California nurses are celebrating today, June 1, the historic implementation of long-awaited safe nurse-to-patient staffing ratios in the state’s acute psychiatric hospitals (APH) that should dramatically improve the care behavioral health patients receive and that RNs can provide. The state only established these emergency regulations after California Nurses Association (CNA) pressured the governor and the California Department of Public Health (CDPH) to do so. 

“We know from more than two decades of experience with mandatory, minimum RN-to-patient staffing ratios in general hospitals that ratios not only improve care and save lives, but better safety and working conditions for nurses to keep us at the bedside,” said Cathy Kennedy, RN and president of CNA. “All patients deserve a high quality of care and it’s about time the state set safe staffing rules for psych hospitals as we nurses originally intended when we passed this law.”

Though mandatory minimum safe registered nurse-to-patient staffing ratios for acute psychiatric hospitals were mandated by the seminal safe staffing legislation California Nurses Association sponsored and fought to pass in 1999, A.B. 394 (Kuehl), the state failed for over two decades to follow up with regulations for acute psychiatric hospitals after they rolled out ratios for general acute-care hospitals in 2004. After a San Francisco Chronicle investigation exposed staffing problems at acute psychiatric hospitals last year, CNA demanded that the state establish these long-promised regulations for such facilities.

In the face of intense lobbying by the profit-driven corporate hospital industry to adopt weak regulations, the current emergency regulations represent a significant correction upon earlier versions. Due to nurses’ strong advocacy through public comments, testimony, and direct action, CDPH closed up major loopholes that would have not only let acute psychiatric hospitals evade meaningful staffing ratios, but also have undermined the existing RN-to-patient standards in general acute-care hospitals.

Thanks to nurse advocacy, the regulations set to go into effect today:

• Removed language that would have allowed one registered nurse to be responsible for up to 24 patients during a 12-hour shift or up to 16 patients during an 8-hour shift.
• Prohibit the averaging of staffing ratios across any shift or time period.
• Do not adopt dangerous night shift ratios.
• Prohibit nurse administrators and supervisors from counting towards the ratios if they have non-direct care responsibilities.
• Mandate that the numerical ratios represent the maximum number of patients an RN can be assigned at one time.

CNA nurses know that they must remain vigilant during the permanent rulemaking process to prevent industry pressure from weakening these staffing standards and to make even further improvements to these regulations, including language to clarify that the ratios are registered nurse-to-patient ratios; to set ratios at one RN for no more than four pediatric patients; to stop layoffs of ancillary staff in implementing the rule; and to hold in-person public hearings to hear from nurses and patients across the state before final rules are adopted.

Hospitalized patients deserve the same standard of care no matter what kind of facility they are in, so establishing effective, meaningful registered nurse-to-patient staffing ratios for acute psychiatric hospitals that are the same as the safe staffing protections for patients in general acute-care hospitals is critical. All patients deserve the same high-standard of patient care.

California Nurses Association/National Nurses United is the largest and fastest-growing union and professional association of registered nurses in the nation with more than 100,000 members in more than 200 facilities throughout California and more than 225,000 RNs nationwide.