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121RN Response to UHW 'Neutrality' on RN Ratios

June 16, 2012

It should be no surprise that there has been a vocal and passionate reaction by our Registered Nurse members to UHW’s efforts in lobbying California’s Federation of Labor to change its long-held position to support and defend nurse staffing ratios. Though UHW characterized their recent action as “neutral,” we have enough experience with the legislative process to know that neutrality is a green light for lawmakers to take action. In this case, UHW was asking the entire labor community to give a green light to the California Hospital Association’s efforts to weaken staffing standards.

UHW’s visionary agreement with the California Hospital Association holds exciting promise for SEIU and the labor movement. We understand the significance of this agreement. However, we don’t build a labor movement by reducing standards for workers. The enactment of staffing standards in California was a historic moment for labor, and represents one of the single most important achievements for the Registered Nurses we represent. That is why enforcing and protecting those nurse-to-patient staffing ratios is a priority for our Union.

The California Hospital Association’s proposal to suspend ratios during meal and rest breaks has significant implications. Because meal and break periods are staggered throughout the day, on a typical nursing unit during a typical shift, as much as half of the day could be classified as a meal or break period for the nurses on duty. That would mean that a nurse’s patient load could double during a significant part of any shift. Faced with the choice of leaving their patients with inadequate coverage or their coworkers with an impossible assignment, nurses will simply refuse to take meal or rest breaks.

We understand that our hospitals – especially our safety net hospitals – are facing significant financial pressures and we are sensitive to these budgetary constraints. But a suspension of ratios introduces new set of issues for our hospitals. Registered Nurse and Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing Linda Aiken has reported that each patient added to nurses’ workloads is associated with a 7 percent increase in mortality following common surgeries.[[1]](javascript:parent.onLocalLink('_ftn1',window.frameElement)) Increased patient workloads are associated with nurse burnout and nurse turnover; staffing ratios have been shown to increase nurse retention. An SEIU study on RN turnover estimated costs of as much as $82,000 to $88,000 to replace an experienced nurse when one quits.

Clearly, there is a strong business case for nurse staffing ratios. They are associated with improved patient outcomes and lower nurse turn-over. And, because nurses will simply forgo a missed meal or rest break, suspending ratios for meal and rest periods will increase missed break penalty costs for employers. There is no evidence that the Hospital Association’s proposal would save our hospitals money in the long run. Having state mandated ratios in place for all times during a shift ensures a level playing field for hospitals who are committed to patient safety and ensuring safe working conditions for our nurse members.

We are calling on UHW to declare nurse-to-patient staffing ratios “off limits” in its ongoing work with the California Hospital Association as they explore cost savings and revenue-generating initiatives. We also stand ready to assist UHW in any way we can to support UHW in its work with the California Hospital Association, as long as we all stand united in support of patient safety standards and standards for workers.

Registered Nurses with questions or concerns about this issue are encouraged to contact SEIU 121RN Executive Director Sue Weinstein, RN, at (213) 247-4586 or

[[1]](javascript:parent.onLocalLink('_ftnref1',window.frameElement)) Aiken, L. H., S. P. Clarke, and D. M. Sloane. 2002. ‘‘Hospital Staffing, Organizational Support, and Quality of Care: Cross-National Findings.’’ International Journal of Quality in Health Care 14 (1): 5–13.