California’s Nurse-Patient Ratio Law Saves Lives, Reduces Nursing Shortage

Zenei Cortez, a registered nurse in California and member of the Council of Presidents of the California Nurses Association/National Nurses Organizing Committee, describes how her union helped in the battle to win safe staffing. (The full version appears in the California Progress Report). United Nurses Association of California/AFSCME (UNAC/AFSCME) was part of that campaign, and as the union’s state secretary, Barbara Blake, RN, notes:

Every day, our members tell us about the difference these safer ratios are making in their patients’ lives. They clearly see the link between their political activism in 1998 and the improved quality of care they can deliver in 2008. This is a crystal-clear example of how vital nurses unions such as UNAC are in improving the lives of our patients and our communities.

Here’s a reason to celebrate the New Year—safer staffing in California hospitals, once again. As of Jan. 1, California’s historic staffing law for registered nurse staffing ratios, achieved through years of advocacy by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), completes its phase-in period.

Over the five-year course of their phase-in, these ratios have revolutionized hospital care and improved patient safety by mandating hospitals maintain minimum, specific nurse-to-patient staffing ratios for all hospital units at all times.

Ratios differ by hospital area, such as a minimum of no less than one RN for every five patients in general medical or post-surgical care units, 1-to-4 in pediatrics and 1-to-4 in emergency rooms. The ratios are a floor, not a ceiling, with hospitals also required to increase registered nurse staffing as needed based on individual patient illness or acuity.

Under our new ratio law, lives are being saved, our ability to be effective advocates for our patients is stronger and more RNs are entering the workforce and staying at the bedside longer, mitigating the nursing shortage.

Since the law was signed, 80,000 more licensed RNs have come into the state’s workforce. In contrast with the years before the law was signed in 1999, more RNs were entering the state than leaving, and more were staying at the bedside.

But because of their achievements, the ratios have sparked a brush fire around the country by nurses demanding similar laws in other states.

CNA/NNOC has sponsored similar proposed bills in Arizona, Illinois, Maine, Ohio and Texas, and is working with the Massachusetts Nurses Association on a proposed ratio law in their state. RNs across the nation have seen the future and the enormous benefits of this law. They know it works for patients, nurses and communities.

The ratio law was authored by current California state Sen. Sheila Kuehl and was signed in 1999 by then-Gov. Gray Davis.

CNA/NNOC sponsored the law, and we have had to fight long and hard against concerted efforts by the state’s wealthy hospital industry to kill it.

After campaigning to block it, the hospital lobby filed a lawsuit in December 2003 to repeal key portions of the law. The suit failed.

Then the hospitals persuaded Gov. Arnold Schwarzenegger (R) to issue an emergency regulation in November 2004 to overturn emergency room ratios and improved medical/surgical ratios.

In response, CNA/NNOC launched more than 100 protests against Schwarzenegger that also helped ignite a massive grassroots movement that led to the stinging defeat of four Schwarzenegger-ballot initiatives in a 2005 special election.

Subsequently, the Schwarzenegger administration dropped its fight against the law, and the California Department of Public Health has sent letters to hospitals notifying them of their obligation to meet the standards and improve the ratios as of Jan. 1. Additionally, the letter also reiterates that hospitals must increase staffing beyond the ratios if needed by patient acuity:

Hospitals must ensure that they are staffed to assure that the needs of the patients are met….Hospitals are reminded that the regulations only reflect the minimum standards for staffing.

Hospital industry efforts to overturn the law have failed due to their enormous popularity with patients and the public, support from legislators, validation from the courts and their demonstrated success in improving patient care.

Nurses who have experience with the ratio law praise its effects. Says Kathy Dennis, an RN, at Mercy General Hospital in Sacramento:

Finally we have the time to do proper nursing care and fully evaluate each patient’s needs. We now have the time to check each patient’s chart and make sure there are no treatment delays. And finally there is the time to do the patient and family teaching that is essential to avoiding future complications and hospitalizations.

According to Trande Phillips, RN, at Kaiser Permanente’s Walnut Creek Medical Center:

Before the ratios were enacted, we had complete turnover of our entire RN staff twice in three years.

We were always working short staffed and patients suffered. Now the only time nurses leave is if they are moving or going back to school.

With ratios, the days when a patient had to call 911 from their hospital bed to find the licensed, experienced, professional registered nurse they need are, hopefully, gone forever in California. It’s a reason for holiday cheer.

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