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Nurse-patient Ratio

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Is this legislative effective to support a positive nursing work environment? To provide safe and efficient patient care, the staffing ratios has been mandated. In 1999, California developed into the first state to mandate minimum nurse-to-patient ratios in hospitals. The California legislature passed Assembly Bill ( AB 394) after years of comprehensive press for political action enforced by the nursing representative unions, including the California Nurses Association (CNA) and the Service Employees International Union ( SEIU). Their goal concerns about patient’s safety and the interrelation between increased nurse workforce and improved patient outcomes ( McHugh, Carthon, Sloane, Wu, Kelly, & Aiken, 2012). In January 2004, California Department of Health Services (DHS) organize the concluding revision of a particular nurse-to-patient ratio in acute hospitals, psychiatric institutions, and specialty hospital. This legislation was focused on establishing a licensed nurses classification to include both registered nurses (RNs) and licensed vocational nurses (LVNs).

The regulation of AB 394 particularized staffing ratios for distinctive unit like for example in medical-surgical wards were agreed at one individual licensed nurse for each five patients except for the specialized unit like intensive care unit, NICU, emergency triage, and critical care unit hospital must be in compliance to mandate patient safety. Supporting AB 394, minimal nurse-to-patient ratios have emerged in excelling licensed nurse staffing ( Donaldson & Shapiro 2010; McHugh et al., 2011). The benefits of improved nurse staffing would help from high patient satisfaction and safeties, better working quality, which would in turn lower the numbers of nurses quitting hospital positions and the nursing occupation. Creating an improved work environment may also bring more individuals to nursing. And finally, that nurse staffing has changed, additional analysis must determine the impact on the expenditure, results, and cost-effectiveness on hospitals. Nursing employment construct a substantial effect on hospital expenses, and evaluation of the California’s policy outcome issues ( Aiken et al., 2010; Cook et al., 2010, Donaldson and Shapiro 2010; Hickey et al., 2011).

Future research must determine the cost related to the legislation and analyze whether these staffing variations change the patient event and quality. An alternate approach might mandate with monetary and other support for those organizations most in need. Controversial aspects of education the nursing the nursing profession, healthcare organization, consumers, and others Mandated nurse-to-patient ratios are a controversial topic in healthcare. In this process, state laws are organized that require a certain level of staffing within a particular unit. Organizations such as hospitals must balance income with expenditures, the nurses, and patient safety may be a compromised by this process. For Education-Nursing Shortage: The nursing shortage is a growing concern in the United States (US). The baby boomers enter their senior year which is causing more demand for qualified healthcare professionals. The US will need to produce 1.13 million new registered nurse (RNs) by 2012-2022 to fill the created jobs and replace the baby boomers ( Bureau of Labor Statistics, 2013).

With the nursing shortage rising enormous, hospital staffing is threatened in seeking a licensed nurse to fill the vacancies created by mandated ratio. ANA is proposing definite actions associated with federal funding, nursing education and hiring practices to assure adequate nursing workforce demand. Possible solution to address nursing shortage includes, increasing RN education funding, grant for loan forgiveness, multi-state partnership among community college, share curriculum, resources, funding more faculty members, expanding the available clinical BSN programs, consider more job opening for new graduates, induction of seminars and spread the awareness of high pay regarding the opportunities in nursing profession. Nursing Profession: When nurse staffing is inadequate, nurse workload arises and the patient care can be compromised, due to ineffective delivery of nursing care that affects the quality ( Kalisch, Landstrom, & Williams 2009; Kalisch & Lee, 2010).

Expanded workload due to inadequate staffing may lead to human errors. The advantage of minimum nurse staffing may result in better patient outcomes ( Blegen et al., 2011). Thus increasing nurse staffing will lessen unattended care and human errors, that may lead to high quality of patient care. Healthcare Organization: The current staffing policies are mandated by two factors that includes, the financial effects on the hospital and the lack of sufficient staff levels in the hospital. The hospital administration points to a lack of available nurses as the reason for insufficient staff. By requiring a particular ratio, an organization total compensation cost may actually increase due to factors such as an increased overtime pay for the nurses. In addition to implementing mandatory overtime, employees often use registry and traveling nurses to fill the gaps in nursing staffing that is expensive without guaranteed reimbursement for insurance payments.


Mark, B. A., & Harless, D. W. (2012). California’s minimum Nurse Staffing Legislation: Results from a natural experiment. Health Services Research, 48(2 pt1), p. 435-454. doi: 10.1111/j.1475-6773.2012.01465.x McHugh, M. D., Carthon, M. B., Sloane, D. M., Wu, E., Kelly, L., & Aiken, L. H. (2012). Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lesson from California. The Milbank Quarterly, 90(1), pp. 160-186. doi: 10.111/j.1468-0009.211.00658

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