New Nurse Staffing Ratios Have Full CHOC Support
Message from Tom Brotherton, Executive Vice President and Chief Operating Officer

On January 1, California became the first state in the country to implement a law requiring very specific nurse-to-patient ratios for every unit of a hospital. At CHOC, the now-required 1:4 staffing ratio on our medical/surgical floor has been in place since 2002.

CHOC proactively increased nurse staffing well in advance of this deadline because we knew it would result in better care for our patients. Additionally, two CHOC nurses helped develop the statement of principles on nurse ratios recently adopted by the California Children's Hospital Association Executive Nurses (CCHAEN). Even though we have prepared and intend to comply with the staffing ratios, continuing to meet the requirements still presents challenges. As our commitment:

• We intend to address in a safe and rational manner the implementation of nurse staffing ratios for our pediatric patients.
• We intend to comply with the legislation.
• We intend to proactively prepare for the anticipated demands on the resources of our organizations. Given that, there will be unanticipated demands on our organizations that will frequently cause challenges in meeting the nurse ratio requirements. When that situation exists, we will make every reasonable effort to get back within the requirements as soon as possible.
• We often care for the most seriously ill and injured children in the state, a unique and vulnerable patient population, whereby resources for diverting care to other organizations is limited and such diversion could potentially lead to a negative health outcome for the child. As a result, we anticipate that children's hospitals will face unique challenges in juggling compliance with the nurse ratios. Whereas other organizations may be able to divert to open community hospital beds, relatively few such options exist for children's hospitals. Despite this reality, we will remain committed to utilizing all possible resources to ensure appropriate nurse staffing to manage this responsibility.

We encourage comments or questions about nurse ratios. Please feel free to contact my office at 714-532-8822 or tbrotherton@choc.org.