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14 Q. Is there any data that proves mandated RN-to-patient ratios improves patient outcomes? A. Yes! There are more than 60 studies that directly link safe RN staffing to reduced rates of patient deaths and post-operative complications, including respiratory failure, urinary tract infections, pneumonia, shock, upper gastrointestinal bleeding, and shorter hospital lengths-of-stay. Check out additional research findings in the appendix. n New Jersey hospitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California's 1:5 ratios in surgical units — Health Services Research, August 2010. n Increasing the number of full-time RNs on staff per day by one, there were 9 percent fewer hospital-related deaths in intensive care units, 16 percent fewer in surgical patients, and 6 percent fewer in medical patients — Healthcare Risk Management, February 2008. n Cancer surgery patients are safer in hospitals with better RN-to-patient ratios. A study of 1,300 Texas patients undergoing a common surgery for bladder cancer documented a cut in patient mortality rates of more than 50 percent — Cancer Journal of the American Cancer Society, September 2005. Q. Can LPNs/LVNs be counted in the ratios? A. No. RN and LPN/LVN practice and licenses are not interchangeable. What distinguishes an RN from an LPN/LVN or other nursing staff is her or his broad, legally-defined scope of practice — the legal authority that governs what she or he can and cannot do — and the legal mandate and right to act as patient advocate in all circumstances. There is no parity between the RN and the LPN/LVN licenses for the purpose of the ratios. The LPN/LVN is limited by law to performing technical and manual duties assigned by the direct-care RN. RN responsibilities include: patient assessment, formulating a diagnosis, designing a care plan, implementa- tion and evaluation of care, and patient and family education. Perhaps most critical to patient safety is the independent authority of an RN. In an era when so many healthcare corporations place economic goals ahead of quality care, the RN is specifically ordered to protect the safety and well-being of the patient regardless of the economic interest of the employer. RNs advocate in the exclusive interest of their patients.