Legislation Mandating Nurse Staffing Plans and Ratios Remains Controversial

Albeit controversial, mandating nurse staffing ratios is one way of approaching staffing in patient care areas. The American Nurses Association (ANA) has been outspoken on this issue, calling for legislation mandating staffing plans and ratios.

A recent ANA survey of nearly 220,000 RNs reported that 54% of nurses do not have sufficient time with patients, 43% have been working extra hours because of short staffing, and 20% found that inadequate staffing affected admissions, transfers, and discharges.

Legislation to aid in staffing plans and ratios has been discussed on both the state and federal levels. Currently, 15 states (CA, CT, IL, ME, MN, NV, NY, NJ, NC, OH, OR, RI, TX, VT, and WA) plus the District of Columbia have enacted legislation or adopted regulations to address nurse staffing. Of these states, seven (CT, IL, NV, OH, OR, TX, and WA) require hospitals to have staffing committees to address staffing plans and policies; one state (CA) requires the minimum nurse-patient ratio to be maintained at all time; and five states (IL, NJ, NY, RI, and VT) require public disclosure or reporting.

In a statement on its website, ANA says that it “supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. This approach aides in establishing staffing levels that are flexible and account for changes; including intensity of patient’s needs, the number of admissions, discharges and transfers during a shift, level of experience of nursing staff, layout of the unit, and availability of resources (ancillary staff, technology etc.).” Rather than mandated fixed ratios or a one-size-fits-all approach, this type of model would give hospitals the flexibility to develop staffing plans that fit their particular institutional and patient needs. Depending on the severity of patient illnesses, experience and training of nursing staff, technology, and nurse support services—all of which can change with little to no notice—mandated ratios can be inadequate.

More information on legislation pertaining to nurse staffing and details on the laws in each state are available on ANA’s Nurse Staffing Plans and Ratios page.