“You never forget those times when you know you’ve truly saved a life,” says Registered Nurse Miriam Cortez. “Like the time we had a patient ready for medical transport to a nursing facility. He’d had a head trauma and began vomiting while waiting to be transported. I knew that was a red flag, possibly indicating a sudden change in brain pressure. I immediately assessed his condition and called the doctor, and a brain scan showed that there had been a major shift in the brain. So instead of transporting the young man out of the hospital, he went straight to ICU.”

Whenever Miriam hears about hospitals pushing their nurses to work out of ratio, she remembers that moment. What if she’d been overloaded? What if attending to the extra patients meant that she’d missed that young man’s symptoms? What if the distraction of too many requests robbed her of critical thinking skills when they were most needed?

“We’re talking life and death here,” says Miriam. “They’ve done studies that show mortality rates really do go up when nurses are out of ratio. I mean think about it: if I’m on a 12-hour shift and you throw just one more patient in the mix, that’s like taking almost half an hour of care or more from each patient. That means they’re forcing you to cut corners and rush. That means not noticing important things.”

It’s that critical assessment time that worries Miriam most—those moments when nurses often catch issues early.

And that’s why, Miriam explains, she stood firm for patient safety one morning when management directed her to take an unlawful six patient assignment.

“I got to the floor at the beginning of my shift,” says Miriam. “And when I was handed my assignments, I saw that I had six patients—in violation of state standards, against the law. I’d been out of ratio before, but that morning, I just saw so clearly the scope and importance of not being out of ratio, how unsafe it is for patients and staff…so I accepted a five patient assignment and told my manager I couldn’t accept a sixth.”

Miriam proceeded to introduce herself to her patients. And that’s when management went into a familiar pattern of intimidation and bullying that is frequently seen on her floor. Her manager and director called her into management's office.

“They actually asked me, ‘If you’re so concerned about patient care, why don’t you care about this sixth patient?’ It was like they were questioning—even mocking—my concern for patients. I had one patient that day who was dying and another who’d just come out of ICU with complications. I’ve developed good nursing judgment. I knew the level of care that would be required for these patients. I held my ground. I said, ‘I’m sorry. It’s unsafe. I can’t do it.’”

They continued to push and threaten Miriam, questioning again her commitment to patient care and to the unit. Miriam was frustrated that management was bullying her instead of attempting to find a solution to provide for patient and nursing safety. Instead of finding a solution, management suspended Miriam and wrote her up for insubordination. They sent her home without pay. She still has a disciplinary suspension on her record—and Miriam, with her union, is still fighting this. It was the employer who broke the law, not Miriam. This type of retaliation against nurses puts them in fear when they want to advocate for patient safety. It’s an attempt to silence conscientious nurses.

It’s pretty simple. The laws are there for a reason: to protect patients and nurses. That’s why Registered Nurses like Miriam worked with Assemblymember Freddie Rodriguez (D-Pomona) to introduce AB 1102: The Protect Hospital Patient Safety Act (which amends Section 1278.5 of the Health and Safety Code).

The Governor agreed with us and signed this legislation into law on September 25, 2017.