California is currently the only state with mandated nurse-patient ratios, although other states have deliberated on this type of legislation. In the public eye, the ongoing debate about fixed ratios is often framed as a labor dispute: overworked nurses facing off against tight-fisted hospital administrators. Yet nurses know there are issues at play as well, including patient safety, quality of care, and workforce burnout and dissatisfaction.

Adequate nurse staffing is clearly a crucial element in safe, effective hospital care. Still, not all nurses are in favor of mandated, fixed staffing ratios, and many have spoken out against this one-size-fits-all approach. It’s not that they’re advocating for understaffed hospital units, but they’re lobbying against rigidity.

How Many Nurses Do We Need?

The number of RNs and LPNs needed on a hospital unit on any given day varies, depending on complex variables that include nurse’s skills and level of experience and the complexity and acuity of the patients’ conditions. There is actually no hard, scientific data that indicates a set number of patients that nurses can safely handle while providing high-quality care.

When specific nurse-patient hospitals are mandated by law, there are unintended consequences as hospitals strive to be in compliance at all times.

Should routine surgeries be canceled if a surgical unit nurse calls in sick and no replacement can be found? Should they go on as scheduled if the mandated ratio has been met by staffing the unit solely with young, inexperienced nurses, when the majority of the patients are frail and elderly with multiple chronic conditions? Should nurses work a 12-hour shift without a break if taking one would cause the staffing ratio to temporarily dip below the mandated level? And what happens during an emergency situation, like the Boston Marathon bombing – is it okay to temporarily pull nurses away from their units until more staff can be called in?

Some researchers studying staffing ratios have found that the totality of the nursing practice environment is more critical to the quality of nursing care than any one element, including staffing.

A 2011 study by nurse researcher Linda Aiken concluded that adding more nurses to a unit “markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average working environments, and has no effect in hospitals with poor environments.”

For reasons like this, many hospitals are adopting dynamic staffing approaches that are based on patient acuity, which can be defined as the measurement of the intensity of nursing care required by a patient. This approach recognizes that what really matters is the right number of patient-care hours, provided by nurses with the right skill level for the situation – and that this can change over the course of a day or a nursing shift.

One Thing that Improves Outcomes and Patient Safety: Education.

A BSN program helps nurses to develop critical thinking skills and improve existing communication skills. It can open minds to new ideas and new models of care – resulting in the highest possible standard of patient care that you’re able to provide. Perhaps this is why such a large body of research has linked BSN-prepared nurses with better patient outcomes.