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18 » RNs in Motion RN Safe Staffing Ratios PATIENT ADVOCACY— OUR GUIDING PRINCIPLE 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 January 2004, despite continued efforts by 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 has grown exponentially since the law's passage. Now the scientific evidence is in, too. Numerous studies show that the law improves patient outcomes, 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 pres- tigious nurse researcher, Linda Aiken, RN, Ph.D., 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 hospitals 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 sustain moral distress or injury and leave the profession. 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 McHugh M.D. 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 more recent study, led by Karen Lasater, RN, Ph.D., 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. Intensive-Critical Care Neonatal Intensive Care Operating Room Post-anesthesia Recovery Labor and Delivery Antepartum Postpartum Couplets Postpartum Women Only Pediatrics Emergency Room Trauma Patient in ER ICU Patient in ER Step Down Telemetry Medical/Surgical Other Specialty Care Psychiatric Care 1:2 1:2 1:1 1 :2 1:2 1:4 1:4 1:6 1:4 1:4 1:1 1:2 1:3 1:4 1:5 1:4 1:6 CALIFORNIA RATIOS All ratios are minimums. Hospitals must increase staffing based upon individual patient needs.