Hospitals cannot function without nurses. But across the globe—and especially here in the U.S.—nurses are stretched thin by unsafe workloads and chronic understaffing. The result? Burnout, moral distress, and an exodus of experienced nurses from the bedside—with serious consequences for patients.
A new international policy brief from the Center for Health Outcomes and Policy Research (CHOPR) at Penn Nursing provides the strongest case yet for mandated nurse-to-patient ratios as a proven, cost-effective policy to improve nurse retention, patient safety, and health equity.
These aren’t experimental ideas anymore. From California to Queensland, Australia, governments that implemented safe staffing laws have saved lives, improved outcomes, and avoided added costs—even without increased public funding.
Key Findings
Every additional patient assigned to a nurse increases the risk of death by 7%.
California’s landmark ratio law, implemented 20 years ago, has led to better staffing, less burnout, and improved patient outcomes—without causing hospital closures or requiring additional state funding.
In Queensland, Australia, staffing ratio reforms in the first two years led to 145 fewer deaths and $70 million in cost savings, more than enough to finance the cost of employing more nurses.
Other approaches, like staffing committees and public reporting, have failed to consistently improve nurse staffing or outcomes.
Why This Matters More Than Ever
With massive federal funding cuts unfolding across sectors, the stakes for hospitals, policymakers, and patients are rising fast. Investing in nurse staffing may seem costly upfront, but the data shows it saves lives and money—particularly in vulnerable communities where burnout and turnover are highest. Now is the time for policymakers to act—not with more studies, but with enforceable staffing standards that protect patients and keep experienced nurses at the bedside.
The Bottom Line
We cannot train our way out of the nurse staffing crisis. To rebuild a stable nursing workforce and improve care, we need bold policy reforms that guarantee safe and manageable workloads. The evidence—from California to Queensland—is no longer theoretical. Safe staffing saves lives.
Claire Fagin Leadership Professor, Penn Nursing; Professor, Sociology, School of Arts and Sciences; Founding Director, Center for Health Outcomes and Policy Research, Penn Nursing
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