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Ratios:4 3/18/09 4:09 PM Page 11 Before California sta≈ng ratios took effect registered nurse Colleen Sichley used to perform a small ritual in her car before the start of each shift. She would turn off the engine, take a deep breath, collect herself, close her eyes, and start to pray. "Please, please help me to make sure that all these people make it out alive," she'd think. Sichley later discovered that too many of her colleagues did the same thing. "We were afraid to go to work," she said, recalling that in those days, when she worked as a geriatric RN, she would sometimes care for 16 patients with just the help of one licensed vocational nurse and one technician. "I would pick and choose which patients were the worst off and whom I'd spend time with. When we would leave in the morning, you would see nurses crying on their way out to their car." It's hard to believe this was a common scenario just five years ago. While there will always be room for improvement in hospital staffing, California's landmark RN-to-patient ratio laws have transformed floors and units across the state into much safer and better places to work by limiting the number of patients that can be assigned to one RN. Where RNs used to care for nine, 10, or even more patients on a general medical-surgical floor, state law now says they can be responsible for no more than five, and the limits are even lower for other units. RN-topatient ratios have also brought registered nurses back to the bedside. Data from the California Board of Registered Nursing shows that the number of RNs actively licensed to work in the state has grown by nearly 100,000 since the law was signed in 1999. Even patients are now BERS MARCH 2009 W W W. C A L N U R S E S . O R G REGISTERED NURSE 11