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16 » RNs in Motion RN Safe Staffing Ratios PATIENT ADVOCACY— OUR GUIDING PRINCIPLE FIRST-IN-THE-NATION SAFE STAFFING RATIO LAW: A MODEL FOR THE NATION California's ratio law took many years to win and has been in effect since January 2004, despite continued efforts of the hospital industry to have the law overturned or other- wise weakened. NNOC and NNU are now actively working to pass a com- prehensive national bill, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, sponsored by U.S. Sen. Sherrod Brown (D-OH), and a similar bill in the U.S. House of Representatives, sponsored by Rep. Jan Schakowsky (D-IL). We are also working with RNs across the country on state-specific legislation. 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 due to staffing ratios, and the number of actively licensed RNs in California has grown. Research Shows Staffing Ratios Save Lives The scientific evidence is conclusive. Numerous studies show that the law reduces deaths and assures that nurses spend more time with patients. A landmark 2010 study led by the nation's most pres- tigious 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. The research concluded that New Jersey hospitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California's ratios in postsurgical units; fewer RNs in California miss changes in patient conditions because of their workload; and California RNs are far less likely to report burnout and leave the profession than New Jersey or Pennsylvania nurses. A 2015 study associated the California RN staffing ratio law with a 31.6 percent reduction in occupational injuries and illnesses among RNs working in the state's hospitals. Researchers M. D. McHugh et al. found in their 2016 study that decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an in-hospital cardiac arrest. A 2020 study led by Karen Lasater, RN, PhD, 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 these improved outcomes were made with no net increase in costs. Intensive/Critical Care Neonatal Intensive Care Operating Room plus at least one additional scrub assistant Post-anesthesia Labor and Delivery Antepartum Combined Labor & Delivery & Postpartum Well Baby Nursery Postpartum Couplets Intermediate Care Nursery Pediatrics Emergency Room Trauma Patient in ER ICU Patient in ER Step Down Telemetry Medical/Surgical Coronary Care Acute Respiratory Care Burn Unit Other Specialty Care Units Psychiatric Rehabilitation Skilled Nursing Facility 1:2 1:2 1:1 1:2 1:2 1:3 1:3 1:6 1:3 1:4 1:3 1:3 1:1 1:2 1:3 1:3 1:4 1:2 1:2 1:2 1:4 1:4 1:5 1:5 PROPOSED RN RATIOS (modeled on California law)