The introduction of staffing ratios, why is it taking long for other states to adopt the policy

The introduction of staffing ratios, why is it taking long for other states to adopt the policy


Each country works towards improving its healthcare system by consistently coming up with policies that cater to new changes. Due to the rising number of patients and their increasingly diverse needs, a policy on staffing ratios was introduced in the US. Staffing ratios are geared towards ensuring adequate staff in hospitals at all times.

Different hospital units’ needs provide the blueprint on how the nurse ratios are determined. This allows the management to adjust their staffing needs depending on factors such as the number of admissions, available resources, patient’s needs, and discharges taking place. The units include the intensive care unit where the recommended nurse to patient ratio is 1:2 and operating rooms where the recommended nurse to patient ratio is 1:1.

In the United States, each state is allowed by the federal government to enact its specific laws on staffing. To acquire the perceived benefits of the policy in their health care facilities, there are some states with mandatory nurse staffing ratios. They are California, Connecticut, Massachusetts, Illinois, Minnesota, Nevada, New Jersey, New York, Oregon, Ohio, Vermont, Texas, Rhode Island, and Washington.

Some of these states further require each hospital to form a committee that will focus on achieving the staffing policy. These states are Texas, Connecticut, Ohio, Oregon, Illinois, Nevada, and Washington.

However, out of all these states, only California has formulated in law the minimum nurse to patient ratio in every unit that should be maintained at all times.

Why are other states taking long to adopt?

The debate on whether the implementation of the staffing ratios is feasible still rages on, and many of the states have not adopted the policy. There are several concerns raised when it comes to the nurse staffing policy and these concerns have primarily led to the slow adoption of the policy. They are:

  1. Costs

The hospitals’ executives and associations feel that if the policy were put in law, it would impose on them hefty costs in its implementation. The costs forecasted include the hiring of new nurses to achieve the new ratios as well as operational costs for implementing and maintaining the policy.

  1. Operational Independence

The hospital administrators also feel that the policy would deprive them of the liberty to decide on their staffing strategies depending on each units’ needs. Every hospital has its dynamics, and the administrators feel that they understand best how to cater to the daily staffing needs of their institutions.

  1. A Decline in other staffing ratios

To adopt the policy, the hospitals may reduce the number of support staff, for instance, to shield their revenue. This may force the nurses to assume these roles and thereby reduce the quality of care even further.

  1. Severe nurse shortage

The United States is experiencing a significant nurse shortfall which would impede the implementation of the policy. The hospitals would find it difficult and time-consuming to fill the required ratios as there are not enough nurses available.

  1. Reduced quality of care

While filling the ratios required, the hospitals may employ less qualified staff to cater to the patients, which would lead to reduced quality of care and inequality in the provision of healthcare.

The staffing ratio policy in many states does not seem to provide a solution to the increased number of patients or better provision of healthcare services. Instead, it portends to bring up more challenges for the healthcare system. Until these concerns are addressed, the other states may take even longer to adopt the policy.


I am Dr. Marion Johnson, a Nurse Supervisor, Educator, and A clinician with a Doctor of Nursing Practice Degree (DNP) and a Master of Science in Nursing Degree (MSN) both from Walden University. I have worked as a nurse in the healthcare industry for over 15 years. Presently, I am doing something I love most, which is being an online instructor. In this position, I believe I can learn, educate, create and implement positive input into the nursing field. Besides work, I am also an avid reader of nursing journals and articles that is why I have a passion for reading, learning and sharing on the trending topics in the nursing arena.

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