This letter addresses the requirements for licensed nurse-to-patient ratios for inpatient rehabilitation units in general acute care hospitals. It is the hospitals’ responsibility to refer to the appropriate regulations and identify whether the inpatient rehabilitation unit is a specialty care unit or medical/surgical care unit, and to staff accordingly.
As provided under Title 22 of the California Code of Regulations, Section 70217(a) the following excerpt identifies the licensed nurse-to-patient ratio for medical/surgical care units and specialty care units :
(11) The licensed nurse-to-patient ratio in medical/surgical care units shall be 1:6 or fewer at all times. Commencing January 1, 2005, the licensed nurse-to-patient ratio in medical/surgical care units shall be 1:5 or fewer at all times. A medical/surgical unit is a unit with beds classified as medical/surgical in which patients, who require less care than that which is available in intensive care units, step-down units, or specialty care units receive 24-hour inpatient general medical services, post-surgical services, or both general medical and post-surgical services. These units may include mixed patient populations of diverse diagnoses and diverse age groups who require care appropriate to a medical/surgical unit.
(12) The licensed nurse-to-patient ratio in a specialty care unit shall be 1:5 or fewer at all times. Commencing January 1, 2008, the licensed nurse-to-patient ratio in a specialty care unit shall be 1:4 or fewer at all times. A specialty care unit is defined as a unit which is organized, operated, and maintained to provide care for a specific medical condition or a specific patient population. Services provided in these units are more specialized to meet the needs of patients with the specific condition or disease process than that which is required on medical/surgical units, and is not otherwise covered by subdivision (a).
Furthermore, Title 22 of the California Code of Regulations, Section 70217(b) requires that hospitals staff according to patient acuity in order to meet the needs of the patients.
Hospital policy and procedure changes should be made to reflect the requirements of these regulations.
The California Department of Public Health appreciates your continued support and cooperation for ensuring that the health and safety of these patients are met.
Original Signed by Kathleen Billingsley, R.N.
Kathleen Billingsley, R.N.