BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
360 (Yee)
Hearing Date: 5/11/2009 Amended: 4/23/2009
Consultant: Katie Johnson Policy Vote: Health 7-4
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BILL SUMMARY: SB 360 would require hospitals to ensure that all
direct care registered nurses receive and complete an
orientation of a minimum of five standard shifts where the
orientee would be observed by an experienced direct care nurse,
as specified, prior to being counted toward the hospital's
established nurse-to-patient ratio.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
CDCR nurse up to $100 up to $200 up
to $200 General
observation costs
Increased UC medical See Staff Comments
center and other
hospitals' costs
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STAFF COMMENTS: This bill meets the criteria for referral to
the Suspense File.
Existing law provides for the licensure and regulation of health
facilities, including hospitals, by the California Department of
Public Health (CDPH) and requires the CDPH to establish minimum
hospital nurse-to-patient ratios by licensed nurse
classification and by hospital unit. Existing law requires
specified hospitals to adopt written procedures for training and
orientation of nursing staff which would prohibit a registered
nurse from being assigned to a nursing unit until that nurse has
received the specified orientation and demonstrated sufficient
competency. The CDPH does not anticipate any workload increase
as a result of the passage of this bill.
This bill would require each general acute care hospital, acute
psychiatric hospital, and special hospital to ensure that all
direct care registered nurses, including new hires, casual, per
diem, temporary agency, registry and traveler staff, receive and
complete orientation to the unit to which they would be
assigned. This bill would require these health facilities to
adopt written policies for the training and orientation of
nursing staff.
This bill would provide that current competency may only be
demonstrated and validated by the direct observation of the
orientee by another direct care registered nurse who has
previously demonstrated current competency. This bill would
require that an observing nurse directly observe the orientee
for a minimum of five standard nursing shifts. This bill would
prohibit an orientee from being included in the calculation of
the licensed nurse-to-patient ratio. This bill would define
"orientee" as a direct care registered nurse who has not
received and completed orientation to the hospital and patient
care unit or clinical area to which he or she would be assigned
and whose
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SB 360 (Yee)
current competency has not been demonstrated and validated. This
bill would exempt a state inpatient mental health hospital, a
state developmental center, and a state veterans' home from the
provisions of this bill.
It is estimated that the California Department of Corrections
and Rehabilitation (CDCR) would need annual General Funds of up
to $200,000 to provide these observation services for its two
acute care hospitals which are staffed by approximately 300
nurses.
This bill would increase the cost of providing health care to
Californians and would, as such, put unknown, but potentially
significant pressure on the General Fund and federal funds which
provide funding for the Medi-Cal program in hospitals. The
Medi-Cal program offers comprehensive coverage to low-income
individuals. The University of California operates five medical
centers and estimates an increased cost of approximately $3.1
million system-wide. There would also be increased costs to all
California hospitals on the order of $40 to 80 million
system-wide.
This bill is substantially similar to SB 1721 (Yee) of 2008,
which was held on the Assembly Appropriations Committee suspense
file.