progressively higher ratios found on the evening and night shifts compared with the day shift. The number of patients reported by individual nurses as being assigned to them was identical to the average number of patients assigned to nurses as calculated by dividing the total number of patients on the unit by the total number of RNs on the unit (Sochalski, 2001). The higher patient loads reported by the Pennsylvania nurses may be due in part to higher nurse staffing levels in California. AHA data show that California has higher average and median RN hours per adjusted patient day than the nation as a whole. California is ranked 19th among states in median RN and LPN/LVN hppd (Spetz et al., 2000).

Other hospital units Publicly reported data on nurse staffing in other hospital units are scarce. Information on staffing levels in transition (step-down) units is available from the CalNOC data presented above. Additional information on step-down unit and other inpatient unit staffing comes from California OSHPD data. OSHPD data for 1998–1999 indicate the nurse-to-patient ratios shown in Table 5-6, derived from hospital reports of RN hppd across all shifts and based on the assumption that an average patient day is 24 hours in length. OSHPD data also revealed that rural hospitals had higher staffing levels than urban hospitals (Spetz et al., 2000).

Nurse staffing levels in nursing homes also are typically reported in terms of hprd. They are calculated by dividing the total nursing hours worked in the facility by the total resident days of care per year. Although staffing levels vary widely across facilities, since 1997 the average nursing