California Safe Staffing Ratios

Nurses hold signs calling for safe staffing

Decades of research have documented how safe staffing reduces patient mortality, re-admission to the hospital post discharge, and recovery. Currently, California is the only state to enact an enforceable RN-to-patient staffing law, thanks to the determined, multi-year efforts of members of the California Nurses Association. Ratios, coupled with nurses’ powerful voice of advocacy, protect our patients from complications that arise from missed care such as medical errors, health care disparities, infections, and so much more. Read more ».

California RN-to-Patient Safe Staffing Ratios graph

What does the California ratios law actually require?

A.B. 394, the CNA-sponsored safe staffing law, has multiple provisions designed to remedy unsafe staffing in acute-care facilities. California’s safe staffing standards are based on individual patient acuity, of which the RN ratios is the minimum.

Crowd outside of CA capitol holding signs calling for safe staffing ratios

Learning from the California experience

In 1999, the registered nurses of the California Nurses Association successfully sponsored and lobbied the California Legislature to pass A.B. 394, the historic bill that made minimum, specific numerical staffing ratios the golden standard in the Golden State.


Group of nurses inside hopsital hold signs "Safe Staffing Saves Lives"

The science of ratios

Decades of studies have shown that more nurses equate to lives saved and fewer complications. Researchers have been focusing on what exactly is the mediating link between increasing RN staffing and improved outcomes.

Nurses inside hospital hold signs "Staff Up for Safe Care"

RN Staffing Ratios: A Necessary Solution to the Patient Safety Crisis in U.S. Hospitals

NNU/CNA’s proposal for minimum, mandated, nurse-to-patient staffing ratios protects our patients’ right to nursing care. Read our booklet to learn more.

Protecting and Retaining California’s Nursing Workforce

There is no shortage of registered nurses in California; rather there is a shortage of nurses willing to work in unsafe environments. Read our whitepaper to learn more.

Protecting Our Front Line: Ending the Shortage of Good Nursing Jobs and the Industry-created Unsafe Staffing Crisis

In this report, National Nurses United describes how the hospital industry has driven registered nurses from the bedside.

RN Staffing Ratios Whitepaper

Learn more by reading NNU's staffing ratios whitepaper.


Safe staffing ratios protect patients and nurses

Safe RN ratios have been proven to improve the quality of care and nurse recruitment and retention in California hospitals.

California Nurses Association organized—and won safe staffing ratios

California’s historic first-in-the-nation safe staffing ratios took 13 years to win and have been in effect since January 2004 despite continued efforts of the hospital industry to overturn the law.

Safe staffing ratios help nurses address disparities in health care

Studies show that staffing ratios save lives, yet understaffing is a major issue RNs struggle with every day. Together, we can change that.

Press releases

Registered nurses at Dignity Health’s Bakersfield Memorial Hospital will hold an informational picket on Thursday, May 2, to stand in solidarity against the hospital administration’s refusal to address RNs’ serious patient care concerns.
Registered nurses at Antelope Valley Medical Center in Lancaster, Calif., will hold a rally on Thursday, Jan. 4 to highlight their patient safety concerns, including chronic short-staffing, management’s failure to meet California’s mandatory minimum RN-to-patient ratios, and retaliation against RNs advocating for safe patient care.
Seton Medical Center (Seton) nurses in Daly City, Calif. will hold an informational picket on Dec. 12, 2023 to protest their employer’s drastic health care cuts, among other actions, that could exacerbate the hospital’s persistent recruitment and retention issues.
Registered nurses at MarinHealth Medical Center in Greenbrae, Calif. gave notice to their employer that they will hold a one-day strike to protest the administration’s refusal to address RNs’ deep concerns about patient care, safe staffing, and retention and recruitment of nurses.