California Law AB 394 --

California Law AB 394 -- Safe Staffing

In the 1990s it became clear in California that there was a need for legislation that would require healthcare facilities to have sufficient numbers of nurses on hand, and AB 394 was authored by three state senators (Burton, Escutia, and Perata) in to fill that need. It was called the "California Safe Staffing Law" and it didn't pass with ease at all. The California Nurse Association explains that it took twelve years to win this legislation. This paper covers the legislation, and what it means in terms of safety for patients and security for nurses.

a law has passed that makes healthcare facilities safer for patients by lowing the ratio of nurses to patients; hence, lives have been saved and more nurses have entered the medical workforce. In the nursing field, this is historic on the part of California; a similar piece of legislation has been introduced in the U.S. Congress by California Senator Barbara Boxer; the specifics of national legislation would emulate California AB 394.

The California Safe Staffing Law

The California Safe Staffing Law was resisted heavily and heartily by the hospital industry and by then governor Arnold Schwarzenegger, according to the California Nurses Association (CNA), which is part of the National Nurses Organizing Committee. In fact Schwarzenegger referred to the CNA as a "special interest group" and he said the CNA didn't like him as governor because "…I'm always kicking their butt" (CNA). When the governor put a special initiative on the November 2005 ballot, the nurses helped organize a "…broad grassroots movement" that defeated Schwarzenegger's initiative and the governor then dropped his attempt to roll back AB 394.

Meantime, over the five years of the official "…phase-in" of AB 394 the new ratios have "revolutionized hospital care and improved patient safety" because the law mandates that hospitals must have "…minimum, specific nurse-to-patient staffing ratios" at all times (Medical News Today -- MNT, 2008). The radios include: a) 1:3 in "Step Down" (transitional units between intensive care and general medical-surgical floors, reduced from 1:4); b) 1:4 in "Telemetry" (this is where patients are hooked up to monitors, it was previously 1:5); c) 1:4 in cancer care units and "Other Specialty Care" units (it was 1:5 ratio) (MNT); d) in surgical units the ratio is now 1 nurse to every 5 patients; and e) in Intensive Care it is 1:2.

"Finally, we have the time to do proper nursing care and fully evaluate each patient's needs," said Kathy Dennis, an RN at Mercy General Hospital in Sacramento. "We now have time to check each patient's chart and make sure there are no treatment delays" (MNT).

The various studies as to the effectiveness of the legislation show positive results, according to an article in the National Nurses United website. In 2012, the Agency of Health Research and Quality (AHRQ) Healthcare Innovations Exchange conducted a study of the California Safe Staffing Law and explained that "…Higher nurse workloads" are linked with "…more patient deaths, complications, and medical errors" (NNU.org).

The Healthcare Risk Management study in 2008 found that adding just one full-time RN on staff each day resulted in "…9% fewer hospital-related deaths in intensive care units" and 16% fewer deaths in surgical units (NNU.org).