California Nurses Celebrate Safe Staffing Ratios in Acute Psychiatric Hospitals

California nurses are marking June 1 as the day long-awaited safe nurse-to-patient staffing ratios finally took effect in the state’s acute psychiatric hospitals, a change they say should improve care for behavioral health patients and strengthen the care registered nurses can provide. The emergency regulations were adopted only after California Nurses Association pressure on the governor and the California Department of Public Health, according to the union.

“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,” said Cathy Kennedy, RN and president of CNA. “All patients deserve a high quality of care and it’s about time the state set safe staffing rules for psych hospitals as we nurses originally intended when we passed this law.”

The staffing rules had been required under California’s landmark safe staffing legislation, A.B. 394, which CNA sponsored and fought to pass in 1999. The state later implemented ratios for general acute-care hospitals in 2004, but for more than two decades did not follow up with regulations for acute psychiatric hospitals. After a San Francisco Chronicle investigation last year reported staffing problems at acute psychiatric hospitals, CNA pushed the state to establish the long-promised rules for those facilities.

According to the union, the latest emergency regulations are a meaningful correction to earlier versions that had been weakened by lobbying from the corporate hospital industry. CNA said nurses played a central role in pushing back on those earlier drafts through public comments, testimony, and direct action. In response, the California Department of Public Health closed major loopholes that could have allowed acute psychiatric hospitals to avoid meaningful staffing ratios and could also have undermined existing RN-to-patient standards in general acute-care hospitals.

The regulations taking effect today include several changes that CNA says reflect nurse advocacy. They remove language that would have allowed one registered nurse to be responsible for as many as 24 patients during a 12-hour shift or 16 patients during an 8-hour shift. They also prohibit averaging staffing ratios across a shift or other time period, do not adopt night shift ratios, and bar nurse administrators and supervisors from being counted toward the ratios when they have non-direct care responsibilities. In addition, the rules say the numerical ratios represent the maximum number of patients an RN can be assigned at one time.

CNA said nurses will need to stay engaged during the permanent rulemaking process to prevent the industry from weakening the standards further. The union said it also wants additional improvements, including language that makes clear the ratios are registered nurse-to-patient ratios, a limit of one RN for no more than four pediatric patients, protection against layoffs of ancillary staff as the rule is implemented, and in-person public hearings so nurses and patients from across the state can be heard before final rules are adopted.

The union said hospitalized patients deserve the same standard of care regardless of facility type, and that effective, meaningful staffing ratios in acute psychiatric hospitals are critical. CNA said the goal is to ensure the same safe staffing protections apply to patients in both acute psychiatric settings and general acute-care hospitals.

California Nurses Association/National Nurses United describes itself as 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.