California’s proposed nurse-to-patient ratio regulations for psychiatric hospitals could cost more than $145.2 million statewide, including $107.7 million for salaries and benefits and $37.5 million for recruitment, training and onboarding costs, according to a March 6 letter from the California Hospital Association to state officials.
Regulators have proposed emergency regulations but the state delayed the initial Jan. 31 implementation date following pushback from the public and hospitals. It now expects to adopt staffing regulations by June 1, according to a letter from the California Department of Public Health, with permanent regulations expected by July 31, 2027.
The proposed emergency regulations would require psychiatric hospitals to staff one licensed nurse for every six adult patients and one licensed nurse for every five adolescent patients. At least 50% of nurses counted toward staffing ratios must be registered and be awake and on duty in the hospital.
Leaders and advocates warn the streamlined process will significantly affect hospital staffing, cost and inpatient capacity across the state.
Here are six things to know:
- Twenty-five acute psychiatric hospitals representing 40% of California’s inpatient psychiatric capacity report they would need to hire 910 full-time staff to comply with the proposed ratios by June 1, 2026.
- The projected hiring need includes 585 registered nurses, 210 licensed vocational nurses and 115 licensed psychiatric technicians, according to CHA’s survey of hospitals.
- About half of the hospitals affected are in counties designated as registered nurse or licensed vocational nurse shortage areas, and only 16% of hospitals are “very likely” to meet the staffing requirements by June 1, 2026.
- Because the draft regulations do not allow mental health technicians to count toward staffing ratios, more than 760 technicians could be at risk of losing their jobs, CHA said.
- California already faces a 2,000-bed shortage of acute psychiatric capacity, and CHA said the regulations could lead some hospitals to close beds if they cannot meet staffing requirements.
- Violations would carry fines of $15,000 for the first infraction, $30,000 for the second and each subsequent infraction.
