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What remains constant and vital at any time in healthcare is ensuring the delivery of high-quality care. As we step into 2024, it is crucial to delve into the heart of this relationship, focusing on the principal critical factor that significantly influences the patient’s experience: staffing ratios. 

This article explores the essential link between these ratios and the delivery of high-quality healthcare. 

The Impact of Nurse-to-Patient Ratios 

Generally, the standard rule of thumb is to have a nurse-to-patient ratio of 1:4-5 in medical–surgical units, 1:3-4 in intermediate units, and 1:2 in ICUs 2. However, staffing shortages have resulted in heavier nursing workloads, and nurses in every state care for, on average, 6.3 patients per patient, far exceeding the 4-patient ratio proposed by the American Nurses Association.¹ 

Related Reading: 2023 Nursing Shortage: A Necessary Cultural Shift in Healthcare Delivery 

Impact on Nursing Outcomes 

Nurse staffing ratios are more than just numbers on a schedule. They even extend beyond the scope of medical procedures. Nurse staffing ratios dictate the time and attention each nurse can provide to each patient, fostering a culture of patient-centered care. 

Research consistently underscores the direct correlation between nurse-to-patient ratios and patient outcomes. Researchers determined that in-hospital mortality increased by 7% for each additional medical patient and 8% for each surgical patient added to nurses’ workloads.² Adequate staffing ratios have also been linked to reduced mortality rates, lower infection rates, and overall better patient satisfaction. 

The demands on healthcare systems have surged, particularly during and after the pandemic, and with them, the burden on nursing professionals. Inadequate staffing ratios can lead to nurse burnout, compromising the quality of care and potentially jeopardizing patient safety.³  

Furthermore, patients may experience longer wait times, reduced communication with their nurses, and a diminished sense of support during their healthcare journey. 

The Oregon Nurses Association (ONA) has advocated for staffing requirements for years, but the issue has gained more attention because of the COVID-19 pandemic. To understand the urgency of the ONA’s call, we must listen to the voices of those on the frontlines—the nurses. 

Related Reading: How’s The Nursing Shortage Now? 4 Takeaways From the 2023 Visa Bulletin 

Where Nurses Stand On Nurse-to-Patient Ratio Issues 

Nurses recount narratives of resilience amid adversity amid nurse-to-patient ratio issues. According to data from the Oregon Nurses Association, 27% of active nurses left their jobs in 2022, and more than a third say they will likely quit this year.⁴  

Challenges such as prolonged work hours and consistently high patient loads contribute to a prevailing sense of overwork, stress, and burnout. Beyond physical exhaustion, nurses have also cited the severe effects of inadequate staffing rations on their mental and emotional health. 

Nurses also draw attention to a crucial factor of this issue—the direct impact on patient safety. As patient loads escalate and staffing levels remain insufficient, the potential for medical errors increases. Nurses leading patient care understand the impact of insufficient staffing. They speak up for their well-being and the safety of each patient in dealing with nurse-to-patient ratio challenges.  

Related Reading: Everything You Need to Know About the US Nurses Bill of Rights 

A Proposed Solution for Nursing Staffing Shortages 

House Bill 2697, advocated by the Oregon Nurses Association, proposes mandatory nurse-to-patient ratios in hospitals and significant fines for breaches. Supporters believe it’s vital for improving work conditions and countering prolonged low staffing due to financially cautious hospitals. 

The bill would mandate hospitals to meet specific staffing ratios carefully tailored to the type of unit and health of patients.⁵ The idea is to align staffing levels with the complexity and demands of patient care. For example, an intensive care unit (ICU) may require a different ratio than a general medical-surgical unit, recognizing the specialized skills and attention demanded in each setting. 

The proposed legislation aims to reduce nurse turnover and promote an environment prioritizing healthcare professionals’ well-being and maintaining high-quality patient care. 

Related Reading: The US Nurse Staffing Shortage in 2023 and Beyond 

Opposition Against Minimum Nurse-to-Patient Ratios 

While the call for staffing requirements resonates strongly within the nursing community, there is opposition to this proposed solution. Detractors argue that these regulations would cost too much, be inflexible, and add more pressure to already stretched healthcare budgets. 

Critics of the proposed nurse-to-patient ratio bill argue that hospitals should be free to adjust staffing based on their unique patient needs. They emphasize the financial challenges hospitals face, especially after the pandemic, fearing that strict ratios could worsen economic struggles and lead to closures or service reductions. 

Opponents believe that flexibility in staffing is essential for hospitals to respond to changing circumstances. For instance, surges in-patient admissions, and they also argue against a one-size-fits-all approach that doesn’t account for the dynamic nature of healthcare. 

The Compromise on Nurse-To-Patient Staffing 

In navigating opposing viewpoints on the nurse-to-patient staffing ratio, it becomes clear that finding a balance between flexibility and regulation is crucial. The challenge is to create a framework that addresses the unique circumstances of each hospital while ensuring a baseline of care that protects both nurses and patients. 

1. Legislation and Standardization 

There is no national law that says healthcare sites have to keep certain nurse staffing ratios. However, some states, aside from Oregon, already have laws and rules in place for safe staffing levels. California and Massachusetts are the only states with rules about the number of patients to nurses.  

It’s important to support bills like the National Nursing Shortage Reform and Patient Advocacy Act and the Safe Nurse Staffing for Patient Safety and Quality Care Act, which would make hospitals keep specific numbers of nurses to patients. 

2. Collaborative Framework 

Rather than viewing regulations as a hindrance, hospitals, and regulatory bodies could work together to establish guidelines that allow flexibility within a structured framework. This collaborative effort would consider the diverse needs of healthcare institutions while maintaining a commitment to the well-being of nursing professionals and the safety of patients. 

3. Investments in Health and Infrastructure 

Investments in healthcare infrastructure, in terms of staffing and technology, could be a pivotal factor. Adequate staffing goes beyond numbers; it involves ensuring healthcare professionals have the necessary support systems and resources to deliver optimal care.  

This might include leveraging technology to streamline processes, training additional support staff, and implementing innovative solutions to enhance efficiency. 


Are you facing nurse staffing challenges? PRS Global can connect you with nurses locally and worldwide through direct hiring. We’ll assist you in finding the most qualified nurses and help them adapt to your American healthcare center. Get in touch with us today. 


1 The American Nurses Association on Nurse Patient Ratios, Accessed 13 Nov. 2023. 

2 Bolas, By Mackenzie, et al. “What Patient-to-Nurse Ratios Mean for Hospital Patient Health and Outcomes.” Penn LDI, 9 July 2023, 

3 ScholarWorks@UARK, Accessed 12 Nov. 2023, 

4 Safe Staffing Saves Lives – Oregon Nurses Association (ONA), Accessed 12 Nov. 2023. 

5 Safe Staffing Saves Lives: Amended Bill Overview – Oregonrn.Org, Accessed 13 Nov. 2023.