Nursing & Healthcare News
New Staffing Ratios for Psychiatric Hospitals
Nurses applaud CDPH for “doing the right thing”
Closing a Gap
More than 20 years ago, California became the first state in the nation to mandate minimum nurse-to-patient staffing levels. However, the California Department of Public Health (CDPH) staffing regulations left a gap when it came to psychiatric care.
The minimum staffing ratios applied to psychiatric units in general acute-care hospitals, and to state-run psychiatric hospitals. However, those regulations didn’t apply to freestanding acute psychiatric hospitals (APH) not run by the state.
Until now, those facilities were allowed to determine staffing requirements based on their assessment of patient needs.
That has now changed. New CDPH emergency regulations, which took effect on June 1, 2026, now require APHs to maintain minimum ratios of licensed nursing staff to patients of 1:6 for adult patients and 1:5 for patients under 18. Hospitals that fail to comply can face substantial financial penalties.
More RN Staffing
Many APHs have previously delegated routine patient care tasks to unlicensed mental health technicians, who are paid much less than RNs. Under the emergency regulations, only licensed staff count toward the nursing ratio requirements, and at least half those staff must be registered nurses.
In its Finding of Emergency, CDPH declared, “The failure to provide sufficient licensed nursing staff places patients at risk for being cared for in unsafe environments and adverse events have occurred as a result.”
Investigations by the San Francisco Chronicle have alleged chronic understaffing, patient assaults, neglect, and preventable deaths at some APHs. CDPH says it has cited APHs for “at least” 17 patient deaths.
Further Reforms
The emergency regulations include several reforms frontline nurses had sought.
APHs are no longer allowed to average staffing across multiple shifts. Nurse managers with non-direct-care responsibilities generally cannot be counted toward the staffing ratios. The rules also establish clearer expectations for staffing plans and accountability, and require APHs to ensure that temporary staff are properly oriented to the unit before providing direct patient care.
Enough, Too Much, or Too Little?
During the public comment period, hundreds of nurses signed a statement applauding CDPH for “finally doing the right thing.”
The San Francisco Chronicle notes that the new staffing requirements bring the requirements for APHs closer to the rules for general hospital psychiatric units, which the paper’s investigations have found to have “far fewer serious safety violations than for-profit psychiatric hospitals.”
However, the California Hospital Association (CHA) strongly opposes the new staffing requirements, which CHA insists will worsen shortfalls in acute psychiatric capacity by causing hospitals to close beds rather than risk fines.
National Nurses United (NNU) is concerned that the new rules don’t go far enough. By allowing APHs to meet half their ratio requirements with LVNs and licensed psychiatric technicians rather than RNs, NNU says the emergency regulations set “an inferior standard.”
The emergency regulations will be in effect for 180 days, and will likely be replaced by similar permanent regulations. You can read the full text on the CDPH website.
LUCY FIGUEROA, RN, DNP, is a California-based nurse with experience in acute care and healthcare policy. She writes about the evolving challenges facing today’s nurses.
In this Article: Legislation and Public Policy, Nursing Workforce
