Other Titles
Evaluating Proposed Federal Policy for Nurse-to-Patient Staffing Ratios: Insights From State-Level Data [Title Slide]
Abstract
Background: Approaches to nurse staffing in the United States is a highly debated topic. Nurses, policymakers, and hospital administrators are interested in improving patient outcomes and many researchers have looked to safe staffing as a way to improve these outcomes (Costa & Yakusheva, 2016). Mandated nurse-to-patient staffing ratios have been implemented at the state level and have been proposed at the federal level (Bartmess et al., 2021). Many state hospital associations oppose mandated staffing ratios as they claim these ratios could exacerbate the nursing shortage, deny nurses the flexibility to determine staffing needs, limit access to healthcare, and increase hospital operating costs (Bean, 2023). The purpose of this study was to compare identified quality outcomes and workforce impact between states with and without mandated nurse-to-patient staffing ratios in Medicare-certified acute care hospitals and use these outcomes to evaluate a proposed policy to federally mandate nurse-to-patient staffing ratios in Medicare-certified acute care hospitals.
Methods: A quantitative cross-sectional secondary data analysis of publicly available data from the American Hospital Directory, Bureau of Labor Statistics, Centers for Medicare and Medicaid Services, and the United States Census Bureau, followed by an analysis of federal policy mandating nurse-to-patient staffing, was conducted.
Results: No statistically significant difference was found between states with and without mandated nurse-to-patient staffing ratios for the identified outcomes and reporting period analyzed. These results informed a policy analysis, guided by Russell & Fawcett’s (2005) Conceptual Model for Nursing and Health Policy, that discussed the potential public health impact and political feasibility of the proposed federal policy that would mandate nurse-to-patient staffing ratios.
Conclusions: The results of this study suggest that mandated nurse-to-patient staffing ratios may not impact 30-day mortality post CABG, nurse-sensitive HCAHPS indicators, the number of registered nurses working in hospitals, the number of staffed beds, and the number of discharges per staffed bed at the state level. Additional research needs to be conducted to evaluate proposed and existing health policies that influence nurses and the patients they care for, and to determine how nurse-to-patient staffing ratios impact patient outcomes and patient satisfaction in the United States.
Notes
References:
Bartmess, M., Myers, C. R., & Thomas, S. P. (2021). Nurse staffing legislation: Empirical evidence and policy analysis. Nursing Forum, 56(3), 660-675. https://doi.org/10.1111/nuf.12594
Bean, M. (2023). The case against mandatory nurse staffing ratios. https://www.beckershospitalreview.com/workforce/the-case-against-nurse-staffing-ratios.html
Costa, D. K., & Yakusheva, O. (2016). Why causal inference matters to nurses: The case of nurse staffing and patient outcomes. Online Journal of Issues in Nursing, 21(2).
Russell, G. E., & Fawcett, J. (2005). The conceptual model for nursing and health policy Revisited. Policy, Politics, & Nursing Practice, 6(4), 319-326. https://doi.org/10.1177/1527154405283304
Sigma Membership
Phi Iota
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Quantitative Research
Keywords:
Workforce, Policy and Advocacy, Acute Care, Nurse-Patient Ratio, Health Policy, Patient Care, Patient Safety
Recommended Citation
Amidon, Brayton, "Analyzing Proposed Federal Policy for Nurse-to-Patient Staffing Ratios: Insights from State Data" (2026). International Nursing Research Congress (INRC). 189.
https://www.sigmarepository.org/inrc/2026/presentations_2026/189
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-23
Analyzing Proposed Federal Policy for Nurse-to-Patient Staffing Ratios: Insights from State Data
Toronto, Ontario, Canada
Background: Approaches to nurse staffing in the United States is a highly debated topic. Nurses, policymakers, and hospital administrators are interested in improving patient outcomes and many researchers have looked to safe staffing as a way to improve these outcomes (Costa & Yakusheva, 2016). Mandated nurse-to-patient staffing ratios have been implemented at the state level and have been proposed at the federal level (Bartmess et al., 2021). Many state hospital associations oppose mandated staffing ratios as they claim these ratios could exacerbate the nursing shortage, deny nurses the flexibility to determine staffing needs, limit access to healthcare, and increase hospital operating costs (Bean, 2023). The purpose of this study was to compare identified quality outcomes and workforce impact between states with and without mandated nurse-to-patient staffing ratios in Medicare-certified acute care hospitals and use these outcomes to evaluate a proposed policy to federally mandate nurse-to-patient staffing ratios in Medicare-certified acute care hospitals.
Methods: A quantitative cross-sectional secondary data analysis of publicly available data from the American Hospital Directory, Bureau of Labor Statistics, Centers for Medicare and Medicaid Services, and the United States Census Bureau, followed by an analysis of federal policy mandating nurse-to-patient staffing, was conducted.
Results: No statistically significant difference was found between states with and without mandated nurse-to-patient staffing ratios for the identified outcomes and reporting period analyzed. These results informed a policy analysis, guided by Russell & Fawcett’s (2005) Conceptual Model for Nursing and Health Policy, that discussed the potential public health impact and political feasibility of the proposed federal policy that would mandate nurse-to-patient staffing ratios.
Conclusions: The results of this study suggest that mandated nurse-to-patient staffing ratios may not impact 30-day mortality post CABG, nurse-sensitive HCAHPS indicators, the number of registered nurses working in hospitals, the number of staffed beds, and the number of discharges per staffed bed at the state level. Additional research needs to be conducted to evaluate proposed and existing health policies that influence nurses and the patients they care for, and to determine how nurse-to-patient staffing ratios impact patient outcomes and patient satisfaction in the United States.
Description
This presentation will highlight the impact that state-mandated nurse-to-patient staffing ratios have on patient outcomes, patient experience, and the nursing workforce. Additionally, a policy analysis of proposed federal legislation that would mandate nurse-to-patient staffing ratios in the United States will be presented. Attendees will have a better understanding of a complex policy debate and leave with evidence that can inform discussions related to safe staffing.