Minnesota Hospital Association

Policy & Advocacy

efforts in other states

Only California has adopted mandated nurse staffing ratios

California passed mandatory nurse staffing ratios in 1999 and put them in place in 2004, after intense lobbying from the California Nurses Association. The mandated staffing ratios dictated how many patients each nurse could care for on all the various patient units throughout hospitals.

The consequences of the mandated ratios include: frustrations among nurses over a loss of autonomy; difficulty juggling the logistics of dealing with rigid ratios and other labor laws; the closing of some patient-care units; and diversion of emergency department patients.   

In addition, the government-mandated nurse staffing ratio has increased health care costs across the continuum of care. A 2009 study found that after the implementation of California’s nurse-to-staff ratios, “wage growth for RNs far outstripped wage growth in other states without such legislation.” In 2017, California RNs earned an average of $102,700 per year. RNs at MHA member hospitals average an annual salary of $85,238, well above the national average RN salary of $73,549.   

Finally, mandated nurse ratios in California have not demonstrated an increase in quality and safety.   

Massachusetts voters defeated a 2018 nurse staffing ratio ballot initiative

Massachusetts voters in 2018 defeated a nurses’ union ballot initiative that would have put mandated ratios in all units in all hospitals at all times.   

Prior to the November election, the Massachusetts Health Policy Commission released an independent study on how mandated nurse-to-patient staffing ratios contained in the ballot question would affect the Massachusetts health care system. The study found that a mandate would cost the state up to $949 million annually and increase the cost of health care overall, would most likely result in "no systematic improvement in patient outcomes" and would adversely affect community hospitals serving a high proportion of MassHealth and Medicare patients.   

The ballot initiative was defeated 70 percent to 30 percent.