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RN Safe Staffing Ratios – Saving Lives

The CNA/NNU national and state-specific safe staffing bills are all modeled on the standards set by legislation in California.

Thanks to CNA/NNU-organized RNs, staffing ratios have been in effect in California since 2004, bringing RNs back to the bedside by the thousands and dramatically improving staffing. It took many years, and nurses had to challenge a very popular governor along the way to defend the ratios, but CNA/NNU prevailed and is now actively working to pass a comprehensive national bill, the National Nursing Shortage Reform and Patient Advocacy Act, S. 1031, sponsored by U.S. Sen. Barbara Boxer (D-CA) and a similar bill in the U.S. House of Representatives, H.R. 2273, sponsored by Rep.­ Jan Schakowsky. CNA/NNU is also working with RNs in states all across the nation to adopt state-specific legislation entitled Hospital Patient Protection Acts.

None of the dire warnings from the hospital industry about the effects of ratios have come to pass. There has been no rise of hospital closures as a result of ratios, California hospitals are financially sound, and in the many years since the law was signed, California has increased the number of actively licensed RNs by more than 120,000 RNs — tripling the average annual increase prior to its enactment.

Now the scientific evidence is in too. A study led by the nation’s most prestigious nurse researcher, Linda Aiken, RN, Ph.D., at the University of Pennsylvania School of Nursing, provides unassailable evidence: The law reduces patient deaths and assures nurses more time to spend with patients.

Examining patient outcomes and surveying 22,000 RNs in California, Pennsylvania, and New Jersey, the research found:

  • New Jersey hospitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California's ratios in post-surgical units.
  • Fewer California RNs miss changes in patient conditions because of their workload.
  • California RNs are far less likely to report burnout and leave than New Jersey or Pennsylvania nurses.

Safe Staffing Ratio Laws — More than Just the Numbers

Both California’s A.B. 394 and the federal bills, S. 1031 and H.R. 2273, have multiple provisions designed to remedy unsafe staffing in acute-care facilities.

  • Mandates minimum, specific, numerical ratios for each unit to apply at all times including break coverage.
  • Requires a patient classification system: additional RNs added based on patient needs.
  • Assure RNs the legal guarantee to serve as patient advocates.
  • Prohibits use of mandatory overtime.
  • No lay-offs of ancillary staff as a result of the ratios.
  • Regulates use of unlicensed staff.
  • Restricts unsafe floating of nursing staff.
  • Whistle-blowing protection for caregivers who report unsafe practices.
  • LVNs/LPNs are not in the ratio count and are assistive to the RN.
  • Federal assistance for the purchase of safe patient handling equipment.

Ratios