FOR: March 1, 2023
CONTACT: Hal Weiss (213) 247-4585

Patient advocates point to the vital role of staffing ratios in ensuring patient safety and in stemming the tide of nurses leaving the bedside.

Oxnard, CA – Nurses with the Service Employees International Union Local 121RN (SEIU 121RN) held a rally and press conference at a Ventura County regional office of the California Department of Public Health (CDPH) Tuesday to demand that the agency enforce safe staffing laws, which were largely put on hold after California’s COVID-19 state of emergency was declared nearly three years ago. That emergency order is now lifted, and nurses say CDPH must now act in accordance with its mission of protecting the public health, by penalizing hospitals that violate safe staffing laws in ways that impact patient care.

Specifically, nurses and their supporters point to CDPH’s authority under Senate Bill 227, dubbed the “Stop Repeat Offender Hospitals Bill” as the mechanism to enforce the law. The law requires CDPH to issue significant fines to hospitals—up to $30,000—for repeated violations of nurse-to-patient ratios outlined in California’s Title 22. Nurses say that they saw no enforcement of the law during the pandemic, a time when they needed the most support to care for the sickest patients.

The lack of sufficient staffing was the catalyst for what has widely been called a healthcare “burnout crisis”, forcing thousands of bedside nurses out of the industry, nurses say. Chronic unsafe staffing is a problem that preexisted the pandemic by years, they say, and which has persisted even in hospitals that have a low census of COVID patients, or where nurses are not out due to illness.

Corina Haney is a Registered Nurse in the burn unit at West Hills Hospital in Los Angeles, which is owned by Hospital Corporation of America (HCA) the nation’s largest and most profitable operator. Standing in front of CDPH’s Ventura County offices, she described a litany of negative patient outcomes that can result when nurses in her department are not staffed in accordance with the nurse-to-patient ratios, including medication delays and more.

“I want to be able to give my patients my full attention,” Haney said. “That means taking time to educate them about what to do and not do to recover properly. It means going slow on their dressings—not rushing to get to the next patient. If we’re not following our ratios, we’re cheating our patients out of the care that they deserve.”

SB227 was signed into law in 2019. Its passage was the culmination of a statewide campaign, spurred by SEIU 121RN and designed to strengthen California’s existing nurse-to-patient ratios, which had been in effect since 2004. The law took effect on January 1, 2020, just months before COVID-19 brought with it a sudden influx of critically ill patients, and a multitude of new challenges for hospitals. The declaration of the emergency order on March 4, 2020 gave broad powers to agency directors to use their discretion on enforcement of laws. For CDPH, that meant not penalizing hospitals for violating the law in accordance with SB227. A further declaration specifically instructed CDPH to focus on enforcement only when “there are allegations of the most serious violations impacting health and safety.”

Nurses say that responses to staffing complaints were slow or that they never received a response at all—even when the complaint involved potential patient harm.

Gina Young works in the subacute unit Dignity-Health owned St. John’s Regional Medical Center in Ventura County, where she treats long term care patients who are often on respirators. Her unit was hit particularly hard by COVID-19. Young described a December, 2021 incident, during which a single RN on her unit was assigned 72 patients on two floors. Title 22 calls for four RN care hours in a 24-hour period for each patient, which typically means a ratio of one nurse to every 26 patients.

“We were lucky we didn’t have a fatal emergency that night,” Young said. “But we should never rely on luck in healthcare.”

Young filed a complaint immediately, but it did not receive a resolution for six months. When she made calls to CDPH offices to follow up, she was told that they too needed more staff.

Nurses expressed hope that their call for enforcement would not fall on deaf ears. They encouraged the agency to invest in and support their evaluators so that they can do their jobs for patients throughout California.

California Treasurer Fiona Ma, who joined nurses at their rally, cited the responsibility of all government officials in supporting healthcare workers and protecting patients.

“All of us in government have an obligation to uphold the laws that are made in the California legislature,” Ma said. “We also have a duty to protect California’s nurses, who put themselves in harm’s way every day. We can do that by enforcing our safe hospital staffing laws, starting now.”

Nurses and their advocates say that without enforcement of the law, hospitals will continue to intentionally understaff their units as a cost-cutting measure. They point out that large hospital corporations like HCA earn billions in profit, but run many of their hospitals on skeleton staffs.

“When hospitals willfully staff unsafely, patients are not getting the care they are entitled to receive,” said SEIU 121RN Executive Director Rosanna Mendez. “These laws were designed to protect public safety, and they were meant to be followed. No hospital should be above the law, and nurses who advocate for their patients should not be subjected to retaliation. Nurses are leaving the bedside because they can’t do their jobs for patients, and that is leading us to a public health crisis. Hospitals can’t function without nurses.”

The laws should act as a deterrent to chronic unsafe staffing, nurses argue, but the lack of enforcement—coupled with retaliation against nurses who advocate for their patients—creates an environment of fear for nurses and leaves patients without protection and adequate care.

Haney described a “culture of fear” at her hospital, where concern about retaliation from hospital management for speaking out keeps many colleagues from issuing official complaints. In addition to demanding enforcement of the law, SEIU 121RN nurses called on CDPH to instruct investigators to meet with complainants in private.
“It is the perfect recipe for destroying our morale, and that is exactly what has happened,” Haney said. “The solution lies within CDPH.”

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SEIU Local 121RN represents registered nurses and other healthcare professionals in California. This member-led organization is committed to supporting optimum working conditions that allow nurses to provide quality patient care and safety.