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  Health Watch USA Published a Policy Paper on Value Purchasing Designed to Support Nursing and Increase Healthcare Quality in the Journal of Nursing Scholarship.  
Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing.   Journal of Nursing Scholarship    2012 Oct 15. doi: 10.1111/j.1547-5069.2012.01469.x. [Epub ahead of print]   PMID: 23066956    FREE ACCESS


April 2010:  Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.  View Abstract

July 2009:  A recent study by the Robert Wood Johnson foundation found that  26.2% of nurses leave their job within two years.   Comments in the survey were the need for higher nurse to patient ratio and the need to decrease mandatory overtime.   Read RWJ Study

In 2007:  Evidence from California shows an increase in the number of licensed RNs associated with the passage of minimum registered nurse to patient ratios and an increase in graduates from nursing programs. (Download report Spetz, 2007).  Orsolini-Hain and Malone (Policy, Politics and Nursing Practice, 2007 p 165 ) stated:   "Although other reasons may partly explain this increase, stabilizing nurse to patient ratios may actually help retain experienced nurses by creating a more realistic workload."   These authors also concluded that simply training more nurses will not solve the problem and that mandatory nurse-patient ratios should be implemented. 

On June 20, 2006, the American Nurses Association  filed a lawsuit against the DHHS for inadequate Nursing Staffing in Hospitals.   Read the News Release     Review the Complaint

In 2002, the Institute of Medicine found that as many as 98,000 patients die each year from medical errors and that adequate nursing care was inseparably linked to patient safety.  "How well we are cared for by nurses affects our health, and sometimes can be a matter of life and death."  
 View Article PDF

The importance of Nursing Care and Adequate Nurse to Patient Ratios:

Effective enforcement of proper nursing care in hospitals by the Joint Commission is being questioned in a law suit by the American Nurses Association.  In addition, nurse whistleblowers are not receiving adequate protection from the State of Kentucky.  Read the article which was published in the Lexington Herald Leader on April, 16, 2007.  View Article PDF

Nursing care is the key to good hospital care. An article summarizing the importance of hospital nursing care and variations in hospital nursing staffing ratios can was published in the Lexington, KY Herald Leader on Nov 21. 2005.
View Article PDF

Nursing Care Editorials

Too Few Nurses are
Staffing Hospitals (PDF)

The Importance of
Nursing Care (PDF)

Let Consumer Demand Assure
Adequate Nursing Staff (PDF)


"…hospital nurse staffing legislation represents a credible approach to reducing mortality and increasing nurse retention."

Linda H. Aiken,
PhD, RN JAMA, 2002

"I'm tired of nurses who aren't at the bedside and  yet who oppose…bans on mandatory overtime, minimum nurse -  patient staffing ratios, or public disclosure of these ratios.  If you're a staff nurse and oppose these things, you're probably working at a fine institution. But too many nurses aren't."

Diana J. Mason,
PhD, RN Editor-in-Chief,
American Journal of Nursing

Hospital Nurse Staffing and Quality of Care  A report from the Department of Health and Human Services
-- March 2004.

HealthGrades  263,000 patients that died from 2000 through 2002 "were potentially attributable to ... patient safety incidents." -- July 2004.  

Joint Commission  Inadequate nursing care was a factor in nearly 24% of all sentinel (severe) events and that “care is literally being left undone”. -- Aug. 2002.  

Aiken, L.H., et. al. (JAMA, 2002) studied surgical patients and found that for each additional patient that a nurse is responsible for the overall hospital death rate increased by 7%.  Thus, if a nurse is responsible for four patients and the care load is doubled, there is a 31% increase in the patient death rate.  In patients who had complications, this rate is even higher.  

Needleman J., et. al. (NEJM, 2002)  found that the higher the proportion of care provided by registered nurses the shorter the length of stay in the hospital, the lower the rate of urinary tract infections and upper gastrointestinal bleeding, and the lower the rate of pneumonia, shock, cardiac arrest and "failure to rescue".  

Rothberg, et. al. (Medical Care 43: 785-791, 2005) did an economic analysis of nursing staffing ratios and concluded that ratios of 4:1 were found to be "reasonably cost-effective".

Nursing Staff in Hospitals and Nursing Homes.  Is It Adequate?  A report from the Institute of Medicine, National Academy Press Washington D.C. 1996.  

Keeping Patients Safe Transforming the Work Environment of Nurses  
The National Academy of Science’s Institute of Medicine estimated in 2004 that as many as 98,000 patients die each year from medical errors.  They concluded that “how well we are cared for by nurses affects our health, and sometimes can be a mater of life or death."  

Consumer Perspectives:  The Effect of Current Nursing Staffing Levels on Patient Care.  "45% of people who have had direct hospital experience believed that their safety or the safety of an immediate family member(s) was -- to some extent -- compromised by a lack of available nurses.   12% believed their safety or the safety of their family member was extremely or vary compromised."  --National Consumer League May 2004  

Nurses are responsible for 86% of all interceptions of medical errors.  Leape, JAMA, 1995

Read what the Massachusetts Nursing Association states about as to why mandatory nursing staffing ratios are needed.   View Statement  

How to obtain data on the adequacy of nurse staffing. 

The number of hospital RNs, LPNs , and Full-time Employees (FTEs) at facilities can be obtained from the American Hospital Directory.    This number does not include temporary staffing nurses, and the age of the data may vary by over a year.  The number will also vary between hospitals depending upon the intensity of service they provide.  For example, hospitals with Cardiovascular Surgery will have more nursing staffing per hospital bed than a small rural hospital.   

Pressure Sores and Ulcers, an indicator of adequate nursing staff.