Policy Perspective| Volume 9, ISSUE 1, P68-70, April 2018

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A Broadening Coalition: Patient Safety Enters the Nurse-to-Patient Ratio Debate

      With another legislative session underway, legislators will again debate whether nurse staffing levels should be mandated by law. Often viewed as a labor issue, pitting professional nursing organizations against employers and hospital associations, evidence continues to mount that minimum nurse-to-patient ratios improve patient safety. In addition, higher patient satisfaction and enhanced patient outcomes are associated with higher nurse-to-patient ratios. Several years have passed since California became the first—and, to date, only—state in the nation to enact nurse-to-patient ratio legislation. Data gathered from the implementation of ratios in California may convince other state legislatures to follow suit.
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        • Aiken L.H.
        Safety in numbers: A mandatory minimum nurse to patient ratio improves outcomes.
        Nursing Standard. 2010; 24 (Retrieved from): 62-63
        • Aiken L.H.
        • Sloane D.M.
        • Cimiotti J.P.
        • Clarke S.P.
        • Flynn L.
        • Seago J.A.
        • Smith H.L.
        Implications of the California nurse staffing mandate for other states.
        Health Services Research. 2010; 45: 904-921
      1. District of Columbia Hospital Association (n.d.). Studies show that mandatory nurse ratios are not the answer. Retrieved from

        • Everhart D.
        • Neff D.
        • Al-Amin M.
        • Nogle J.
        • Weech-Maldonado R.
        • Jordan L.R.
        The effects of nurse staffing on hospital financial performance: Competitive versus less competitive markets.
        Health Care Management Review. 2015; 38: 146-155
        • Fitzgerald B.
        Nurses, hospitals find themselves in opposition on staffing-level bill.
        in: NJBIZ. 2015, February 9 (Retrieved from)
        • Fla. Legis. S. 638, 2018 Reg. Sess
        (Retrieved from)
        • Fowler D.
        • Comeaux Y.
        The legislative role in nurse staffing ratios.
        in: MEDSURG Nursing. 2017, March 1 (Retrieved from)
      2. H.R. 2393, 115h Cong., 1st Sess.
      3. Illinois Hospital Association. (n.d.). Oppose nurse-patient ratio legislation. Retrieved from

        • Kerfoot K.M.
        • Douglas K.S.
        The impact of research on staffing: An interview with Linda Aiken—part 1.
        Nursing Economics. 2013; 31 (Retrieved from): 216-220
        • Korol S.
        Massachusetts Nurses Association supports ballot question requiring nurse-to-patient ratios, raised $1M in 2017: 5 insights.
        in: Becker’s Healthcare. 2018, February 5 (Retrieved from)
        • Mass. Legis. H.R. 4112, 2018 Reg. Sess
        (Retrieved from)
        • N.J. Legis. A. 1470, 2018 Reg. Sess
        (Retrieved from)
        • N.Y. Legis. S. 7425, 2018 Reg. Sess
        (Retrieved from)
        • National Nurses United
        The ratio solution: NNU’s RN-to-patient ratios save lives–better outcomes and more RNs.
        (Retrieved from)
        • Nguyen A.
        Acuity-based staffing: Reducing costs, increasing quality.
        Nursing Management. 2015; 46: 35-39
      4. The RN safe staffing act—What you should know. (n.d.) MedPro Healthcare Staffing. Retrieved from

      5. S. 991, 108h Cong., 1st Sess. (2003).

        • Schoenberg S.
        Massachusetts Senate preparing health care cost bill.
        in: Mass Live. 2017, October 2 (Retrieved from)
        • Silber J.H.
        • Rosenbaum P.R.
        • McHugh M.D.
        • Ludwig J.M.
        • Smith H.L.
        • Niknam B.A.
        • Aiken L.H.
        Comparison of the value of nursing work environments in hospitals across different levels of patient risk.
        JAMA Surgery. 2016; 151: 527-536
        • Wallis L.
        Nurse-patient staffing ratios: Where are we headed, and why?.
        AJN Reports. 2013; 113 (Retrieved from): 21-22
        • W.Va. Legis. H.R. 2085, 2018 Reg. Sess
        (Retrieved from)

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      • Conflict of Interest Compliance Article 2
        Journal of Nursing Regulation Vol. 12Issue 2
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          As is standard in scholarly publishing, NCSBN’s Journal of Nursing Regulation (JNR) requires its authors to disclose any potential conflicts of interest (COI). Although COI information has always been collected by our staff in order to support editors’ review of the paper, it was not our standard practice to publish COI statements in each article. In this issue, JNR is retrospectively publishing the COI statements, which were collected with the below papers at submission, in order to make potential COI’s transparent to readers, as well as editors.
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