Back to articles

Nurse-to-Patient Ratio: How Many is Too Many?

March 12, 2019

Illustration showing a single nurse for a number of patients in specific states on a U.S. map.

One of the most important topics being discussed within the field of nursing is rising nurse-to-patient ratios. In general, nurses across the country are being asked to care for more patients at a time, and individual states or healthcare centers are left to deal with this growing problem.

In most states, individual healthcare facilities have the ability to set their own safe staffing standards. Currently, 14 U.S. states have passed some form of safe staffing laws. However, in 13 of those states, the laws only require there to be a general plan in place to manage the ratio as opposed to regulate it. The outlier, California, became the first state to pass a law mandating an average nurse-to-patient ratio in 2004. Their standard is one nurse for every five patients on average in medical-surgical units.

Despite California being the only state to have a law on the books, more states are recognizing how important safe nurse staffing levels are to both patient care and the success of the nursing field. In recent years, there has been a new wave of support behind state- and federally-mandated nurse staffing minimums. Studies have shown benefits to both nurses and patients in California in the years after the state law was enacted, and lawmakers in Pennsylvania and Massachusetts recently considered codifying minimum nurse staffing standards, as well.

Why is Nurse-to-Patient Ratio Important?

A balanced nurse-to-patient ratio can lead to many positive outcomes. Nurses, patients, and even healthcare facilities have experienced success when using a safe nurse staffing method.


When nurses have fewer patients to care for at one time, they’ve shown higher levels of job satisfaction. A study published by labor union AFL-CIO showed that, in contrast to nurses studied in New Jersey and Pennsylvania, California nurses felt their workload was reasonable and led to providing better care. They also reported receiving adequate support services, such as nursing assistants. They even had time to take quick breaks during their shift.

When nurses are without this support and feel unreasonable expectations placed upon them, they could experience a phenomenon known as nurse burnout. In 2018, as many as 62 percent of nurses felt symptoms of burnout in their jobs, according to the RN Network. Nurses suffering from burnout have a harder time providing quality patient care and often report strained relationships at work.


The quality of patient care decreases as the number of patients in a nurse’s care increases. A study published in the New England Journal of Medicine found that unsafe staffing levels were “associated with increased mortality” for patients.

Aside from risk to the patient, satisfaction is a concern as well. Where nurse-to-patient ratios weren’t effectively balanced, patients reported viewing nursing staff and the facilities where they worked poorly. Research published in the BMJ noted that patients’ thoughts on their care in a hospital were associated with nurse staffing and quality of care.

The Survival Guide for Your First Year as a Nurse

Take a look at this free, informative guide from King University. You’ll learn tips and receive advice from veteran nurses so that you’ll be prepared to thrive in your nursing career.

Access the Guide


It may not seem like it, but employing more nurses can actually be cost effective for healthcare facilities. A study published in Medical Care found that hiring more nurses and having a lower nurse-to-patient ratio shortened hospital stays for patients and helped save in medical costs.

As mentioned above, quality nursing care also improves the overall perception of a hospital facility, as well as outcomes for the patients. The better nursing care provided, the better the perception of the facility.

What You Can Do About Safe Staffing

Even in an adequately staffed hospital, there could still be days with an imbalanced nurse-to-patient ratio. A nurse could call out sick or more patients than normal could be admitted. In either case, a higher nurse-to-patient ratio means that nurses have to step up to the challenge of caring for more patients. We talked with a pediatric nurse with years of experience, and she explained how drastic the situation is between a manageable nurse-to-patient ratio and a high ratio.

“When you have a light patient load, you likely have time to do a full set of vitals and systems assessments, administer all medications, and inquire about any requests or needs before leaving each patient’s room,” Dawn D., RN said. “When you have a larger patient load, you need to decide what takes the greatest priority; which patient needs your attention first?”

You likely won’t have a say in the nurse-to-patient ratio at your facility. That’s why, according to Dawn, it’s important to be a team player.

“It’s uncommon for every nurse on your shift to have a difficult patient load,” she said. “When you see a coworker struggling to keep up, offer to help. In turn, your coworkers will likely do the same for you when you are having a busy day.”

There are also other ways for you to make an impact outside of the hospital. Nurses are playing a larger role in politics as more states take notice of the impact of nurse-to-patient ratios. In Tennessee, the Tennessee Nurses Association created a Political Action Committee (PAC) called the Tennessee Nurses Political Action Committee (TNPAC) to help lobby the state legislature for nursing improvements. They also provide legislative updates to members as bills pertaining to the healthcare industry and nursing move through the Tennessee General Assembly. Individually, you can educate elected officials and raise awareness of nursing issues in your community, as well as take a leadership role in your state’s nurse’s association.

Being active in finding a solution to rising nurse-to-patient ratios could make the difference at your hospital and in your community. If you’re looking to step into a leadership role and make a positive impact, enroll today in King University’s online RN to BSN program. Grounded in Christian faith, our program will teach you strategies to become a better nurse, enabling you to provide better care to patients. With transfer credits, you can complete this program in as little as 16 months, and thanks to our online format, you can accomplish your education goals while balancing your busy life.