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Laws and Regulations To maintain patient safety in the face of the eco- nomic and technological pressures RNs encounter in the present hospital environment, all registered nurses must know the scope of our nursing practice, and our rights and responsibilities under our state's Nursing Practice Act (NPA). As patient advocates, RNs must act in the exclusive interest of our patients. This includes challenging any order that, in the RN's independent and pro- fessional judgment, is against the patient's interest, ensuring caregivers are trained and competent, and that staffing meets individual patients' acuity needs. California Nurses Association/National Nurses United collective bargaining agreements provide the tools that give nurses the ability to take effective collective action to maintain patient safety. Those tools include the Assignment Despite Objection (ADO) form, which is overseen by the RN-elected Professional Practice Committee (PPC). Nursing practice information, advisories, and guidelines are provided to the public by individ- ual states' boards of registered nursing (BRNs) to ensure ongoing communication of compe- tency standards to consumers, registered nurses, advanced practice nurses, employers, educators, and other regulators. As the scope of nursing prac- tice changes and grows, so does this information. Nursing practice acts are the body of state laws that mandate the BRN to set out the scope of practice and responsibilities for RNs, including nursing education, licensure, practice, and discipline. California's Nursing Practice Act Sponsored by CNA and signed into law in 1939, the California Nursing Practice Act (NPA) is enforced by the California BRN. Business and Professions Code Section 2725 defines the scope of nursing practice. In 1974, CNA again sponsored extensive and comprehensive amendments to the NPA, recognizing that the practice of nursing was con- tinuously evolving to include more sophisticated patient care activities and also recognizing the exis- tence of overlapping functions between physicians and registered nurses. Regulations that further clarified the law appear in the California Code of Regulations, Title 16. Adopted in 1985, this section of the law, commonly referred to as the Standards of Competent Perfor- mance, mandates the duty and right of a registered nurse to act as the patient's advocate. Title 16 states that an RN: Acts as the client's advocate as circumstances require by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided. California Code of Regulations Title 22 Title 22 contains the RN-to-patient ratios and com- petency validation, and requirements for floating and patient acuity systems. 21 Patient Advocacy Our Guiding Principle Know Your Practice