Coronavirus Response Newsletter

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CDPH Announces Expedited Process for Nurse Staffing Ratio Waivers 

The California Department of Public Health (CDPH) is now offering an expedited option for hospitals to flex the nurse staffing ratios. This process, which took effect immediately with the release of All-Facilities Letter 20-26.4, means hospitals can use certain alternative measures as soon as they submit the waiver request form.   

These alternative measures are that, for hospitals with patient surges or staffing shortages, the state will allow nurses to care for one additional patient in the ICU and in step-down units, and two additional patients in telemetry, ED, and med/surg units. As a result, this will flex nurse-to-patient ratios as follows: 

  • ICU — from 1:2 to 1:3 
  • Step-down units — from 1:3 to 1:4 
  • ED and telemetry — from 1:4 to 1:6 
  • Med/surg — from 1:5 to 1:7 

Hospitals that meet these criteria will be presumptively approved. CDPH will have 10 working days to ask the hospital any questions, largely for line of sight into surge activity, and these waivers will be in place for 60 days from the date of the request. 

This expedited process is an important addition to the current waiver process, in which hospitals individually submit ratio waivers for review and approval by CDPH surveyors. In many cases, this current waiver process has resulted in significant delays as hospitals wait for approval and does not provide the certainty hospitals need. 

Hospitals that need additional relief beyond the ratios or units of the hospital outlined in the expedited process can continue to submit waiver requests through the current process. CDPH will consider these on a case-by-case basis.  

For both the expedited process and the current process, a hospital seeking a waiver must submit CDPH form 5000A and supporting documentation to the CDPH Center for Health Care Quality (CHCQ) Duty Officer at and copy the local CDPH District Office