National Nurses United

Time is on our side,yes it is. Winning ratios in California did not happen overnight, so all nurses in other states should take heart. It took years of education, lobbying, organizing, and fighting to get the law finally passed in 1999. Then it took another five years of advocacy and input into the state Department of Health Services to ensure realistic and safe numerical ratios were adopted. And it takes constant vigilance to enforce the ratios and fend off efforts to undermine them or repeal the ratios entirely. 1976 California Nurses Association (CNA) wins first state-mandated ratios of 1:2 for intensive care units. 1993 CNA proposes the first hospital-wide ratio legislation in the United States, A.B. 1445. 1996 CNA works with consumer protection groups to put Proposition 216 on the state ballot, a measure that would have offered protections for patients against HMOs as well as establishing minimum staffing ratios for hospitals. The measure did not pass, but helped dramatically raise awareness among the public for minimum staffing standards. 1998 CNA-sponsored ratio bill, A.B. 695, wins approval in the Legislature for the first time. RNs flood the state Capitol with letters, calls, and postcards. Gov. Pete Wilson vetoes the bill after extensive lobbying by the hospital industry. 1999 A.B. 394 is introduced by Assemblymember Sheila Kuehl. CNA presents 14,000 letters in support and commissions an opinion poll showing 80 percent public support for the bill. After 2,500 CNA RNs rally at the Capitol, the Legislature passes A.B. 394 and Gov. Gray Davis signs it into law. The bill directs the California Department of Health Services to determine specific ratios. 2002 In a joint press conference with the CNA Board of Directors, Gov. Davis presents the ratios that are ultimately adopted. The hospital industry's proposal of 1:10 for medical surgical, telemetry, and oncology units is soundly defeated. 2004 On Jan. 1, RN staffing ratios become effective in all California acute-care hospitals. A California Superior Court rejects a hospital industry lawsuit arguing that ratios don't apply during meals and breaks, ruling that ratios must be maintained at all times. Just 11 months later, Gov. Arnold Schwarzenegger issues an emergency regulation which suspends portions of the ratio law in emergency departments and delays improved ratios for medical surgical units that were to take effect in 2005. CNA files suit against Schwarzenegger's administration and mounts a public campaign to protest his actions. 2005 More than 1,500 RNs packed the California Department of Health Services hearing on the plan to make Schwarzenegger's emergency regulations a permanent rule change. CNA also delivers 11,000 letters from RNs opposing the new rules. A California Superior Court judge in June finds that the governor broke the law and failed to present any evidence of the pretexts he used for the emergency regulation. In November, after losing every single measure he proposed on a special election ballot, Schwarzenegger drops his fight against the ratios. All told, tens of thousands of nurses joined together and led 107 protests in 371 days throughout California and other states. 2008 Final step of implementation sees ratios drop to 1:3 in step-down and 1:4 in telemetry and specialty units. 2009 Safe staffing ratios result in an increase of 100,000 new, active, licensed RNs in California. 2010 University of Pennsylvania research study documents that California ratios save thousands of patient lives compared to similar states. 2012 The California Hospital Association, working with a local union, proposes to introduce legislation to suspend ratio requirements when RNs are on meal and rest breaks. RNs protest strongly and quickly. No legislator agrees to carry the bill, and the state labor federation opposes the proposal. o C to b e R 2 01 3 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 N at i o N a l N u R s e 15

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