Safety in Numbers

Safety in Numbers

Nurse-to-patient Ratios and the Future of Health Care

Book - 2008
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Baker & Taylor
Examining the controversy of legally mandated nurse-to-patient ratios, this critical study addresses both sides of the debate to assess the costs, benefits, and effectiveness of ratios; describes how hospital cost-cutting and layoffs led to large workloads and deteriorating conditions for staff and patients alike; and looks at successful campaigns to regulate change.

Cornell University Press

Legally mandated nurse-to-patient ratios are one of the most controversial topics in health care today. Ratio advocates believe that minimum staffing levels are essential for quality care, better working conditions, and higher rates of RN recruitment and retention that would alleviate the current global nursing shortage. Opponents claim that ratios will unfairly burden hospital budgets, while reducing management flexibility in addressing patient needs.

Safety in Numbers is the first book to examine the arguments for and against ratios. Utilizing survey data, interviews, and other original research, Suzanne Gordon, John Buchanan, and Tanya Bretherton weigh the cost, benefits, and effectiveness of ratios in California and the state of Victoria in Australia, the two places where RN staffing levels have been mandated the longest. They show how hospital cost cutting and layoffs in the 1990s created larger workloads and deteriorating conditions for both nurses and their patients—leading nursing organizations to embrace staffing level regulation. The authors provide an in-depth account of the difficult but ultimately successful campaigns waged by nurses and their allies to win mandated ratios. Safety in Numbers then reports on how nurses, hospital administrators, and health care policymakers handled ratio implementation.

With at least fourteen states in the United States and several other countries now considering staffing level regulation, this balanced assessment of the impact of ratios on patient outcomes and RN job performance and satisfaction could not be timelier. The authors' history and analysis of the nurse-to-patient ratios debate will be welcomed as an invaluable guide for patient advocates, nurses, health care managers, public officials, and anyone else concerned about the quality of patient care in the United States and the world.

The first book to examine the arguments for and against mandated nurse-to-patient ratios, utilizing survey data, interviews, and other original research to focus on two case studies (California and the Australian state of Victoria).

Book News
This publication examines the effectiveness of nurse-to-patient staffing ratios and concludes that measures on these ratios written into law in Australia and California have improved patients' health and safety. The authors provide detailed sections on both the Californian and Australian measures with a concluding section on arguments and alternatives. An appendix examines the decision of the Australian Industrial Relations Commission on nurse-to-patient ratios. This study is recommended for those in patient advocacy, nursing, and health care managers and administrators. Annotation ©2008 Book News, Inc., Portland, OR (

Publisher: Ithaca : ILR Press/Cornell University Press, 2008.
ISBN: 9780801446832
Characteristics: ix, 272 p. ; 24 cm.
Additional Contributors: Buchanan, John 1959-
Bretherton, Tanya


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