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CE Home Study Course Collective Patient Advocacy Trailblazers, Part 2 The Road to Ratios This home study is part two of a two-part continuing education series. The ���rst installment appeared in the September 2012 issue of National Nurse and is required reading for successful completion of this home study course. You can also ���nd the ���rst part online through the ���media��� and ���nurse magazine��� links at www.nationalnursesunited.org. P art i examined the impact of healthcare restructuring on safe patient care standards, which prompted the historic enactment of the California Nurses Association (CNA)-sponsored legislation, AB 394 (Kuehl). Known as the California Safe Staf���ng Law, it established ���rst-in-the nation minimum, speci���c, and numerical direct-care registered nurse-to-patient staf���ng ratios by clinical unit for acute-care hospitals. This landmark law has set the stage for the introduction of two pieces of legislation by National Nurses United to improve and expand nursing care and patient protection standards at the federal level: HR 2187 (Schakowsky), Nurse Staf���ng Standards for Patient Safety and Quality Care Act, and SB 992 (Boxer), the United States Nursing Shortage Reform and Patient Advocacy Act. Part II continues with a discussion of legislative intent to establish clearly de���ned, legally protected and enforceable ratios, duties, and rights of all direct-care RNs to act as patient advocates in the exclusive interests of patients. Description This CE course examines selected national and international roots of direct-care nurses��� historic struggle to achieve autonomous control of their working conditions, education, licensure, and professional practice standards. Protecting and promoting the legacy passed on to us by pioneering nurse activists is our responsibility in order to safeguard the future of the nursing profession. The ability of direct-care registered nurses to assure the best achievable patient outcomes should not be subordinate to the healthcare industry���s for-pro���t business enterprise. RNs will learn the background, development, and implementation of important healthcare laws, including landmark safe staf���ng legislation that is evidencebased on speci���c numerical nurse-to-patient ratios. RNs will learn about their rights to collectively pursue enforcement strategies to ensure facility compliance with legal requirements to increase staf���ng 22 N AT I O N A L N U R S E based on explicit and transparent indicators which include patient acuity and severity of illness. RNs will learn the rationale and importance of protecting their rights to form and join a strong, all-RN professional and labor organization for the purposes of collective bargaining over wages, hours, and working conditions���rights protected by current federal law. RNs will gain an appreciation of the historic signi���cance and importance of professional union representation to protect their license and advance their professional interests as community advocates. This protection is imperative when RNs exercise their duty to take action, as circumstances require, to prevent injury or harm to patients when patient needs or wishes for treatment and care are not respected or provided, due to short-staf���ng or an early discharge to achieve a market-driven length-of-stay goal. RNs have a duty to act to change administrative policies that are not congruent with their professional values, ethics, education, and experience, and engage in legislative advocacy to protect their ability to provide safe, therapeutic, and effective patient care. Objectives: Upon completion of this home study RNs will be able to: ��� List four workplace hazards identi���ed by the Occupational Safety and Health Administration that can be mitigated by the implementation of safe staf���ng ratios ��� Describe the essential principals of safe staf���ng and other RN and patient protections included in the National Nursing Shortage Reform and Patient Advocacy Act/Nurse Staf���ng Standards for Patient Safety and Submitted by the Joint Quality Care Act (S 992 /HR 2187). Nursing Practice ��� Compare and contrast evidence-based patient Commission, DeAnn and nurse outcomes between California and outMcEwen, RN, and comes in other states without current ratio legislaHedy Dumpel, RN, JD tion, including Pennsylvania and New Jersey Provider Approved ��� Name two factors identi���ed by the Institute of by the California Medicine that increase the risk of nursing errors Board of Registered ��� Identify and describe two advocacy actions RNs Nursing, Provider can take to reduce the risk of patient harm and poor #00754 for 5.0 contact hours (cehs). outcomes Recognized by all states with the excepKey Components of the California tion of Arkansas, Nurse-to-Patient Ratio Law Delaware, MassachuBackground: The Impact of Healthcare Restructursetts, Montana, North Carolina, and ing on Safe Patient Care and Staf���ng Standards South Carolina. In the beginning of the 1990s, hospitals, in response to managed care, began to restructure, W W W. N A T I O N A L N U R S E S U N I T E D . O R G NOVEMBER 2012