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Did you know that California law sets nurse-to-patient ratio requirements for hospitals?

January 10, 2018

Title 22 Enforcement

SEIU led the way in establishing these minimum staffing levels, starting when SEIU nurses at San Francisco General Hospital negotiated contract provisions in 1983 to maintain safe staffing practices.

And we just led the way again with our new law to ENFORCE those ratios. Read more here.

As registered nurses, it's our responsibility to protect our patients and our license by following California's Title 22 regulations.

This isn't always easy. Many hospitals routinely try to cut expenses by decreasing staff and not following state-mandated nurse-to-patient ratios. Nurse-to-patient ratios must be followed at all times. There are no exceptions, not even for breaks and lunches.

And according to Title 22, “Nurse Administrators, Nurse Supervisors, Nurse Managers, and Charge Nurses, and other licensed nurses shall be included in the calculation of the licensed nurse-to-patient ratio only when those licensed nurses are engaged in providing direct patient care. When a Nurse Administrator, Nurse Supervisor, Nurse Manager, Charge Nurse or other licensed nurse is engaged in activities other than direct patient care, that nurse shall not be included in the ratio.”

Here are the ratios required by the State of California

Hospital UnitNurse:Patient Ratios

Intensive Care:

Critical Care/ICU1:2 (or fewer)
Neonatal ICU 1:2
Continuing Care 1:4


 Labor & Delivery 1:2 (active labor)
 Antepartum 1:4 (non active labor)
 Postpartum 1:6 (mothers)
 Couplet Care 1:4 (couplets)
 Well-Baby Nursery 1:8

 Emergency (ER):

 Trauma 1:1
 Critical Care 1:2
 Visits 1:4 + triage nurse

 Hospital Services:

 Medical / Surgical 1:5
 Operating Room 1:1
 Pediatrics 1:4
 Postanesthesia 1:2
Psychiatry 1:6
Specialty (e.g. Oncology) 1:4 or fewer
Step-down 1:3
Telemetry 1:4

Have you been asked to take an illegal, out-of-ratio assignment?

If your supervisor asks you to go out of the ratios indicated in the chart above, click here to follow the instructions on our flow chart.

And click here to check out our guide on how to report incidents at your hospital.