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California is the only state that currently has legislation supporting a minimum nurse staffing law. Similar laws in other states have failed to pass. New York, Texas, Florida, New Jersey, Iowa, Minnesota, and Washington, DC, are considering legislation that requires hospitals to have aminimum number of nurses on staff at all times. Support for these laws fromnurses and nursing organizations is mixed. However, nurses will concede that inappropriate nursing staff endangers patients. A 2004 survey carried out by the US Agency for Healthcare Research and Quality determined that patients in hospitals with low nurse-to-patient ratios fare worse than do the patients receiving care in hospitals with higher ratios. Evidence is conflicted as to whether mandating a ratio actually leads to improved patient health.


Hospital administrators are usually opposed to these laws. The argument is that the legislation removes the ability to make staffing decisions and also creates a financial burden for the healthcare facilities.


Dawn Kettinger, speaking for the Minnesota Nurses Association in support of nurse-to-patient ratio legislation, says the laws are attempting to create a standard for hospitals that simply requires adequate staffing. Ms Kettinger and others emphasize that hospitals have not willingly established that standard in the absence of legislation.


Nurses in California report that providing patient care is more manageable, thanks to the laws. However, they also note that the laws provide scheduling challenges. For example, if a nurse takes a break, another nurse has to be available to cover for her in order to maintain the staffing ratios.


Janet Haebler of the American Nurses Association comments that legislating nurse-to-patient ratios is not the way to solve staffing problems. The American Nurses Association supports laws that require hospitals to establish committees wherein nurses and administrator cooperate to create appropriate staffing plans. She notes that input from nurses in staffing decisions is critical.


The controversy will continue. As we participate in revolutionary changes in healthcare, we are advised to examineevidence to determine if we support legislation for nurse-to-patient ratios or if we can depend on each facility to make these decisions. We need our voices and those of our students to be heard in relation to this issue.


Source: Schultz D. Nurses fighting state by state for minimum staffing laws. April 24, 2013. Kaiser Health News. MedScape Nurses News. Available at http://\. Accessed June 10, 2013.


Submitted by: Alma Jackson, PhD, RN, COHN-S, News Editor at