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Should all states mandate a Nurse to Patient Ratio?

Stressed and overwhelmed at work? Does staffing ALWAYS seem to be a problem? This seems like a reoccurring them in hospitals in most places but not all. Federal regulations state that hospitals receiving federal funding must have adequate licensed nurses to provide care to all patients “as necessary”. However, what does “as necessary” even mean? The vagueness of this regulation leaves the interpretation up to those responsible for appropriate staffing. This allows nurse administrators to push limits regarding staffing to facilitate the care for all patients, with front-end nurses carrying the burden. Formerly working as a medical-surgical nurses, There were some days where we would have up to eight patients, That is insane! How can really care for 8 patient safely?! Most nights you feel like you barely made it out of there.

Since there is not an exact formula or ratio to safe-staffing, Lawmakers have not been able to agree on a national standard. So what are the benefits of nurse-staffing law? Well ethically speaking, improving staffing levels promotes the dignity of the nursing profession. Nurses strive to provide quality care that is safe and effective. It also increases nurse satisfaction, which leads to nurse retention. Busy medical floors are often overwhelmed by inadequate staffing due to high turnover rates, which are a result of nurse dissatisfaction and burnout. Ever felt "the burn"? We've all been there. However, In California (the only state with a nurse staffing law) where there is 1 to 5 nurse-patient ratio, nurse satisfaction increased for all RNs working in acute care between 2004 and 2008 (Tellez & Seago, 2013).

{Patricia} I've had the pleasure of working in California through a travel agency. I must say, it was an awesome experience! Yes, there were busy days. However, I did not once feel as if my load was unsafe. Also, there was plenty of support available to help me along the way. The biggest difference that I noticed immediately was the positive atmosphere and overall job satisfaction. No exaggeration, I barely heard nurses complaining at all...and I never once heard someone complain about staffing.

So if a mandatory nurse staffing law is so great, why haven’t they implemented this? Why is it not backed by the American Nurses Association? The answer is because it is possible that it could do more harm than good economically. This law could require hospitals to hire more nurses without necessarily an increase in revenue. In order to combat this law, it might cause hospitals to cut back on necessary support staff that we need to function smoothly. On the other hand, we must also consider that it would actually increase total revenue indirectly through lower infection rates or decreased falls. If nurses had less patients and had more time to thoroughly assess skin breakdown, would hospitals save more money on hospital acquired pressure ulcers? Maybe…

We may never come to complete agreement on the perfect nurse to patient ratio. However, what we can agree on is that improved working environments yield nurses that are more satisfied with their position and innovative in their practice. As nurses, we must continue to advocate for

finding solutions to these poor staffing conditions that affect us daily and create a negative working environment. Open discussion about a staffing policy can be the first step towards improving the staffing issues that plague nurses all across the United States.


Tellez, M., & Seago, J. (2013). California nurse staffing law and RN workforce changes. Nursing Economics, 31(1), 18–28.

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