Nurse-Patient Ratios: Lobbying a Policy Change

Improper nurse-patient ratios in many hospitals indeed represent a significant problem. It is one of the workplace factors that are associated with burnout and job dissatisfaction, often leading nurses to quit the profession and, in this way, aggravating the issue of workforce shortage (McHugh & Ma, 2014). In addition, nurse staffing levels are strongly correlated with the overall patient outcomes, including in-hospital mortality because, in the context of increased workloads, practitioners inevitably omit some care tasks (Griffiths et al., 2018). For this reason, it is pivotal for nurses to advocate for the improvement of nurse-patient ratios.

It seems that the introduction of a mandatory minimum nurse staffing standard at the national level would be a great solution to the problem and, luckily, the case of California’s legislation provides an example. As the study by Mark, Harless, Spetz, Reiter and Pink (2012) reveals, within a decade after the legislation was adopted, Californian hospitals demonstrated a significant increase in their nursing staff ratios, whereas hospitals in other states showed less successful results. In order to achieve excellent outcomes across the country, it may be suggested for nurses to engage in a detailed study of California’s case. As researchers, advocates, and policymakers, nurses should examine all the pros and cons of implementing the minimum nurse staffing standard by conducting a cost-benefit analysis of actions that took place in California. It would also be appropriate to investigate factors that served as facilitators and barriers to the improvement of the nurse-patient ratio in distinct state hospitals, as well as perceptions of nurses and other practitioners who work there. All these types of evidence can consequently help to support the development of advocacy campaigns and arguments that one may use when lobbying a policy change.


Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., … Missed Care Study Group (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487.

Mark, B. A., Harless, D. W., Spetz, J., Reiter, K. L., & Pink, G. H. (2012). California’s minimum nurse staffing legislation: Results from a natural experiment. Health Services Research, 48(2 Pt 1), 435-454.

McHugh, M. D., & Ma, C. (2014). Wage, work environment, and staffing: Effects on nurse outcomes. Policy, Politics & Nursing Practice, 15(3-4), 72-80.