title: Licensed caregiver characteristics and staffing in California acute care hospital units.
abstract: OBJECTIVE
  Concerns about declining quality of care and nurse staffing shortages led to legislation mandating minimum nurse-to-patient ratios in the state of California. Although research finds that better registered nurse (RN) staffing results in higher quality of care, little evidence exists on which to base specific nurse-patient ratios. The authors describe the results of a California survey characterizing licensed caregivers, identifying staffing levels by unit type, and describing how staffing levels vary across hospital types.
  
  
  METHODS
  A stratified random sample of general acute care hospitals was surveyed to collect cross-sectional data on hospitals' nursing workforce and staffing practices and to assess the impact of potential patient-to-nurse staffing ratios. All academic medical centers; rural, private, and city/county hospitals; and hospitals affiliated with a large group-model health maintenance organization (HMO) were eligible for inclusion.
  
  
  RESULTS
  Eighty hospitals were surveyed, representing all major metropolitan areas in the state. Acute care hospitals in California have diverse nursing staffs with variations in education, experience, and employment status. Considerable variations in skill mix were identified, with the proportion of RNs ranging from 30% to 84%, depending on the unit type surveyed.
  
  
  CONCLUSIONS
  As states struggle with an anticipated critical shortage of RNs, these results have several implications for health and education policy. Future studies of this type will be needed to evaluate the impact of anticipated changes in the regulation of nurse staffing.
authors.affiliation: California State University Stanislaus, Turlock 95382, USA. PHodge@csustan.edu
authors.forename: Margaret Blakeman
authors.initials: MB
authors.lastname: Hodge
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.forename: Danielle
authors.initials: D
authors.lastname: Harvey
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Samuels
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Olson
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Sauvé
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D002140:California; D003430:Cross-Sectional Studies; D004506:Education, Nursing; D006757:Hospital Units; D006801:Humans; D007884:Legislation, Nursing; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence; D011787:Quality of Health Care; D000078329:Workforce; D016526:Workload