California Nurses Celebrate Implementation of Safe Staffing Ratios in APHs

California Implements New Staffing Ratios in Psychiatric Hospitals

On June 1, California nurses are marking a significant milestone with the introduction of safe nurse-to-patient staffing ratios in the state's acute psychiatric hospitals. These new regulations aim to enhance the quality of care for behavioral health patients and improve the working conditions for registered nurses (RNs). The California Nurses Association (CNA) played a pivotal role in advocating for these changes, influencing both the governor and the California Department of Public Health (CDPH) to act.

Cathy Kennedy, RN and president of CNA, highlighted the importance of these ratios, saying, “We know from more than two decades of experience with mandatory, minimum RN-to-patient staffing ratios in general hospitals that ratios not only improve care and save lives, but better safety and working conditions for nurses to keep us at the bedside.” She emphasized that all patients are entitled to high-quality care, and the new regulations fulfill a long-standing goal of setting safe staffing rules for psychiatric hospitals.

The journey to these regulations began with the safe staffing legislation A.B. 394 (Kuehl), sponsored by the CNA in 1999, which mandated staffing ratios in general hospitals by 2004. However, similar rules for psychiatric facilities were not implemented until now. A San Francisco Chronicle investigation last year shed light on staffing issues, prompting CNA to push for the fulfillment of these long-overdue regulations.

Nurse advocacy was crucial in shaping the current emergency regulations, which countered pressure from the corporate hospital sector to weaken staffing standards. Through public comments and direct action, nurses ensured that loopholes were closed, preventing acute psychiatric hospitals from bypassing meaningful staffing ratios and preserving standards in general acute-care hospitals.

Key Features of the New Regulations

• Eliminates provisions that would allow a single RN to oversee up to 24 patients during a 12-hour shift or 16 patients during an 8-hour shift.
• Prohibits averaging staffing ratios over any shift or time period.
• Avoids adopting unsafe night shift ratios.
• Precludes nurse administrators and supervisors with non-direct care duties from being counted towards staffing ratios.
• Specifies that the numerical ratios are the maximum number of patients an RN can manage at any given time.

Despite these achievements, CNA nurses remain vigilant as the permanent rulemaking process continues. They aim to fend off industry pressure that might dilute these standards and seek further enhancements, such as clarifying the RN-to-patient ratios, setting pediatric ratios at one RN per four patients, and preventing layoffs of ancillary staff. They also advocate for in-person public hearings to gather input from nurses and patients statewide before finalizing the rules.

Ensuring consistent standards of care across all healthcare facilities is crucial. The establishment of effective RN-to-patient staffing ratios in psychiatric hospitals, matching those in general acute-care hospitals, is a critical step towards ensuring that all patients receive the highest standard of care.

California Nurses Association/National Nurses United is the largest and fastest-growing union and professional association of registered nurses in the nation with more than 100,000 members in more than 200 facilities throughout California and more than 225,000 RNs nationwide.

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