Issue link: https://nnumagazine.uberflip.com/i/117852
merge, and consolidate in a very rapid fashion. They also redesigned and recon���gured staf���ng patterns. Reports of hiring freezes and layoffs of RNs in hospitals led to increasing concerns among California RNs about the threats to safe, therapeutic, and effective patient care in hospitals. Hospitals were implementing a variety of nursing care delivery models involving major down-substitutions, reducing the proportion of RNs to other nursing personnel by replacing them with lesser-trained and, at times, untrained and lower-salaried personnel at a time when the increasing complexity and acuity of hospital patient care caseloads called for more skilled nursing care provided by registered nurses. As a result, patient care staf���ng standards sharply deteriorated in hospitals. Patients and RNs experienced these negative effects every day. The key reasons for RN dissatisfaction were ���excessive workload��� and ���oppressive working conditions.��� Hospitals hired consulting ���rms who were paid hundreds of millions of dollars to implement ���work redesign models.��� Although NOVEMBER 2012 based on a manufacturing model, these schemes carried names such as ���patientfocused care��� or ���patient-centered care.��� The emphasis was on fragmenting the nursing process into a series of ���tasks��� and shifting registered nurses away from handson care to serve as ���team leaders��� of licensed and unlicensed assistive personnel (UAPs) who would be either assigned to the patient or perform the tasks. Studies have shown that there are a substantial number of injuries to patients due to treatment mistakes and other errors resulting from substandard care. The removal of the RN as a safety net from the bedside has compounded the problems since landmark studies have identi���ed RNs as the major interceptors of errors. Safe Staf���ng Legislation: After extensive and aggressive lobbying California Nurses Association RN leaders with Gov. Gray Davis in 1999 on the day he signed AB 394, the bill that established the country���s first RN-to-patient staffing ratios. W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 23