California passes first nurse staffing quota law

In October 1999, California became the first state to pass legislation requiring minimum nurse-to-patient ratios for all patient care units in hospitals. The bill requires nurse staffing numbers to be based on:

- the severity of illness;

- the need for specialized equipment and technology;

- the complexity of clinical judgment needed to manage the patient care plan;

- ability for self-care;

- licensed level of staff.

The bill also prohibits the use of unlicensed personnel for nursing functions when an RN is not available and prevents non-RNs from performing nursing functions such as:

- 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;

- patient and family education and post- discharge care;

- moderate complexity laboratory tests.

The bill also requires that orientation be provided for an RN coming into a nursing unit or clinical area as well as for temporary personnel.