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Nurse-to-Patient Ratios



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    In the article, Coffman, Seago, and Spetz (2002) questioned that mandating minimum nurse-to-patient ratios could eventually help to improve outcomes and conditions of both nurses and patients in acute care hospitals in California. They found that mandatory ratios could create opportunity costs that were not easily measured and that might outweigh their benefits. They also suggested that policymakers should consider other strategies or approaches to address nurse’ concerns on hospital staffing and enhance their job satisfaction and retention in hospital facilities.

    The authors showed that proponents of Assembly Bill 394 emphasized its potential to improve the quality of care provided to patients and reduce the turnover in nursing staff in California hospitals, but it also created more problems in hospitals. The potential benefits of Assembly Bill included helping to alleviate the nursing shortage, improve working conditions, and attract more young persons to nursing.

    In the meantime, the authors also reported that many California hospitals and their units were not in compliance with proposed minimum nurse-to-patient ratios. The minimum nurse-to-patient ratios increased hospital expenditures. Hiring registry and traveling nurses and increasing LVN staffing would increase hospital expenditures and lower quality of patients’ care. Because of mandatory ratios, hospitals were most likely to reduce other personal and increase the amount of nonnursing work performed by Registered Nurses.

    Mandating minimum nurse-to-patient ratios also discouraged innovation in the development of other types of health professionals by hospitals and in the amounts and combinations of labor and capital. The authors concluded that the cost of mandatory ratios outweighed the benefits, so the policymakers should explore other approaches instead of simply mandating minimum nurse-to-patient ratios. As one of the nurses, of course I support and desperately want to mandate minimum nurse-to-patient ratios.

    Minimum ratios definitely help to reduce nurses’ burnout and increase our job satisfaction, but mandatory ratios don’t guarantee improved quality of patient care or better outcome for patients, since patient outcomes depend not only on the nurses, but also on other factors such as physicians, healing environment, severity of patients’ illnesses, etc. To promote the best quality of nursing care, maintaining adequate and more realistic nurse-to-patient ratios should be necessary.

    During my nursing management clinical rotations, I notice that a nurse usually needs to take care of 37 to 42 patients who are mentally retarded and most of them also have different levels of psychological illnesses at the same time. It is extremely challenging and stressful for individual nurse who works in this facility. Nurses also believe that they are not able to provide basic nursing care to patients, and it is unsafe for patients, too.

    To promote adequate nurse-to-patient ratios, facilities should adopt Patient Classification System which is a tool to determine the patient nursing care needs. Each nurse is required to fill out this document when he/she provides nursing care for this patient. Charge nurses can use this tool to assign how many patients to individual nurse. In conclusion, it is more effective in solving under-staffing in nursing than mandating nurse-to-patient ratios.


    Coffman, J. M., Seago, J. A., & Spetz, J. (2002). Minimum nurse-to-patient ratios in acute care hospitals in California. Health Affairs, 21(5), 53-64. Retrieved from

    Nurse-to-Patient Ratios. (2017, Feb 27). Retrieved from

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