California is the first state to mandate specific nurse-to-patient ratios in general acute care hospitals. These ratios went into effect January 1, 2004 and apply "at all times". Little is known about the changes in staffing that occurred subsequent to the implementation of this legislation. This study identifies and describes changes in nurse and non-nursing staffing that may have occurred as a result of the enactment of these nurse-to-patient ratios. The results of this study indicate that most hospitals made upward adjustments in their RN and registry nurse staff but decreases in support staff and other non-nurse staff were not evident. These findings suggest that these mandated ratios had the desired effect of increasing the number of nurses caring for acutely ill patients.

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Central line-associated bloodstream infection (CLABSI) rates above the national average precipitated a quality improvement project aimed at reducing this trend. We implemented daily chlorhexidine bathing and used 4 strategies to promote a change in practice and culture in our medical/surgical units. These strategies include the following: (1) staff education, (2) leadership support, (3) resource availability, and (4) increased awareness and accountability. Since implementing these strategies, there has been a significant reduction in CLABSI rates in the medical/surgical units.

California's nurse-to-patient ratios have been in place since 2004. The author reviews outcomes at the nurse level from a comprehensive literature review. Data suggest that increased levels of nurse staffing have resulted in greater job satisfaction.