Nurses Celebrate California's Return to Safe Staffing Ratios

State's repeal of waivers 'incredible victory for patients and nurses.'

California's waivers of the state's landmark safe staffing ratios will end by February 8—some possibly even sooner—the California Department of Public Health (CDPH) announced Monday.

The CDPH also said it will not approve new expedited staffing waivers.

The announcement was welcome news to more than 100,000 RN members of the California Nurses Association, many of whom had actively protested—some even going on strike—against the waivers.

"This is an incredible victory for patients and nurses, because we know that safe staffing saves lives," said Zenei Triunfo-Cortez, RN, and a president of the California Nurses Association and its national organization, National Nurses United. "It was our collective action as a union that defeated the money and lobbying power of the hospital industry, which we know is focused on the bottom line, not safe patient care."

Hospital employers began applying with CDPH last summer for waivers of California’s safe staffing standards, which specify for various hospital units the maximum number of patients that can be assigned to one nurse—with adjustments made for severity of patient illness.

COVID-19 already had severely strained staffing because care is more complicated, patients are the sickest they've seen, and many staff were unable to work because they themselves had contracted the virus.

In December, CDPH allowed hospitals to automatically obtain blanket "expedited waivers" of safe staffing ratios for critical departments such as the ICU and emergency room, among others.

Nurses have been protesting all waivers of safe staffing standards, arguing that patients need more, not less, care during the pandemic and have staged direct actions inside and outside their hospitals in defense of safe staffing standards, including a mass mobilization most recently on January 27.

California is the only state that stipulates by law a required minimum nurse-to-patient ratio, which occurred after more than 10 years of lobbying and activism. The patient-ratio bill passed the state legislature in 1999, but didn't go into effect until January 2004 followed by several more years of overcoming multiple court challenges, including one from then-Gov. Arnold Schwarzenegger, according to Kaiser Health News.

CDPH's announcement noted that all existing approved staffing waivers will expire February 8, unless CDPH determines on an individual basis that there is an unprecedented circumstance. Otherwise, hospitals must maintain efforts to meet required staffing levels at all times.

If there is any indication that a hospital has not maintained efforts to increase staffing, CDPH will investigate, the announcement said. Additionally, CDPH may do unannounced audits to assess these efforts.

"This win reinforces what we have learned over the decades in defending safe staffing standards against multiple attacks: Fighting back together works," said Triunfo-Cortez. "But we must continue to stay united and vigilant in protecting and enforcing the safe staffing standards we need to provide the kind of nursing care we know our patients deserve. Because we know this won't be the last time the industry tries to get rid of ratios."