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Ardization is a huge debate right now. Standardization is making something conform to
a standard. However, when the act being conformed is not static but dynamic like healthcare, the
standardization, or conformity, is rarely without flaws. The question is not “should we have a nurse-patient
ratio?”, but rather “should we mandate the ratio on a state level?”. It is common sense that limiting the amount
of patients that a nurse can care for will increase patient safety as well as the nurses’ well-being. The debate
should really be about how this ratio should be established. I believe the evidence shows that the ratio should
not be a standardized, legislated number. Nurse to patient ratios cannot be a simple number laid down by the
Mandating ratios can cause longer wait times in the emergency department and some hospitals may have to
turn down patients because they do not have the nurses to meet the ratios. This can be seen especially during
outbreaks, natural disasters and pandemics. In a worse case scenario, smaller hospitals may be forced out of
business (Tung, 2019). For example, nurse-patient ratios established in the UK have come under major strain
during the COVID outbreak (Maben & Bridges, 2021).
California, which has had a mandated ratio, experienced a large health care expense due to experiencing a
nursing shortage brought on by the mandated ratio. In 2004 Gov. Schwarzenegger had to enact a large boost
to fund nursing education and hospitals had to up their salaries to attract and keep more nurses. The
mandated ratio has been a huge expense for the health care system of California which is creating hesitation in
many other states about following the same mandated ratios(Nurse staffing ratio laws, 2020).
The American Nurses Association (ANA) has publicly stated that they are not against ratios, but they are
against legislating ratios. The ANA believes that the mandated ratios will take away flexibility and autonomy
from the nurses and they propose a more flexible approach that can change with each situation. A simple
number of how many patients a nurse can care for cannot accurately measure the work involved. Some
patients require more time and higher skill levels than others (TUng, 2019). As an alternative to mandated
ratios, the ANA has introduced the Safe Staffing for Nurse and Patient Safety Act of 2018 (S.2446, H.R 5052)
which would require hospitals to form a committee to develop staffing plans specific to each unit (Glynn,2018).
We should be able to improve the work environment and patient safety by the use of better staffing ratios. The
idea that a state-mandated ratio is the answer does not take into consideration that volatile nature of health
care. Each and every facility has different acuity, size, funding, and needs that will fluctuate constantly. The
solution to nurse-patient ratios is not mandating a number but finding a path that allows for flexibility to meet
the needs of everyone. I believe the safe staffing legislature that requires hospitals to form their own
committees to determine their own unique staffing ratios is a better plan than mandating a standardized ratio
Glynn, D. (2018) A message from ANA MA President. Retrieved on March 5, 2021 from
Maben, J., & Bridges, J. (2020). Covid‐19: Supporting nurses’ psychological and mental health. Journal of
Clinical Nursing DOI: 10.1111/jocn.15307
Nurse Staffing Ratio Law: Debating the merits of a nurse-staffing ratio law.(2020). Retrieved on March 5, 2021
Tung, L. (2019, November 29). Why mandated nurse-to-patient ratios have become one of the most
controversial ideas in health care. WHYY.


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