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Health and Safety with National Nurses United 10 Safe Staffing Ratios Our Health and Safety Division is focusing on key areas that most affect nurses' health and safety on the job: staffing ratios, patient handling, workplace violence, and infectious diseases. NNU has a track record of winning strong protections in each of these areas. [ Ratios Background ] Registered nurses are a critical component in guaranteeing patient safety and the highest quality healthcare. Hospitals, with an eye on the bottom line, spent most of the 1990s reducing their RN workforce through layoffs and attrition. Hospitals were implementing a variety of nursing care delivery models involving major down substitutions, reducing the proportion of RNs to other nursing personnel by replacing them with lesser trained and, at times, untrained and lower-salaried personnel at a time when the increasing complexity and acuity of hospital patient care caseloads called for more skilled nursing care provided by registered nurses. As a result, patient care staffing standards sharply deteriorated in hospitals. Patients and RNs experienced these negative effects every day. California RNs left the bedside and there was an exodus from acute-care facilities as a result of two key reasons for RN dissatisfaction: excessive patient work loads and oppressive working conditions. [ Safe Staffing Legislation ] After extensive and aggressive lobbying and highly visible mobili- zation campaigns by NNU, in 1999 California adopted the first-in-the nation minimum, specific, and numerical nurse-to-patient ratios by clinical units for acute-care hospitals. The at-all-times ratios became effective in 2004 after a lengthy public comment period. [ The Result ] Safe RN ratios have improved quality of care and nurse recruitment and retention in California hospitals. Led by NNU, Massachusetts has recently established minimum, numerical ratios in intensive care units.