New National ‘Ratios’ Bills Set Safety Limits on Number of Patients Assigned to Nurses

Bonnie Castillo
4 min readMay 5, 2017

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In 49 states, there are no limits on how many patients hospital corporations can assign to nurses at one time. National Nurses United-sponsored legislation fights back.

With the boom in assembly lines during the industrial revolution, employers were able to move products faster, using less staff, padding their bottom line. As I’ve written before, we’ve all seen pop culture comedy examples of what happens next, when profit-driven corporations speed up the pace faster and faster — until a character like Charlie Chaplin in Modern Times works so frantically that he falls right into the machine, getting ground up in the gears.

What nurses feel like without ratios.

Our patients are not products, and nurses are not assembly line workers — but you would not know that by the frantic pace at which our hospital employers, who currently have no repercussions for saving money by cutting corners on safe staffing, expect nurses to provide care. When we are saddled with 9 or 10 patients at once, we are not practicing at our full capacity, and the repercussions for our patients, who come to us with illnesses and injuries where every moment of attention counts, include loss of life.

This is unacceptable. Nurses across the U.S. — where 49 out of 50 states currently have no limit on the number of patients nurses can be assigned — are standing up to say the focus on profit over patients must end. Nurses demand safe staffing now.

To that end, National Nurses United (NNU) — the largest union of registered nurses in the country — is proud to announce the introduction today in the U.S. Senate by Sen. Sherrod Brown (S.1063) and in the U.S. House of Representatives by Rep. Jan Schakowsky (H.R. 2392) NNU-sponsored legislation setting specific safety limits on the numbers of patients each RN can care for in hospitals throughout the U.S.

The bills, both known as the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, establish minimum RN-to-patient ratios for every hospital unit at all times. They also provide whistleblower protection to assure that nurses are free to speak out for enforcement of safe staffing standards.

The bills are modeled on a California law, fought for and won by the California Nurses Association/National Nurses United (CNA/NNU), that has saved patient lives, improved the quality of care, and reduced nurse burnout keeping experienced RNs at the patient bedside.

Nurses applaud Sen. Brown and Rep. Schakowsky for doing the right thing by our patients, and we hope other elected officials will do the same. After all, the benefit to enacting these protections at the national level would be immense. Studies have shown again and again that mandatory safe staffing ratios save lives.

A 2010 study (Aiken et. al), for example, found that compared to California, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths if they matched California’s ratios in medical-surgical units.

Safe staffing is also critical for the health and safety of nurses. A 2015 study in the International Archives of Occupational and Environmental Health showed that the California safe staffing law was associated with 55.57 fewer occupational injuries and illnesses per 10,000 RNs per year, a value 31.6 % lower than the expected rate without the law.

Sometimes change is a long game (California’s regulations were enacted in 2004, after nurses with CNA/NNU, fought for 13 years to achieve them), but nurses never give up on our patients. That’s why we will never give up in our fight to ensure nurses across America have safe staffing protections. It’s a two-fold fight, as we push for legislation at the national level, and also at the state level.

On February 14, for example, NNU registered nurses in Ohio and elected officials gathered at the Ohio Statehouse, in Columbus, to mark the reintroduction by Senator Michael Skindell of the Ohio Patient Protection Act — a bill which sets specific limits on how many patients nurses can care for at once in hospitals throughout Ohio. NNU is also sponsoring safe staffing legislation in Florida and fighting for safe patient ratios legislation in other states.

Hospital corporations have a lot of money to fight against safe staffing legislation. But the evidence, and morality, is on nurses’ side. Nurses will never accept that the fragile lives entrusted to our care are a means of increased profit for corporate employers. Patients are not products, we are not assembly line workers, and when these safe staffing bills are voted into law, nurses will finally be protected in the process of doing our life’s work: providing the focused, professional, safe care that saves lives.

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Bonnie Castillo
Bonnie Castillo

Written by Bonnie Castillo

Union Nurse Leader & Medicare For All Activist. Executive Director of @NationalNurses, the Largest U.S. Organization of Registered Nurses. #TIME100

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