Question: In 1999, California became the first state to pass a law that requires minimum staffing ratios for nurses in general acute care hospitals (Coffman, Seago, and Spetz 2002). California Assembly Bill 394 (AB 394) mandated the Department of Health Services to create "minimum, specific, and numerical nurse-to-patient ratios by licensed nurse classification and by hospital unit for the inpatient parts of general hospitals in the state." In January 2004, those regulations came into effect, translating into the following: In the emergency department, one nurse cannot care for more than four patients, while in postoperative surgical units, nurses cannot care for more than six patients. Using the national nursing supplyand-demand model, the following table on page 42 shows the projected supply of registered nurses (RNs) and a trend for inpatient days in general acute care hospitals in North Carolina, from 2007 through 2023. The North Carolina General Assembly is considering implementing a mandatory staffing ratio that matches the California rules for emergency departments and post-op

surgical units in general acute care hospitals. The North Carolina Hospital Association found that in all of the hospitals in the state with emergency departments and post-op surgical units, emergency departments accounted for 8 percent of total inpatient days in 2007, and the post-op units accounted for 11 percent of inpatient days. Overall, hospital RNs accounted for 38 percent of all RNs practicing in North Carolina. Three percent of these hospital RNs worked in emergency departments, while 2.2 percent worked in post-op units. The available supply of RNs in 2007 allowed all hospitals in the state to fully staff their emergency departments and postop units.

Exercise: If North Carolina implements a staffing law exactly like the one in California, and that law is put into effect on January 1, 2009, how would the numbers in the above table change? Estimate the change in the number of RNs required to staff the emergency departments and post-op units of acute care hospitals in North Carolina. The use of both units is expected to rise in direct proportion to the overall use of hospitals as measured by inpatient days.