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California's Safe Staffing Ratio Law — It's More Than Just the Numbers CNA's first-in-the-nation safe staffing RN ratios took 13 years to win and have been in effect since Janu- ary 2004, despite continued efforts of the hospital industry to have the law overturned or otherwise weakened. None of the dire warnings from the hospital industry about the effects of ratios have come to pass. There has been no rise of hospital closures as a result of ratios and the number of actively licensed RNs in California grew by 84 percent, an average of 10,000 a year compared to fewer than 3,000 a year prior to the law's passage Now the scientific evidence is in, too. Numerous studies show that the law improves patient out- comes, reduces nurses' occupational injury and illness and increases job satisfaction, and ensures nurses more time to spend with patients. A landmark 2010 study led by the nation's most prestigious nurse researcher, Linda Aiken, RN, PhD, at the University of Pennsylvania School of Nursing, examined patient outcomes and surveyed 22,000 RNs in California, Pennsylvania, and New Jersey. Her team concluded that New Jersey hos- pitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California's ratios in post-surgical units; that fewer RNs miss changes in patient conditions because of workload; and that California RNs are far less likely to burn out and leave the profession. A 2015 study associated the California RN staffing ratio law with a 31.6 percent reduction in occupa- tional injuries and illnesses among RNs working in the state's hospitals. Researchers McHugh M.D. et al, found in their 2016 study that decreased patient- to-nurse ratios on medical-surgical units are asso- ciated with higher odds of patient survival after an in-hospital cardiac arrest. A more recent study, led by Karen Lasater, RN, Phd, in 2020, showed that hospitals with better nursing ratios achieved improved outcomes for Medicare patients including those with the highest risk of mortality on admission. The study also showed that, even adjusting for additional nursing expenses, these improved outcomes were made with no net increase in costs. Patient Advocacy— Our Guiding Principle RN Safe Staffing Ratios 22 RNs in Motion Intensive-Critical Care Neonatal Intensive Care Operating Room Post-anesthesia Recovery Labor and Delivery Antepartum Postpartum couplets Postpartum women only Pediatrics Emergency Room ICU patients in the ER Trauma patients in the ER Step-Down Unit Telemetry Unit Medical-Surgical Unit Other Specialty Care Psychiatric Care All ratios are minimums. Hospi- tals must increase staffing based upon individual patient needs. 1:2 1:2 1:1 1:2 1:2 1:4 1:4 1:6 1:4 1:4 1:2 1:1 1:3 1:4 1:5 1:4 1:6 California Ratios