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Mandating nurse staffing ratios

The study also found that increasing staffing levels for all nursing personnel—RNs, LPNs, and certified nurse assistants (CNAs)—contributes to fewer adverse patient outcomes.

Sharing such information with hospital administrators may allay fears that worthwhile hospital initiatives have to take a backseat to hiring nursing staff.

(See Requirements for staffing systems in pdf format by clicking on the download now button.) In a few states, some interesting alternatives to mandated nurse-patient ratios have evolved.

In New Jersey, hospitals are required to publicly post the ratio of healthcare workers, including RNs, LPNs, and CNAs.

In Massachusetts, the mandatory nurse-patient ratios law has a provision for adjusting staffing ratios based on patient needs. Problems with mandatory ratios The California law says that only licensed nurses providing direct patient care can be included in the ratios.

But licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) can account for up to 50% of the licensed nurses on most units, and the law doesn’t distinguish RNs from LPNs and LVNs.

Other states haven’t followed California’s lead, most likely for a few reasons. Legislated nurse-patient ratios perpetuate the myth that “a nurse is a nurse” by failing to account for differences in nurses’ skill levels and expertise as well as hospital resources and other support for nursing care.

Second, to meet mandated ratios, many California hospitals are laying off unlicensed healthcare personnel, housekeepers, and other support staff.

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Since then, many states have considered mandated ratios as well as some alternative staffing solutions for all healthcare facilities.

Illinois passed the “Patient Acuity Staffing Plan,” which allows hospitals the flexibility to meet changing patient-care needs but also requires input from direct-care RNs.

Although legislation in Nevada passed in 2003, a subcommittee has been appointed to conduct a study on staffing ratios, so the law hasn’t yet been implemented.

In facilities that must increase nursing staff to meet mandated ratios, investments in technology and facilities that would improve care may need to be deferred.

However, at least one study shows that hiring more RNs didn’t significantly decrease the hospital’s profit.


  1. Mandated nurse staffing ratios, and their effects on patient care and nurses' flexibility, spark intense debate. Read both sides' positions, and listen to our

  2. Staffing and Workforce Development. flexibility of nurse staffing that goes beyond fixed nurse-to-patient ratios is. Relying on staffing ratios alone.

  3. Impact of Mandatory Nursing Staffing Levels on Patient. had patient-to-nurse ratios in Pennsylvania and New Jersey been consistent with those in California.

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