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Connecting the Dots on Nurse Staffing Ratio Penalties

Earlier this year, we predicted a long and tough fight in the Legislature on nurse staffing ratio penalties. The battle isn’t over yet, but we’ve made some important headway in telling the hospital story – and, by extension, the patient story – to Sacramento lawmakers, all of which has resulted in important changes to the bill.

Senate Bill 227 (Leyva, D-Chino) would assess additional hospital penalties for those that violate staffing ratios. Throughout this year, we’ve not wavered in our stance that these penalties are duplicative and excessive. We continue to oppose the bill, but want you to be aware of several changes we’ve secured that significantly mitigate its impact on your hospitals.

  • CHA secured an amendment that reduces the penalties by half of what was introduced earlier this year.
  • We won an amendment that excludes from penalty times when hospitals are out of ratio due to “unforeseen and unpredictable” circumstances, restoring critical flexibility in managing the ratio requirements.
  • We successfully removed a provision that would have prescribed a rigid process for hospitals to follow in meeting required nurse staffing levels, going so far as to dictate that hospitals exhaust their list of “on-call” nurses before assigning a charge nurse.

With the help of letters, emails, visits, and calls to legislators from many of you, we’ve been successful in assuring lawmakers that everyone – hospitals, patients, and nurses – is better off when clinical professionals retain some autonomy when it comes to decisions about their own patients.

And you helped us educate legislators on the fact that not all hospitals have the same options for nurse coverage, especially in rural areas of the state, and that patient needs can shift minute-to-minute, where surge events can unexpectedly demand resources and staff in a way that doesn’t align with staffing ratios, exposing hospitals to the unjustified threat of violations.

CHA’s efforts on SB 227 reflect our partnership on multiple levels before lawmakers, regulators, and the public: connecting each dot necessary to ultimately tell the complete hospital story. We’ll press on in our fight against the financial penalties in SB 227 — and we’ll continue to support you in your mission of care by helping others more fully understand how you accomplish it.

— Carmela