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

In 1999, California passed the first legislation in the United States to es tablish minimum staffing levels in hospitals for registered nurses (RNs) an d licensed vocational nurses. The author provides estimates of the increase s in RN expenditures required by this mandate, by hospital size and for reg ions of California. Issues related to the implementation of minimum ratios also are discussed. Attention must be paid to other staffing regulations, s pecial concerns of rural hospitals, the possibility that minimum ratios res ult in lower RN staffing, and the effect of the nursing shortage on the abi lity of hospitals to meet requirements.