The current nursing shortage sometimes results in less than ideal staffing levels and nurse-to-patient ratios. But, are hospitals are trying to save money on the backs of overworked nurses (not to mention their patients) by regularly scheduling insufficient staff? Democrats in the Illinois state legislature are working to pass mandatory nurse-to-patient ratios to "ensure patient safety." The union points to a 2002 JAMA study that found patients faced a 7% greater likelihood of death for every patient above 4 assigned to a registered nurse.

Most hospitals rely on the charge nurses' judgment for determining staffing
levels. These systems are neither quantitative nor documented. The biggest challenge I see in hospitals trying to improve quality and operational efficiency is the lack of data - and if you can't measure it, you can't manage it. If state legislators must tell hospitals how they should be managed, it would be better to mandate the implementation of a system for measuring caregiver workloads (or patient acuity) than fixed nurse-to-patient ratios.

There is also no doubt that mandated staffing results in temporary emergency room closings (aka ambulance diversions), closed in patient units and entire hospitals. Mandated staffing has also resulted in increased labor costs (23% in California).

The mandatory
ratios also haven't been shown to improve patient care, [Beth] Brooks said. A
2005 study of 268 hospital units at 68 hospitals in California found
that required minimum nurse staff ratios didn't reveal significant
reductions in the incidence of patient falls or pressure ulcers, she
said.

More on mandated ratios here.