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technicians in addition to licensed vocational nurses and registered nurses. DHS/FSOR: The severity of psychiatric disorders varies in acuity. Psychiatric technicians, like LVNs, practice under the direction of a physician, psychologist, registered nurse, or other professional personnel, and are not independent practitioners. 14. Identifying a unit by a name or term other than those used in this subsection does not affect the requirement to staff at the ratios identi���ed for the level or type of care described in this subsection. DHS/FSOR: This provision was added to allow providers maximum ���exibility in the naming of their units. Some hospitals give units names that are perceived to be less troubling for patients and their families than the regulated unit names. For example, intensive care newborn nurseries may be named the ���Special Care Nursery,��� and an oncology unit may be called the ���Camellia Care Unit.��� This provision ensures that, while providers may use unit names that they believe will be best received by the population they serve, the use of those names does not affect nor avoid the requirement to comply with the staf���ng regulations that are based on the type of care provided, and not merely the name of the unit. As a direct-care registered nurse in a general, acute-care hospital, having comprehensive knowledge about the DHS ���ndings and reasons for adopting these speci���c minimum numerical nurse to patient ratios is imperative to your role as a patient advocate. These ratios constitute the minimum allowable at all times, and the law further requires that staf���ng must be ���exed up/augmented based on the individual acuity of your patient. CNA: RNs Waged Victorious Fight Against the Attack on the Ratios The California Nurses Association���s��historic ���rst-in-the-nation safe staf���ng RN ratios law took 12 years to win and it has been in effect since January 2004 despite continued efforts of the hospital industry and Governor Schwarzenegger to have it overturned or otherwise weakened. In 2003, the California Hospital Association ���led a lawsuit to stop the regulations, but it failed in court. (See ���Gimme a break!��� article on page 13) When Governor Schwarzenegger decided to roll back CNA���s staf���ng ratios and called nurses a ���special interest who don���t like me because I���m always kicking their butt,��� CNA ignited a broad, grassroots movement that led to a sweeping November 2005 electoral defeat for the governor���s special election initiatives.��(See ���The Nurses v. Schwarzenegger��� article) Two days after his initiatives lost at the polls, Schwarzenegger dropped his year-long ���ght against the ratios. Safe RN ratios have improved quality of care and nurse recruitment and retention in California hospitals. 28 N AT I O N A L N U R S E The Same Ratios Apply at all Times This requirement applies to all shifts, meals, breaks, and excused absences. This provision has been challenged in court by the California Hospital Association (CHA). As an interested party, having written and being the sponsor the legislation, CNA had a vested interest in the outcome of the lawsuit ���led by CHA against DHS and in order to aggressively defend the ���at all times��� requirement, CNA intervened in the lawsuit. (See ���Gimme a break!��� article on page 13). No Averaging There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. If You Build It, They Will Come One of the claims by the hospital industry in its attempts to block the introduction of ratios was that there were not enough nurses to ful���ll the staf���ng mandates of the ratio. California registered nurses knew differently; they had seen their colleagues leave, citing the heavy workload and stress as their reasons for doing so. Direct-care RNs were convinced that if ratios were mandated, that their colleagues would return to the acute-care hospital setting. In fact after the ratios were introduced, California increased the number of actively licensed RNs by more than 120,000 RNs��� tripling the average annual increase prior to its enactment. The total amount of RNs in California in April 2010 was 357,209 compared with 246,068 in 1999. This increase in numbers was seven times more than the total number state health of���cials said would be needed to ful���ll the ratios for general medical/surgical units. RNs who had let their licenses become inactive changed status to active, citing the ratios and attendant decreased workload as the primary reason for returning to the nursing workforce. Pre-ratio landscape According to the Joint Commission for Accreditation of Hospitals, ���Higher-acuity patients plus fewer nurses to care for them is a prescription for danger.��� This was the picture in California prior to ratios introduction. As acuity of patients and complexity of care increased during the 1990s, the hospital industry failed to increase the number of RNs in the acute-care setting. RNs, frustrated with the lack of support and respect from administration and burnt out with excessive workloads, were leaving the profession, citing overwork and the inability to provide the type of care they were educated and wished to provide as the main reasons for leaving. A study conducted in 2001 by Peter D. Hart Research Associates showed that the majority of nurses (74 percent) said they would stay at their jobs if changes were made. Top among the identi���ed desirable changes were: increased staf���ng, less paperwork, and fewer administrative duties. Other common reasons cited for leaving the profession were to ���nd work that was less stressful and less physically demanding. There is consensus amongst researchers on the topic that insuf���cient staf���ng raises the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession. This re���ected the situation in California. Rapid turnover of RNs was common, leaving patients with fragmented care and further stress for the RNs left in the acute-care setting. 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