What should we expect from California's minimum nurse staffing legislation?

In 1999, California passed the first legislation in the United States to establish minimum staffing levels in hospitals for registered nurses (RNs) and licensed vocational nurses. The author provides estimates of the increase in RN expenditures required by this mandate, by hospital size and for regions of California. Issues related to the implementation of minimum ratios also are discussed. Attention must be paid to other staffing regulations, special concerns of rural hospitals, the possibility that minimum ratios result in lower RN staffing, and the effect of the nursing shortage on the ability of hospitals to meet requirements.