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Safe-Staffing Ratios the Largest RN Union in the US Is Fighting For

Enacting these ratios could save lives — and improve income for hospitals.

Extensive research shows that the fewer patients a nurse cares for, the better the patient outcomes and higher job satisfaction. Unfortunately, tighter hospital budgets and growing numbers of patients have placed safe-staffing ratios lower on the priority list. 

Still, nurses’ unions across the country are waging a legal battle to reduce the number of patients per RN. One in particular, the California Nurses Association, succeeded in 2004 after 13 years of fighting. Since the law was enacted, California has seen improved patient care and lower nurse turnover. National Nurses United, the largest RN union in the country, is also advocating for two federal bills, one in the Senate and another in the House, modeled after California’s.

What exactly constitutes “safe staffing”? According to a graphic from National Nurses United, the largest RN union in the country, it’s as follows:

  • One nurse to one operating room trauma patient

  • One nurse to two intensive/critical care, NICU, post-anesthesia, labor and delivery, ICU in ER, coronary care, acute respiratory care, or burn unit patients

  • One nurse to three antepartum, combined labor and delivery/postpartum, postpartum couplets, pediatrics, ER, step down, or telemetry patients

  • One nurse to four intermediate care nursery, med/surg, psychiatric, or other specialty-care unit patients

  • One nurse to five rehabilitation or skilled nursing facility patients

  • One nurse to six well-baby nursery patients

Arguments against safe-staffing ratios primarily revolve around keeping hospitals cost-effective. But according to the Institute for Health & Socio-Economic Policy, hospital income in California grew substantially after 2004 — from $12.5 billion from 1994 to 2003 to $20.6 billion from 2004 to 2010.

That’s partly because unsafe staffing leads to higher rates of costly, hospital-acquired infections and 30-day readmissions. Not to mention, better ratios reduce nurse turnover, saving money on hiring and training new employees.

To get involved in safe-staffing ratio advocacy, you can join the NNU’s safe-staffing ratio coalition, send a letter to Congress showing your support for the legislation, or contact your federal representative directly. You can meet with your state assembly member at the community level and get involved with a local nurses union.

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