Has California returned to its pre-pandemic hospital baseline?

The hospitals we could compare reported more employee RN hours and more patient care in 2024. They also reported substantially more registry nursing hours.

The finding: staffing changed, and registry use remained well above the pre-pandemic baseline.

207 matched hospital reporting units · Annual periods ending in 2019 and 2024 · Updated October 15, 2026

The numbers

Hospital-employed RN hours

+10.3%

2019 baseline: 126,451,017
2024 comparison: 139,485,464

More employee RN hours were reported than before the pandemic.

Days patients spent in hospital

+7.2%

2019 baseline: 9,791,498
2024 comparison: 10,500,950

Hospitals provided more inpatient days of care.

Outpatient visits

+14.6%

2019 baseline: 27,445,847
2024 comparison: 31,456,342

Outpatient activity grew faster than inpatient days.

Registry / agency nursing hours

+61.3%

2019 baseline: 7,978,714
2024 comparison: 12,871,546

Registry hours grew much faster than employee RN hours.

What this tells us

Employee RN hours were above baseline. The total increased 10.3% across these same reporting units.
The work also increased. Inpatient days rose 7.2%, and outpatient visits rose 14.6%. The extra RN hours had more activity to cover.
Registry staffing remained substantially higher. Registry hours rose 61.3%, or 50.4% when measured against inpatient days.

Did employee RN hours keep pace with the work?

Using inpatient days

+2.9%

Employee RN hours per inpatient day increased.

Using an estimate of inpatient and outpatient activity

-2.9%

Employee RN hours per revenue-adjusted day decreased.

The workload measure changes the answer. More total RN hours do not, by themselves, establish that staffing kept pace with all hospital work.

Has California as a whole recovered? These records do not establish that. They show how staffing and workload changed in the hospitals we could match.

Hospital results

Registry nursing hours

1,978 → 2,477
+25.2%

Download the full data →

Definitions, limitations and sources

What the measures mean

Employee RN hours: productive hours reported for hospital-employed RNs throughout the hospital, including work outside inpatient wards. This is not bedside RN hours per patient day or a shift-level nurse-to-patient ratio.

Inpatient days: the sum of days patients spent in the hospital. This is not a count of unique patients. Outpatient visits: reported outpatient encounters, also not unique people.

Registry nursing: the source category may include RNs, LVNs, and aides/orderlies. It does not identify travelers or RNs separately.

Revenue-adjusted days: inpatient days × total gross patient revenue ÷ gross inpatient revenue. This estimates combined inpatient/outpatient activity through revenue proportions. Charge structures and service mix affect it. It does not adjust for patient acuity or establish a staffing deficit.

Aggregate ratios use summed hours divided by summed days. Hospital counts compare each unit separately. Calculations use unrounded values.

Which hospitals and years are included?

The 207 audited reporting units span 44 counties. They account for 59.6% of patient days reported by unique Comparable rows in the retained 2024 selected file. This is coverage of source-file records, not the share of every California hospital, physical campus or actual calendar-year day.

Each pair uses a unique exact HCAI ID, unchanged reported name/county/city, full annual periods, matching start/end month and day, audited Comparable filings, valid labor data, reconciled patient days, stable nonzero and dominant care categories, and no existing CNO source/scope hold.

HCAI groups files by the year reports end. A July 2018–June 2019 baseline is compared with July 2023–June 2024. All baseline periods end before the pandemic. These are annual endpoints, not a recovery trajectory or a description of conditions in 2026.

07-01–06-30: 98 units
01-01–12-31: 91 units
10-01–09-30: 12 units
09-01–08-31: 5 units
04-01–03-31: 1 units

Kaiser and other Non-Comparable reporting types are excluded. Missing reports, partial years, changed identities and care categories can prevent matching. The checks do not resolve every reporting-boundary or within-category care-mix change. Hospitals that closed and services that disappeared require a separate access/capacity analysis.

Other checks and the earlier 91-unit result

The original 91-unit January–December subset showed a 1.6% fall in employee RN hours per inpatient day. Adding matching fiscal-year reporters expands the audited group to 207 and reverses that aggregate direction. Both findings describe their respective groups.

In the 151-unit majority-acute subset, employee RN hours per inpatient day rose +2.2%; hours per revenue-adjusted day fell 3.9%.

62 otherwise-matched units with 2024 filings marked In Process are retained separately. Their totals are not included in the audited headline figures.

Other audited measures: average staffed beds, 28,449 → 30,108 (+5.8%); discharges, 1,696,346 → 1,673,155 (-1.4%).

Original calendar-only records →

Sources and reproducible calculations

Reports ending in 2019: Official HCAI source · Preserved spreadsheet

Reports ending in 2024: Official HCAI source · Preserved spreadsheet

HCAI field documentation · Preserved copy. PRD_HR_RN supplies employee RN hours; CNT_HR_RN supplies registry nursing hours. BED_STF is average staffed beds.

GAO registry category explanation · Preserved GAO report.

HCAI reporting-period description · Federal explanation of adjusted days.

Raw pairs, exact dates, source rows, exclusions and file hashes →

Reproduction: scripts/assess-pandemic-baseline.py.