SEIU Nurses in California led the way in establishing minimum staffing levels, starting when SEIU nurses at San Francisco General Hospital negotiated contract provisions in 1983 to enforce safe staffing practices. This fight for safer staffing levels went hand-in-hand with their struggle to care for AIDS patients and establish needle safety practices.

The fight for safe staffing quickly grew to a statewide SEIU effort, culminating in the passage of California's Assembly Bill 394 (Kuehl) in 1999, a law establishing minimum nurse-to-patient ratios with the aim of increasing patient safety in hospitals and improving the quality of care and nurse retention rates.

In 2008—nearly a decade later—the rulemaking and final implementation was completed. Nearly all of SEIU Nurses’ recommendations made it into the final ratios for every department outlined in Title 22 of the California Code of Regulations.

Twenty years later, SEIU Nurse won another long fight: in 2019, Governor Newsom signed Senate Bill 227 (Leyva)—our Stop Repeat Offender Hospitals bill—which gave us an enforcement mechanism to inspect and fine hospitals that ignore these Title 22 regulations. Read more about Senate Bill 227 here.

Also twenty years later, California remains the only state in the country with nurse-to-patient ratio regulations for every acute care hospital unit.