In 1999, California passed legislation mandating patient-to-nurse ratios for its hospitals, which goes into effect in July 2003. The California legislation was motivated by an increasing hospital nursing shortage and the perception that lower nurse retention in hospital practice was related to burdensome workloads and high levels of job-related burnout and job dissatisfaction. Stakeholder groups advocated widely divergent minimum ratios. On medical and surgical units, recommended ratios ranged from 3 to 10 patients for each nurse. In early 2002, California's governor announced that hospitals must have at least 1 licensed nurse for every 6 medical and surgical patients by July 2003, a ratio that will move to 1 to 5 when the mandates are fully implemented.