The Ratio Solution NNU s RN-to-Patient Ratios Save Lives Better Outcomes and More RNs

Transcription

1 The Ratio Solutio NNU s RN-to-Patiet Ratios Save Lives Better Outcomes ad More RNs The Natioal Voice for Direct-Care RNs

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3 RN Staffig Ratios are Savig Lives ad Brigig RNs Back to the Bedside NNU stads ready to help you brig ratios to your state Dear Colleague, Today i Califoria, RN-to-patiet staffig ratios are the law, thaks to the determied, multi-year efforts of members of the Califoria Nurses Associatio (CNA)/Natioal Nurses Uited (NNU). Sice the law wet ito effect i all Califoria acute-care hospitals i 2004, there are early 130,000 additioal actively licesed RNs i Califoria, ad staffig ad patiet outcomes have improved dramatically. CNA was the author, sposor, ad drivig force behid the ladmark law, which was siged i The hospital idustry ad its allies have tried repeatedly to overtur or weake the law, but CNA/NNU members cotiue to successfully defed ratios. As elected leaders of NNU, we were extremely proud whe a semial 2010 Uiversity of Pesylvaia study showed that the Califoria law saves thousads of patiet lives; surgical uits i New Jersey hospitals would have 14 percet fewer deaths ad Pesylvaia 11 percet fewer deaths if they matched Califoria s 1:5 ratios. Patiets ad urses experiece the effects of the sharp deterioratio i staffig stadards i hospitals across the coutry. We expect specific stadards for clea air ad water, limits o classroom sizes, ad staffig ratios for airlie, day care, ad ursig home staff. Hospital patiets are also etitled to miimum safety stadards ad public protectio. The first victory came i 2004 whe RNs i Arizoa, supported by NNU, wo their ow 1:2 itesive care uit ratios. Califoria s law is the first time that RN-to-patiet ratios are madated ad eforceable throughout acute-care facilities. Nurses have also made gais through uio cotracts that create staffig protectios. RNs across the coutry have take ispiratio from the Califoria law ad are workig for madated state ratios proposed by NNU. States where RNs are workig to wi ratio laws iclude Florida, Illiois, Massachusetts, Miesota, Missouri, Pesylvaia, Texas, ad the District of Columbia. This brochure icludes facts, statistics, ad a research appedix to demostrate how safe RN ratios ehace patiet care while brigig sigificat cost savigs. There is also a state guide to half-measure staffig legislatio that curretly exists. As registered urses, we ca broade the victories wo by Califoria urses ad patiets. Visit our website at to become a part of our campaig to wi madated RN-to-patiet ratios i every state ad for every patiet. Deborah Burger, RN; Kare Higgis, RN; Jea Ross, RN; co-presidets, NNU 3

4 RN Ratios 101 Califoria s Safe Staffig Ratio Law It s more tha just the umbers Califoria s historic first-i-the-atio safe staffig ratios, sposored by the Califoria Nurses Associatio, took 13 years to wi ad have bee i effect sice Jauary 2004 despite cotiued efforts of the hospital idustry to overtur the law. The bill was eacted i 1999 followig a extesive grassroots campaig by RNs with broad support from patiets ad the geeral public that icluded thousads of letters, calls, ad a massive CNA rally o the steps of the state Capitol i Sacrameto o the day of the fial legislative vote. A cocurret public opiio poll foud that by 77 to 13 percet, Califorias believed it is a good idea to have a certai safe umber of traied registered urses per patiet to protect the quality of care ad 69 percet they would expect the goveror to sig the bill. Shortly after, Gov. Gray Davis siged the bill ito law. Hospital executives lobbied to defeat the law, tried to persuade state health officials to adopt usafely high ratios, filed a lawsuit to try to block eforcemet of the ratios at all times, ecouraged hospital maagers to evade the letter ad spirit of the law, ad recruited compliat allies to propose measures to overtur it. All those efforts have failed. Safe RN ratios have improved quality of care ad urse recruitmet ad retetio i Califoria hospitals. Staffig cotiued to improve with a 1:3 ratio (from 1:4) i step-dow uits ad 1:4 (from 1:5) i telemetry ad specialty uits implemeted i Jauary

5 Ratios 101 A.B. 394 the CNA-sposored safe staffig law has multiple provisios desiged to remedy usafe staffig i acute-care facilities. Califoria s safe staffig stadards are based o idividual patiet acuity, of which the RN ratio is the miimum. Madates Miimum, Specific Numerical Ratios Establishes miimum, specific umerical RN-to-patiet ratios for acute-care, acute psychiatric, ad specialty hospitals. Requires a Patiet Classificatio System Additioal RNs Added Based o Patiet Acuity ad Need Additioal RNs must be added to the miimum ratio based upo a documeted patiet classificatio system that measures patiet eeds ad ursig care, icludig severity of illess, complexity of cliical judgmet, ad the eed for specialized techology. Regulates Use of Ulicesed Staff Hospitals may ot assig ulicesed assistive persoel to perform ursig fuctios or perform RN fuctios uder the supervisio of a RN icludig: admiistratio of medicatio, veipucture, ad ivasive procedures. Restricts Usafe Floatig of Nursig Staff Requires orietatio ad validated curret competece before assigig a urse to a cliical area. Temporary persoel must receive the same orietatio ad competecy determiatio as permaet staff. Applies at All Times The ratios apply at all times, icludig meals ad breaks, ad excused absec es. Prohibits Averagig There ca be o averagig of the umber of patiets ad the total umber of RNs. Bars Cuts i Acillary Staff as a Result of Ratios I the first year of implemetatio, CNA successfully fought off challeges from several Califoria hospitals who respoded to the ratios by attemptig to cut back o LVNs ad ulicesed persoel, goig agaist the itet of the law. The state s safe staffig stadards maitai the existig staffig model which utilizes RNs, LVNs, ad ulicesed assistive persoel. Prevets Hospitals from Usig LVNs i Place of RNs LVNs are ot i the ratio cout ad are assistive to the RN. 5

6 NNU RNs Sposor Natioal Ratio Legislatio NNU s Nursig Shortage Reform ad Patiet Advocacy Act S. 992/H.R Uiform Natioal Professioal Stadards 1. Patiet advocate duty ad right 2. Miimum, specific, umerical uit-specific direct-care RN-to-patiet staffig ratios for acute-care hospitals Additioal staff required based o idividual acuity 3. Whistle-blower protectio 4. Prohibitio agaist averagig of ratios 5. Prohibitio agaist madatory overtime 6. Protectio for refusal of usafe patiet assigmets 7. Tough moetary fies for violatios of ratios ad employee ad patiet rights 8. Registered urse workforce iitiative Basic educatioal assistace beefit ad livig stiped Preceptorship ad metorship demostratio project 6

7 Drawig o the lessos from Califoria RNs i states throughout the coutry are actively workig with CNA/NNU to wi their ow madated direct-care RN-to-patiet staffig ratios. Buildig upo the success achieved by CNA/NNU i Califoria, RNs i Illiois, Florida, Missouri, Texas, the District of Columbia, ad elsewhere are actively orgaizig i support of Hospital Patiet Protectio Acts i their states. There ca be o compromise o the eed for madated, miimum RN staffig ratios RNs must take a highly visible, very public lead i this fight The alliace that couts is betwee RNs, patiets, ad the public RNs must act collectively i support of ratios The Califoria safe staffig law gives urses hope I am a float RN ad so I see how RNs i every uit throughout our hospital fially have the time to do proper ursig care, ad fully evaluate each patiet s eeds. We ow have time to check each patiet s chart ad make sure there are o treatmet delays. Ad fially there is time to do the patiet ad family teachig that is essetial to avoidig future complicatios ad hospitalizatios. Kathy Deis, RN Mercy Geeral Hospital, Sacrameto, Califoria

8 Nurses from coast-to-coast campaig for state-based legislatio modeled after the success of the Califoria law District of Columbia Patiets i our atio s capital deserve world-class care. Ufortuately, hospital corporatios cotiue to place a emphasis o the bottom lie, ad care suffers. As patiet advocates, urses i the District of Columbia fight daily battles with hospital maagemet to esure that there are eough urses to care for patiets. Maagemet cosistetly opposes our efforts to wi better staffig for our patiets. It s time for a legislative solutio; it s time for statutorily eforced RN-to-patiet ratios. Lori Marlowe, RN, Washigto, D.C. Florida The Florida Hospital Patiet Protectio Act has bee itroduced i the Florida legislature every year sice It would madate RN-to-patiet ratios at all times, guaratee the right of patiet advocacy, ad provide whistle-blower protectio. Over 3,000 commuity supporters have siged pledges to support the legislatio ad 22 muicipalities have passed resolutios callig o their legislative delegatios to pass this importat life-savig law. Whe patiets are deied access to a medically-appropriate level of ursig care, their outcomes suffer. It s that simple, ad it is totally prevetable. May hospitals uderstaff their uits, deyig access to RNs, ad udermiig patiet safety i the ame of hospital profits. The Florida Hospital Patiet Protectio Act will exted to my patiets the level of care they deserve. Barbra Rivera, RN, St. Petersburg, Florida Missouri It is the hope ad dream of hospital RNs across Missouri to have safe staffig levels so that whe you eed oe of us, we ca be there for you. Our NNOC/NNU campaig for RN-to-p atiet ratios i Missouri cotiues. Whe we set limits o how may patiets RNs are required to care for, patiets have better outcomes ad receive the safe, therapeutic care that we all expect i a hospital. Whe a call light goes o, medicatios are eeded, ad very persoal questios eed to be aswered. We wat the time to be there. Cathy Stepheso, RN, Kasas City, Missouri 8

9 Massachusetts The Patiet Safety Act calls upo the Departmet of Public Health to set a safe limit o the umber of patiets assiged to a urse at oe time, based o a evaluatio of evideced-based research. I additio, the bill calls for staffig to be adjusted based o acuity ad the patiet s eeds, bas the practice of madatory overtime, ad icludes laguage to improve reportig of urse-sesitive measures so that meaigful quality of care compariso ca be made. Uderstaffig is part of the healthcare crisis facig this atio ad the state of Massachusetts. Registered urses are beig forced to care for too may patiets at oe time, ad patiets edure the cosequeces i the form of prevetable medical errors, avoidable complicatios, icreased legth of stay, ad readmissios. We eed to pass safe staffig legislatio to protect our patiets ad the itegrity of our ursig practice. Doa Kelly-Williams, RN, presidet, Massachusetts Nurses Associatio Illiois The 2012 Nursig Care ad Quality Improvemet Act, H.B Whe urses are short staffed, our patiets suffer. Ratios are key to the quality care our patiets deserve. Dorothy Ahmad, RN, Chicago, Illiois Miesota The 2012 Staffig For Patiet Safety Act would set a maximum patiet assigmet for registered urses based o factors icludig ursig itesity ad patiet acuity, ad would require hospital admiistrators to work directly with urses to esure that adequate resources are provided to keep patiets safe. It would also icrease trasparecy surroudig the staffig process. After years of broke promises from hospitals to work directly with urses to address patiet safety issues that resulted from iadequate staffig, we ve bee left with o choice but to take our cocers to the state legislature. We eed legislatio like this to hold hospital admiistrators accoutable ad keep our patiets safe. Lida Hamilto, RN, presidet, Miesota Nurses Associatio Pesylvaia S.B. 438/H.B would establish miimum RN-to-patiet ratios, based o the Califoria law, alog with whistle-blower protectios. Oly direct-care urses ca be couted i the ratios, ad the ratios would cover all shifts. Nothig would preclude ay facility from implemetig higher urse staffig levels. May of the issues we are faced with o the job are a direct result of poor staffig levels. Whe there is ot eough staff, workplace violece agaist urses is harder to prevet, taleted RNs leave the professio because they simply bur out, ad the quality of patiet care is at risk because we just do t have the time to do everythig we would if we had safe ratios. Patricia Eaki, RN, presidet, Pesylvaia Associatio of Staff Nurses ad Allied Professioals 9

10 Groudbreakig study o Ratio Success Story Lives saved improved patiet care A 2010 ladmark research project, the most comprehesive study doe o the Califoria RN staffig ratio law, proved what Califoria urses have log kow Califoria s ratios are the sigle most effective ursig reform to protect patiets ad keep experieced RNs at the bedside. Uiversity of Pesylvaia researchers led by Lida Aike, RN, PhD, director of the Ceter for Health Outcomes ad Policy Research at the Uiversity of Pesylvaia School of Nursig, iterviewed 22,000 RNs i Califoria ad two comparable states, Pesylvaia ad New Jersey. Their fidigs, published by the policy joural, Health Services Research, documeted that: TUESDAY APRIL 20, 2010 Nurse staffig study predicts Calif. madate would save lives elsewhere New Jersey hospitals would have 14 percet fewer patiet deaths ad Pesylvaia 11 percet fewer deaths if they matched Califoria s 1:5 ratios i surgical uits. Califoria RNs have far more time to sped with patiets, ad more of their hospitals have eough RNs o staff to provide quality patiet care. Pioeerig law o urses foud to save lives The differeces betwee Califoria ad the other states are strikig, said Lida Aike. Nurses i Califoria take care of two fewer patiets o average tha urses i Pesylvaia ad New Jersey i geeral surgery. These differeces lead to the prevetio of literally thousads of deaths. Sa Fracisco Chroicle, April 20, 2010

11 TUESDAY APRIL 20, 2010 Workload limits may aid patiets, urses WEDNESDAY APRIL 21, 2010 Califoria urse-staffig law saves lives, study says Fewer Califoria RNs miss chages i patiet coditios because of their workload tha New Jersey or Pesylvaia RNs. I Califoria hospitals with better compliace with the ratios, RNs cite fewer complaits from patiets ad families ad the urses have more cofidece that patiets ca maage their ow care after discharge. Califoria RNs are far more likely to stay at the bedside, ad less likely to report burout tha urses i New Jersey or Pesylvaia. More urses, less death Lida Aike, who led the study ad directs the Ceter for Health Outcomes ad Policy Research at Pe, said improved urse staffig likely could save may thousads a year atioally Aike said the ew study followed decades of research showig that patiet outcomes were better whe urses cared for fewer patiets. Philadelphia Iquirer, April 20, 2010

12 & A Everythig you ever wated to ask about ratios Q. Where will the RNs come from? A. The umber of actively licesed RNs i Califoria has icreased by early 130,000 followig eactmet of the staffig ratio law i Strog, effective ratio laws have bee a critical factor i helpig to mitigate the effects of the ursig shortage. RNs do ot remai i usafe, uderstaffed hospitals. A study published i the Joural of the America Medical Associatio i October 2002 liked higher RN-to-patiet-ratios with a 15 percet icrease i urse dissatisfactio with their jobs. Today s shortage is the direct product of more tha 10 years of the failed policies of market-drive medical care that icluded reckless dowsizig ad displacemet of RNs with ulicesed staff. Califoria ad Victoria Australia, both with madated ratios, prove this poit. I Califoria, sice the sigig of the law i 1999: Vacacies for RNs at Sacrameto-area hospitals plummeted 69 percet sice early 2004 whe the ratios were first implemeted. Throughout the state, may of Califoria s biggest hospital systems have see their turover ad vacacy rates fall below 5 percet, far below the atioal average Sacrameto Busiess Joural, Jauary 11, The umber of actively licesed RNs grew by a average of 10,000 a year, compared to uder 3,000 a year prior to the law s passage Califoria Board of Registered Nursig. There has bee a 60 percet icrease i RN applicatios sice the law was siged i 1999 Califoria Board of Registered Nursig. The ratios have helped fuel a dramatic growth i studet iterest i ursig i Califoria. I the last six years, the umber of RN graduates has jumped by 45 percet Aual School Report, Board of Registered Nursig, Victoria, Australia, which adopted urse-to-patiet ratios i 2000: Experieced a 24.1 percet icrease i the umber of employed urses. There are o vacacies i urba hospitals because better staffig levels lured more tha 7,000 iactive urses back ito the workforce. 12

13 Number of licesed RNs icreased by 4 0% i Califoria sice ratio law passed i 1999 Q. Have ratios caused a icrease i hospital closures? A. No. I 2005, whe the hospital idustry sought to overtur the ratio law, they failed to produce i court ay evidece likig ratios to hospital closures. Claims by the hospital idustry that Califoria s patiet safety law is to blame for hospital ad ER closures igores the fact that 50 hospitals were closed i Califoria betwee 1990 ad 2000 for market-based reasos, log predatig the implemetatio of the ratio law. Virtually all of the few hospitals closed sice Jauary 2004 had reported years of fiacial losses. Natioally, 996 hospitals closed from 1987 to 2007, oe as a result of Califoria s safe staffig law. 13

14 Q. Is there ay data that proves madated RN-to-patiet ratios improves patiet outcomes? A. Yes! There are more tha 60 studies that directly lik safe RN staffig to reduced rates of patiet deaths ad post-operative complicatios, icludig respiratory failure, uriary tract ifectios, peumoia, shock, upper gastroitestial bleedig, ad shorter hospital legths-of-stay. Check out additioal research fidigs i the appedix. New Jersey hospitals would have 14 percet fewer patiet deaths ad Pesylvaia 11 percet fewer deaths if they matched Califoria s 1:5 ratios i surgical uits Health Services Research, August Icreasig the umber of full-time RNs o staff per day by oe, there were 9 percet fewer hospital-related deaths i itesive care uits, 16 percet fewer i surgical patiets, ad 6 percet fewer i medical patiets Healthcare Risk Maagemet, February Cacer surgery patiets are safer i hospitals with better RN-to-patiet ratios. A study of 1,300 Texas patiets udergoig a commo surgery for bladder cacer documeted a cut i patiet mortality rates of more tha 50 percet Cacer Joural of the America Cacer Society, September Q. Ca LPNs/LVNs be couted i the ratios? A. No. RN ad LPN/LVN practice ad liceses are ot iterchageable. What distiguishes a RN from a LPN/LVN or other ursig staff is her or his broad, legally-defied scope of practice the legal authority that govers what she or he ca ad caot do ad the legal madate ad right to act as patiet advocate i all circumstaces. There is o parity betwee the RN ad the LPN/LVN liceses for the purpose of the ratios. The LPN/LVN is limited by law to performig techical ad maual duties assiged by the direct-care RN. RN resposibilities iclude: patiet assessmet, formulatig a diagosis, desigig a care pla, implemetatio ad evaluatio of care, ad patiet ad family educatio. Perhaps most critical to patiet safety is the idepedet authority of a RN. I a era whe so may healthcare corporatios place ecoomic goals ahead of quality care, the RN is specifically ordered to protect the safety ad well-beig of the patiet regardless of the ecoomic iterest of the employer. RNs advocate i the exclusive iterest of their patiets. 14

15 Q. Are t ratios too costly? A. No, i fact ratios have prove to be cost-effective. Safe RN ratios have produced cost savigs for hospitals i reduced spedig o temporary RNs ad overtime costs, lower RN turover, improved patiet outcomes, ad shorter patiet legths of stay. Addig 133,000 RNs to the U.S. hospital workforce would produce medical savigs estimated at $6.1 billio i reduced patiet care costs Medical Care, Jauary Prevetig medical errors reduces loss of life ad could reduce healthcare costs by as much as 30 percet. Isurers paid a additioal $28,218 (52 percet more) ad a additioal $19,480 (48 percet more) for surgery patiets who experieced acute respiratory failure or post-operative ifectio Health Services Research, July Raisig the proportio of RNs by icreasig RN staffig to match the top 25 percet best staffed hospitals would produce et short-term cost savigs of $242 millio Health Affairs, Jauary/ February Q. With the healthcare crisis, are t most hospitals fiacially i trouble? A. No. Hospitals ca afford to improve staffig. Data shows that most hospitals ca afford to employ sufficiet umbers of RNs to provide safe ratios. The health idustry trade publicatio Moder Healthcare reported that hospital idustry profits set aother record $52.9 billio i That s just the profits, ot coutig high executive salaries, stock optios, ad other beefits. Eve with the improved staffig required by the ratios law, Califoria hospitals etted over $4.4 billio i profit i 2010, accordig to data from the Office of Statewide Health Plaig ad Developmet. RN-to-Patiet Ratios:» Save lives» Help solve the ursig shortage» Are Cost effective

16 The Half-Measures Beware of staffig bills masqueradig as ratios I a effort to derail madated RN-to-patiet ratio laws, the hospital idustry alog with its allies have pushed for passage of iferior staffig bills. Whe aalyzig the merits of a particular bill, be suspicious whe a bill has ay of the followig markers. Is it a real ratios law or a fake, weakeed staffig pla? Volutary ad/or permissive ratios These laws may provide specific umeric ratios, however they also iclude loopholes givig employers the right to staff as they please. Oe of the loopholes allows employers to iterchage RNs for other healthcare persoel. No public disclosure No eforcemet No rights for the RN as patiet advocate, o whistle-blower protectio LVN/LPN ad RN iterchageability Staffig based solely o patiet classificatio systems without ratios as a miimum safety stadard These approaches make vague ad udefied refereces to appropriate staffig levels without providig specific ratio umbers. Acuity-based staffig usig tools developed by hospital idustry cosultats is preseted as a alterative to madated miimum ratios. All of these plas are desiged to prevet the implemetatio of real, eforceable, RN-to-patiet ratios. 16

17 Our hospital has added 500 ew RN positios ad we rarely use registry or travelers I work i a medical uit where a majority of our patiets are diabetic ad require lots of teachig ad moitorig. Our ight shift RNs used to have ie to 12 patiets before the ratios were i effect. We could ever keep a core ursig staff o ights. As a result of the ratio law we do t have more tha five patiets which gives us the time we eed to do patiet teachig ad has dramatically improved patiet outcomes ad urse retetio. Our hospital has added 500 ew RN positios ad we rarely use registry or travelers. Mary Bailey, RN Log Beach Memorial Hospital, Log Beach, Califoria

18 NNU A Natioal Social Advocacy Movemet for RNs A strog voice for our professio ad our patiets Natioal Nurses Uited is a atioal uio ad professioal orgaizatio with a powerful ageda of patiet advocacy. It is the atio s largest ad fastest-growig uio of direct-care urses, triplig i size durig the past 10 years. NNU is recogized by RNs across the atio for our premier collective bargaiig cotracts which ehace the collective voice of RNs i patiet care decisios, outlaw dagerous practices such as madatory overtime, dramatically improve retiremet security for RNs, ad offer other provisios that are eeded to retai career RNs at the hospital bedside ad protect patiets. NNU is a leadig atioal advocate for uiversal healthcare reform, through a sigle-payer-style system based o a improved ad expaded Medicare for All. The orgaizatio is campaigig for sigle-payer legislatio, H.R. 676, i Cogress. Other ladmark laws sposored by NNU iclude whistle-blower protectios for caregivers who expose usafe hospital coditios, a ba o iappropriate persoel providig t elephoe medical advice, ad icreased fudig for ursig educatio programs. For more iformatio visit our website at I believe the ratios are a good thig. It s better for the patiets. Cydie Cole, director of ursig at Vetura Couty Medical Ceter Vetura Couty Star, Ja. 9, 2008, Vetura, Califoria

19 Ratios eded turover of RNs o our uit ad decreased the hospital RN vacacy rate from 17% to 5% I the years before the ratios were eacted we had complete turover of our etire RN staff twice i three years. There were ever eough RNs scheduled, ad we were cotiually fightig for two to three more urses to be called i at the last miute. It is extremely difficult to get urses o short otice so we were always workig short staffed ad our patiets suffered. Nurses got frustrated ad left. Whe they come to work ow they kow that they will start the shift with eough urses scheduled to provide better care to our patiets. Now the oly time urses leave our uit is if they are movig out of the area or goig back to school full time. Trade Phillips, RN Kaiser Permaete, Walut Creek, Califoria

20 Pavig the Way The CNA/NNU fight to wi first-i-the-atio ratios i Califoria It took years of rallies, protests, public hearigs, meetigs with legislators, ad tes of thousads of letters to ewspapers, but Califoria RNs ever gave up util safe patiet ratios were i place i every acute-care hospital. The urses vigilace to protect the ratios cotiues to this day CNA wis first state-madated ratios for itesive care uits 1:2. CNA proposes the first hospital-wide ratio legislatio i the U.S. A.B CNA-sposored ratio bill (A.B. 695) wis approval i the Legislature for the first time. RNs flood the state Capitol with letters, calls, ad postcards. Gov. Pete Wilso vetoes the bill after extesive lobbyig by the hospital idustry. A.B. 394 is itroduced by Assemblymember Sheila Kuehl. CNA presets 14,000 letters i support ad commissios a opiio poll showig 80 percet public support for bill. After 2,500 CNA RNs rally, Legislature passes A.B. 394 ad Gov. Gray Davis sigs ito law. The bill directs the Califoria Departmet of Health Services to determie specific ratios I a joit press coferece with the CNA Board of Directors, Gov. Davis presets the ratios that are ultimately adopted. The hospital idustry s proposal of 1:10 for medical surgical, telemetry, ad ocology uits is soudly defeated. Jauary 1, RN staffig ratios become effective i all Califoria acute-care hospitals. A Califoria Superior Court rejects a hospital idustry lawsuit ad upholds the law rulig that ratios must be maitaied at all times, icludig durig meal ad rest breaks. Gov. Arold Schwarzeegger issues a emergecy regulatio which suspeded portios of the ratio law i medical surgical uits ad emergecy departmets. CNA s campaig of public protests, radio ad TV ads, ad RN letters to the editor, garers extesive worldwide media. CNA files a lawsuit agaist Schwarzeegger s emergecy regulatios, chargig that the goveror exceeded his authority by seekig to overtur a legislative madate to protect patiet safety. 20

21 2005 More tha 1,500 RNs packed the Califoria Departmet of Health Services hearig o the pla to make emergecy regulatios a permaet rule chage. CNA also delivers 11,000 letters from RNs opposig the ew rules. A Califoria Superior Court judge fids that the goveror broke the law ad failed to preset ay evidece of the pretexts he used for the emergecy regulatio. Gov. Schwarzeegger drops his fight agaist the ratios. All told, tes of thousads of urses joied together ad led 107 protests i 371 days throughout Califoria ad several states Fial step of implemetatio sees ratios drop to 1:3 i step-dow ad 1:4 i telemetry ad specialty uits. Safe staffig ratios result i a icrease of 100,000 ew active licesed RNs i Califoria. Uiversity of Pesylvaia research study documets that Califoria ratios save thousads of patiet lives compared to similar states. Califoria Hospital Associatio, workig with a local uio, proposes to susped ratio requiremets whe RNs are o meal ad rest breaks. CNA/NNU RNs react strogly ad quickly. No legislator agrees to carry bill ad state labor federatio opposes proposal. Fewer patiets meas more time for quality care Oe less patiet makes a big differece. The fewer patiets you have, the more time you have to sped with a patiet. Ad if you re the patiet, you wat your urse to give you all the care you eed. Shirley Toy, RN Uiversity of Califoria Davis Medical Ceter, Sacrameto, Califoria

22 Appedix Additioal Studies ad Data Studies by the atio s most respected scietific ad medical researchers affirm the sigificace of Califoria s RN-to-patiet ratios for patiet safety As a result of the ratios, Califoria has far fewer patiet deaths tha comparable hospitals i Pesylvaia ad New Jersey, RNs have more time for patiets ad miss fewer chages i patiet coditios Health Services Research, August Uderstaffig of urses is a key factor i the spread of methicilli-resistat staph ifectio (MRSA), the most dagerous type of hospital-acquired ifectio Lacet Ifectious Disease, July Patiets cared for i hospitals with higher RN staffig levels were 68 percet less likely to acquire a prevetable ifectio, accordig to a review of outcome data of 15,000 patiets i 51 U.S. hospitals Medical Care, Jue A 10 percet icrease i adequate staffig ad resources is associated with 17 fewer deaths per 1,000 discharged patiets Sciece Daily, Ja. 16, Improved RN staffig ratios are associated with a reductio i hospital-related mortality, failure to rescue, ad legths of stay. Every additioal patiet assiged to a RN is associated with a 7 percet icrease i the risk of hospital-acquired peumoia, a 53 percet icrease i respiratory failure, ad a 17 percet icrease i medical complicatios Agecy for Healthcare Research ad Quality, May If all hospitals icreased RN staffig to match the top 25 percet best-staffed hospitals, more tha 6,700 i-hospital patiet deaths, ad overall 60,000 adverse outcomes could be avoided Health Affairs, Jauary/February Low urse staffig levels are a key cause of 98,000 prevetable deaths each year Istitute of Medicie, Keepig Patiets Safe: Trasformig the Work Eviromet of Nurses, November Up to 20,000 prevetable patiet deaths each year ca be liked to low RN staffig. For each additioal patiet assiged to a RN, above four, the likelihood of death withi 30 days icreased by 7 percet Joural of the America Medical Associatio, October 22, Most hospitals ca afford to employ sufficiet umbers of RNs to provide safe ratios 22 From 1993 through 2004, $157 billio was cosumed by mergers ad acquisitios i the hospital idustry a average of $402,000 per bed, the highest ever Istitute of Health ad Socio-Ecoomic Policy calculatio of Irvi g Levi Associates merger ad acquisitio data. Natioally, hospitals expeded $146.3 billio from 1993 to 2003 o iformatio techology programs Sheldo I. Dorefest ad Associates, 2004.

23 RN-to-patiet ratios: A cost-effective solutio for hospitals RN-to-patiet ratios have bee demostrated to produce sigificat log-term savigs for hospitals by reducig patiet care costs. By improvig staffig coditios, ratios also help hospitals cut RN turover ad reliace o urse registries. RN uderstaffig i hospital itesive care uits icreases the risk of peumoia ad other prevetable ifectios that ca add thousads of dollars to the cost of care of hospital patiets Critical Care, July 19, Icreasig the hours ad raisig the proportio of urses who are RNs would result i a $5.7 billio savigs ad save 6,700 lives ad four millio days of patiet care i hospitals each year Health Affairs Magazie, Jauary/February Miimum ratios ca avert lawsuits ad higher malpractice premiums that may follow icreased mortality ad morbidity caused by iadequate RN staffig. A family was awarded $2.7 millio after a patiet death due to iadequate urse staffig ABC News, Ja. 21, Improvig RN-to-patiet ratios from 1:8 to 1:4 would produce sigificat cost savigs ad is less costly tha may other basic safety itervetios commo i hospitals, icludig clot-bustig medicatios for heart attacks ad PAP tests for cervical cacer Medical Care, Joural of the America Public Health Associatio, August Travel urses typically cost hospitals at least 20 percet more tha a urse employee eve whe beefits are factored i, says Carol Bradley, chief ursig officer for Califoria for Teet Health System USA Today, Jue 9, Johs Hopkis Uiversity researchers foud that hospitals with fewer RNs i itesive care uits at ight icurred a 14 percet icrease i costs America Joural of Critical Care, November Harvard researchers cite a 3 percet to 6 percet shorter legth of stay for patiets i hospitals with a high percetage of RNs, reducig costs Nurse Staffig ad Patiet Outcomes i Hospitals, Harvard School of Public Health Report, REV: 07/12 23

24 Our Patiets Our Rights Our Stadards Our Voice