Exceptions to Nurse Staffing Ratio Law

Given that CDPH is not planning to issue a statewide blanket waiver of the nurse-to-patient ratio law at this time, hospitals are reminded of the following exceptions related to this law:

  • The ratio regulation states that “The hospital shall plan for routine fluctuations in patient census. If a healthcare emergency causes a change in the number of patients on a unit, the hospital must demonstrate that prompt efforts were made to maintain required staffing levels. A healthcare emergency is defined for this purpose as an unpredictable or unavoidable occurrence at unscheduled or unpredictable intervals relating to healthcare delivery requiring immediate medical interventions and care.”  (See Title 22, Section 70217(g).)
  • The ratio penalty statute states that “A general acute care hospital shall not be subject to an administrative penalty … if the hospital demonstrates to the satisfaction of [CDPH] all of the following:
  • That any fluctuation in required staffing levels was unpredictable and uncontrollable.
  • Prompt efforts were made to maintain required staffing levels.
  • In making those efforts, the hospital immediately used and subsequently exhausted the hospital’s on-call list of nurses and the charge nurse.” (See Health and Safety Code Section 1280.3(f)(4)(A).)

CDPH retains the authority to approve program flexibility requests related to the nurse-to-patient ratio law on an individual hospital basis. Before CDPH will approve such a request, it expects hospitals to try to obtain temporary staffing from its usual vendors, as well as from the following staffing agencies with which CDPH and the state of California have worked. The state has reported that these agencies have displayed a high standard of responsiveness, deployment speed, and clinical competency of their staff. 

Staffing AgencyPoint of ContactEmail AddressPhoneRoles
SLSJanna Contorno[email protected](713) 880-8419Leadership
ProLinkBrent Wallace[email protected](614) 558-3599Leadership
Brendan Tobolski[email protected](716) 462-3112Leadership
SnapNurseCherie Kloss[email protected](404) 424-9725CEO
Bart Richert[email protected](863) 287-3355VP
Jeff Richards[email protected](404) 849-8297Leadership
NuWestMona Veiseh[email protected](425) 602-5716Leadership
Medefis (Medefis/StaffCare/AMN)Kriti Patel[email protected](971) 634-0993Leadership
Lauren LoGuercio[email protected](971) 634-0996Leadership
GQRJosh Redland[email protected](424) 306-2373Leadership
Rory Moaddocks[email protected]Leadership
Loyal SourceBrian Synder[email protected](407) 930-8540Leadership
Supplemental Health Care (SHC)Melissa Evans[email protected](469) 844-8908Leadership
AyaThomas Lee[email protected](858) 279-2787Leadership
Sophia Morris[email protected]thcare.com(866) 546-7122 *11359Leadership
Medical SolutionsKyle Hoy[email protected](402) 986-5130Leadership

In addition, CDPH has stated that it requires hospitals that are requesting program flexibility related to the nurse-to-patient ratio law to request staffing from their MHOAC. The hospital must do this even if the MHOAC has already informed the hospital that it has no staffing to deploy. CDPH wants the request entered into the MHOACs’ Salesforce system, which is a tool used by CDPH to provide a line of sight into hospital staffing needs statewide. Some MHOACs do not realize that CDPH has adopted this requirement — your hospital may need to educate them in this regard.

Finally, CDPH may ask hospitals requesting a program flex to describe the actions they have taken to try to increase staffing. This could include paying overtime or other incentives for staff to accept additional shifts, filling unfilled positions as much as possible, discharging patients as appropriate, rescheduling non-emergent surgeries, diverting ambulance traffic, etc.

CDPH has mentioned that it may consider program flexes requesting approval to use a team nursing model in a more favorable light than program flex requests that simply want nurses to care for additional patients.  

CHA will continue to advocate for state policies that allow hospitals to best deploy available staffing to care for patients.