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Nurse-to-Patient Ratios Legislation Proposal


The problem/concern

The problem at hand is insufficient nurse-to-patient ratios often occurring in healthcare facilities of different kinds and specializations. The major causes of this problem are the shortage of skilled nurses and high nurse turnover in healthcare organizations. The lack of clear legislation limiting the ratios based on the shortage of nurses leads to excessive workloads and long shifts for the remaining nursing professionals. In turn, due to the insufficient ratios, the lives and health of patients become endangered because nurses are overwhelmed by heavy workloads.

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The proposal

The proposed idea is a bill for the future policy that needs to be applied across the entire country. This policy would aim to establish safe nurse-to-patient ratios for various kinds of healthcare facilities and enforce the limits based on the number of nurses working at the facility at any given period. However, this proposal is tightly connected to another issue. In particular, the regulations directed at the establishment of limitations of unfair nurse-to-patient ratios are always related to policies aimed at the enforcement of mandatory disclosure of staffing ratios by healthcare organizations.


Studies, reports, personal experience

It isn’t easy to believe that, in many organizations, the importance of fair nurse-to-patient ratios is strongly underestimated. This problem has been researched for quite some time now, and it is confirmed that there are safe and unsafe ratios. The unsafe ones are unacceptable because they tend to result in negative patient outcomes (Frith, Anderson, Tseng, & Fong, 2012; MacPhee, Dahinten, & Havaei, 2017). Optimal staffing is linked to the quality of nursing care, the rates of medical error, and the overall organizational performance (Avalere Health LLC, 2015). Safe nurse-to-patient ratios are beneficial for nurses and their patients because they prevent work-related stress and job dissatisfaction.

Similar legislation introduced or passed in other states

Several legislations, known as “ratios bills,” were introduced over the last years (Castillo, 2017). Their aims were similar to the objectives of the proposed bill. The issue that stimulated the appearance of these bills is the absence of clear, safe ratios across the country. This tendency is highly dangerous as it can result in medical errors and the loss of patients’ lives.

Assessment: Finances and Stakeholders

The financial impact

Financially, the proposed legislation could become a burden for many healthcare organizations and facilities. This is the case because the inflow of patients equals the inflow of income and funding. Limited nurse-to-patient ratios will stand for the limitations on the number of accommodated patients in understaffed facilities. In turn, this may lead to the outflow of workers due to low salaries. However, the costs of lawsuits and extended patient stays can be saved due to the improved quality of care.

The stakeholder groups that would support this bill

The major stakeholder groups that would support the proposed bill are nurses and patients. They are the primary groups that would be affected by the policy. They would support the bill because their safety and wellbeing depend directly on its presence and enforcement.

The groups that would oppose this bill

The major stakeholder group that is the most likely to oppose this bill is represented by healthcare organizations. The shortage of nursing professionals is a known problem; however, despite its prevalence, the role of healthcare facilities is to provide help to all the patients who need it. Having to reject patients, organizations may lose income, recognition, and a good reputation.

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To discuss the proposed policy, a local legislative authority needs to be contacted for an appointment. The team of individuals introducing the bill has to include several professionals from different healthcare organizations, practitioners who operate as leaders in healthcare, and several spokespersons from the community representing the voices of patients.


Avalere Health LLC. (2015). Optimal nurse staffing to improve quality of care and patient outcomes: Executive summary. Web.

Castillo, B. (2017). New national ‘ratios’ bills set safety limits on number of patients assigned to nurses.

Frith, K., Anderson, E., Tseng, F., & Fong, E. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing Economics, 30(5), 288-293.

MacPhee, M., Dahinten, V., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(7), 1-17.

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