgement needed to design, implement and evaluate the patient care plan and the ability for self-care and the licensure of the personnel.
• Would prohibit a general acute hospital, an acute psychiatric hospital and special hospital, from assigning an unlicensed person to perform nursing functions in lieu of a registered nurse, or from allowing unlicensed personnel under the direct clinical supervision of a registered nurse to perform certain functions including:
  • medication administration;
  • venipuncture or intravenous therapy;
  • parenteral or tube feedings;
  • invasive procedures including inserting nasogastric tubes, inserting catheters or tracheal suctioning;
  • assessment of patient condition;
  • educating patients and their families concerning the patient's health care problems including post discharge care and
  • moderate complexity laboratory tests
• Requires a registered nurse assigned to a nursing unit or clinical area to first receive orientation in the area where practicing. All temporary personnel shall receive orientation and be subject to competency validation.

The American Nurses Association California (ANA\C), a constituent member of the American Nurses Association, supports the passage of California A.B. 394. ANA\C states that issues raised by the bill's critics, which will be considered throughout the rulemaking process, include:

• There is nothing to prevent a hospital from closing an entire unit if it believes the staffing ratios are overly burdensome or cost-prohibitive;
• While nursing positions will be mandated, this will not be the case with other health care providers. This could lead to the elimination of other staff members requiring nurses to carry out responsibilities that are not nursing related as well as working mandatory overtime;
• With the addition of more registered nurses through staffing ratios, there could be added incentive to expand the scope of practice of other licensed personnel and increase utilization unlicensed assistive personnel through amending the nurse practice act or other areas of regulation; and
• When establishing nurse staffing requirements, the experience level and education of the nurse should be considered in addition to patient acuity.

The text of the legislation is available online through http://www.leginfo.ca.gov. Governor Davis' letter to the legislature can be accessed at http://www.ca.gov/s/governor/ab394sign.html

If you have questions about this legislation contact ANA\C at anacalif@pacbell.net

ANA Press Release on the California Staffing Bill

1999 State Legislative Trends: Sufficient Staff and Staffing Ratios (In Other Than Long-Term Care Facilities)