Nurses march in Sacramento for safe staffing

By Elsa Swanson

Hundreds of registered nurses from across California marched through downtown Sacramento in late January to defend the state’s landmark nurse-to-patient staffing ratios and to warn against proposed rules they say would weaken patient care in acute psychiatric hospitals.

The march, organized by the California Nurses Association (CNA), began at Cesar Chavez Plaza and ended at the California Health & Human Services Agency. Nurses said they were there to push back against a California Department of Public Health (CDPH) proposal that sets staffing standards for acute psychiatric hospitals but, in their view, falls far short of what patients and nurses need.

“The new ratios for acute psychiatric hospitals can, should, and must extend the standards from existing ratios for general acute care hospitals,” said Sandy Reding, RN, president of CNA, in a statement. “We fully support RN ratios for acute psychiatric hospitals, and we want the nurses in those hospitals to have the same strong standards the rest of us do.”

California made history more than 20 years ago when it became the first state in the nation to require minimum registered nurse-to-patient ratios in hospitals. That law, Assembly Bill 394, was passed in 1999 after years of organizing by nurses and was designed to make sure patients receive safe, high-quality care. The current CDPH proposal is meant to fulfill that law by extending staffing rules to acute psychiatric hospitals.

But CNA nurses say the draft regulations are filled with loopholes that make the proposed ratios weak and misleading. Even worse, they argue, the new rules could threaten the stronger staffing protections that already exist in general acute-care hospitals.

Under current law, only registered nurses count toward staffing ratios in general acute-care hospitals. In pediatric units, the ratio must be at least one nurse for every four children. The proposed rules for acute psychiatric hospitals would lower that standard, allowing one nurse for every five children and permitting licensed vocational nurses (LVNs) and psychiatric technicians to count for up to half of the staffing numbers.

Nurses say that change matters. While LVNs and psych techs are important members of care teams, CNA leaders stress they do not have the same training or legal responsibility as registered nurses. Under California law, only RNs can perform comprehensive patient assessments and develop care plans.

By counting non-RNs toward staffing ratios, CNA says the state is creating a false sense of safety. In practice, the draft proposal could leave one RN responsible for as many as 24 patients during a 12-hour shift, or 16 patients in an eight-hour shift. That works out to about 30 minutes per patient for an entire shift, the union said.

“That’s nowhere near enough time,” nurses said in a statement, especially in psychiatric settings where patients may be in crisis and need close monitoring.

CNA also warned that approving weaker standards for psychiatric hospitals could open the door for hospital employers to push similar cutbacks elsewhere. Nurses fear the industry will use the lower bar as a new baseline, chipping away at the hard-won ratios that apply to general hospitals.

The concerns come as attention has focused on dangerous conditions inside some psychiatric facilities. A San Francisco Chronicle investigative series found that understaffing in psychiatric hospitals has contributed to serious patient harm and even deaths. CNA nurses say meaningful staffing reform is badly needed—but not at the expense of patient safety.

Another major issue raised at the march was the proposal to rely on multidisciplinary staffing committees to decide when more staff are needed. Nurses argue that without clear language protecting RN authority, those committees could allow non-nurses or management to overrule nurses’ professional judgment.

“There’s no reason for that other than creating loopholes for employers,” CNA leaders said.

The Sacramento march was part of a larger national movement by nurses. Thousands of members of National Nurses United (NNU), including many in Northern California, have taken part in recent rallies calling for safe staffing, protections against workplace violence, and limits on the use of artificial intelligence in patient care. More than 100,000 NNU nurses are preparing to enter contract negotiations this year.

“We will fight fearlessly against the profit-driven hospital industry, which seeks to undermine nursing care through unconscionable understaffing and reckless automation,” said Nancy Hagans, RN, president of NNU.

CNA represents more than 100,000 registered nurses statewide and is affiliated with NNU, the nation’s largest nurses union. Nurses at the march said their message was simple: patients in psychiatric hospitals deserve the same level of care as anyone else, and safe RN-to-patient ratios should never be weakened.