Mandating Nurse-Patient Ratios in American States

Table of Contents


  • The existing nurses shortage in United States of America, as well as globally, brings a major problem in hospitals in providing adequate patient-to-nurse ratio (NEPPC, 2005).
  • Good outcome of patients’ medication is a resultant of several factors such as availability of medical facilities, severity of illness and most importantly human resources factors such as patient-to- nurse ratio (Abood, 2007).
  • Past studied conducted has indicated that there exist a positive correlation between low patient-to-nurse ratio and measures of patients’ outcome, plus nurse retention (Abood, 2007).
  • For example, in attempt in enhancing quality of patients care, as well as nurses satisfaction in their workplace, California implemented minimum nurse-to-patient ratio in acute care hospitals in 2004 (Abood, 2007).
  • A research conducted in California, Pennsylvania and New Jersey about the impacts of patient-to-nurse ratio indicated that California is enacting lower patient-to-nurse ratio, greatly reduced patients’ mortality rate as compared to other States such as New Jersey and Pennsylvania, which have not enacted similar legislation.
  • The research findings also showed that nurses working in Pennsylvania and New Jersey hospitals indicated a high burnout, high job dissatisfaction, as well as high rate of turnover. On the other hand, the study indicated that those nurses who work in California had a high job satisfaction, less burnout and recorded higher nurse retention (Abood, 2007).
  • In comparing the patient-to-nurse ratio of California to that of Pennsylvania and New Jersey, the study estimated that if the two States had adopted similar ratios to those of California during the period of the research, approximately 486 surgical deaths been avoided in the two states (Abood, 2007).
  • The findings from California, Pennsylvania and New Jersey research, about patient-to-nurse ratio presents an imperative policy implication that other policy makers in states that are considering enacting similar legislation can emulate (Abood, 2007).

My Strategies to Influence Votes

The process of enacting legislation is a daunting task. This is because the process requires involvement of various stakeholders for a complete adoption and implementation of a proposed policy. In order to influence the enacting of patient-to-nurse ratio in the State of New Jersey, which has not embraced patient-to-nurse ratio legislation, the researcher will take the role of policy advocate in pursuit for the change of the patient-to-nurse ratio in New Jersey to increase patients’ outcome and nurses’ job satisfaction. The move will entail venturing in the political arena, a place for making laws and allocating the scarce resources.

The task will start by writing an article on the newspaper calling for a need to enact a legislation that will lower the patient-to-nurse ratio. After sensitizing the public about the need for a patient-to-nurse ratio legislation, the advocating nurse would then explore pros and cons for the proposed patient-to-nurse ratio legislation. Thereafter, formulation of an appropriate patient-to-nurse ratio proposal would follow, aimed at lowering the patient-to-nurse ratio to improve patients’ outcome and nurses’ job satisfaction. During this stage, the nurse advocating for the policy adoption should lobby for decision makers against, as well as for the proposed health policy. The nurse should work hand-in-hand with the media and keep the public updated on every progress in the enacting of the legislation (Aikan, Sloane, Cimiotti, Clarke,Flynn, Seago ,Spetz & Smith, 2010).

In order to ensure the success of the proposed patient-to-nurse ratio legislation, the nurse should join professional nursing organization. Joining nursing organization will help the advocating nurse to get more resources, as well as to strategize more effectively in bringing the nursing perspective to the health policy to win their support for the proposed legislation. The nursing organization will in help in offering the advocating nurse important information pertaining to health policy matters related to the proposed policy issues and policy makers (Aikan et al. 2010).

Getting appropriate power broker is imperative for the success of the proposed legislation. The nurses should play a significant role in advocating for appropriate legislations to enhance patient outcomes, as well as their jobs satisfactions. Nurses form the largest percentage of the health care providers with approximately 2.9 million registered nurses in the United States. Therefore, they should use their number as their bargaining power when lobbying for appropriate legislations such as enacting a plocy of low patient-to-nurse ratio. Therefore, joining nursing organization is one way the advocating nurse should strengthen her bargaining power. The nurse should make sure that she/he uses appropriate power to bargain for preferred legislations in the political arena. In order for the advocating nurse to get political support for the proposed patient-to-nurse ratio, nurses should identify an appropriate politician and approach him/her to campaign for support for the proposed legislation. Considering the large number of nurses, the voice of nurses is important for any political candidate that is interested in joining the house of the representative. Therefore, nurses have the capability for voting for those political candidates who support the enacting of the patient-to-nurse ratio as a reward for the support given. In identifying the right political candidate to lobby for the adoption of the proposed policy, the advocating nurse should note that the final decision in voting for the proposed legislation does not merely depend on the merit of the issue, but also on other key factors such as personal preference, pressure of the organized interest groups and party politics.


Thus, the advocating nurse should make sure that she/he identifies supporters and non-supporters among the legislators, and contact important stakeholders such as chairpersons of appropriate committees, as well as one’s legislator and gain their support (Aikan et al. 2010)

Reference List

Abood, S. (2007). Influencing Health Care in the Legislative Arena. The Online Journal of Issues in Nursing.12, 1, 1-30.

Aikan, L.H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J.A., Spetz, J., & Smith, H. (2010). Implications of the California nurse staffing mandate for other States. Health Services Research.13, 1, 5-13.

NEPPC. (2005). Nurse- T-Patient Ratios: Research and Reality. International Medical. 9, 4, 123-187.

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