SACRAMENTO - California hospitals will be required to meet new nurse-to-patient staffing ratios starting at the end of this year, including strict requirements for burn and post-surgery patients, under regulations unveiled Tuesday by state health regulators.

The regulations stem from a 1999 law that made California the first in the nation to mandate nurse-to-patient ratios for hospitals. The Department of Health Services will take public comment on the regulations until July 17.

Nurses said the regulations, which will be phased in starting in 2004, are a sensible way to improve patient care and working conditions for nurses. But hospital officials say the ratios will worsen the state's current nursing shortage and warn it will cost hundreds of millions to implement.

``Hospitals are going to comply with them, but there could be unintended consequences of hospitals either turning away patients and complying with the ratios, or violating the ratios and providing patient care,'' said Jan Emerson, vice president of external affairs for the California Healthcare Association.

The health department estimates the new ratios will cost hospitals $422 million in 2004, $652 million in 2005, and more than $956 million in 2008, when all of the ratios have been put in place.

Currently, the state sets nurse-to-patient ratios for intensive and critical care units, operating rooms, nurseries and acute respiratory care wards. The new regulations will expand the required ratios to the rest of the hospital.

For burn, post-anesthesia care and labor and delivery units, the ratio will be one nurse to every two patients. For pediatrics, emergency rooms and ``step down'' wards -- the level of care between intensive care and a regular hospital room -- the ratio will be one to four.

Oncology and telemetry wards will have a one-to-five ratio, and medical-surgery units, psychiatric and mixed units will require a one-to-six ratio.

In 2008, the ratios for step-down units will change to a one-to-three ratio, telemetry to one to four, and medical-surgery and mixed units to one to five.

Though many nurses said the ratios are an improvement, they questioned why the health department would delay the lower ratios until 2008.

``It's a slight improvement, but we don't want to just improve a little bit; we want to save lives,'' said Ingela Dahlgren, a nurse at Northridge Hospital Medical Center. ``In the most important areas, we need safe staffing now, not in 2008.''

But some hospitals are alarmed the mandate for more nurses will come when the state is expected to have a shortage of 109,000 nurses, said Dorel Harms, of the California Healthcare Association.

``Statistics say that the nurse shortage is going to be more critical then than it is now,'' she said. ``We don't know where we're going to get the nurses.''

The state Employment Development Department estimates an additional 30,000 registered nurses will be needed in the next three years.