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Nurse Staffing Issues: New Jersey Research Paper

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Updated: Jul 14th, 2021

The issue of nurse staffing is high on the agenda for the state of New Jersey as the recent changes in the delivery of care have led to greater levels of acuity compared to previous decades. Inadequate nurse staffing practices accompanied by poor monitoring practices put at risk the delivery of healthcare services as well as the ultimate patient outcomes. Due to the links between adequate staffing and improved rates of mortality and care quality, ensuring that there are enough nurses at facilities is imperative.

The regulation of staffing at healthcare facilities by the government has been one of the solutions implemented for ensuring that patients do not experience adverse health consequences due to poor management. In New Jersey, “An Act concerning nursing staffing standards in inpatient health care facilities and certain State facilities and supplementing Titles 26 and 30 of the Revised Statutes” was introduced (New Jersey Legislature, 2018). In this paper, the overview of this public health policy will be presented with support from evidence-based research publications as well as current events news articles.

Exploration of Evidence

The problem of nurse understaffing at healthcare facilities has been explored in numerous studies. The main purpose of most of such studies is to identify the links between the levels of staffing, patient outcomes, and the satisfaction of healthcare staff. According to Hairr, Salisbury, Johannson, and Redfern-Vance (2014), there is a moderately “strong, inverse relationship between job satisfaction and nurse retention” (p. 142).

Also, the scholars identified a weak positive correlation between the levels of job satisfaction and the staffing of nursing professionals. Based on their correlational study, Hairr et al. (2014) also determined that nurses reported dissatisfaction with their jobs in the past six months of their practice, which is a finding that is especially relevant in the context of New Jersey’s policy. The conclusions that the authors made all point to the extreme need to improve the workload of nurses through efficient staffing management to subsequently boost their satisfaction and ensure retention.

As mentioned in the Act, documenting and forecasting the levels of staffing as well as adjusting personnel requirements to patients’ needs is imperative. However, Hairr et al. (2014) suggested that for staffing levels to improve and nurse satisfaction to increase, it is recommended to also cater to what healthcare staff needs. According to the article of the recent event by Vince Calio (2018), the passing of the legislation in New Jersey was pressed by the poor nurse outcomes and dangerous conditions to patients.

This suggests that without the implementation of appropriate measures to address poor staffing, the well-being of individuals receiving care at healthcare facilities will be put at significant risk. The shift from acute to chronic disease management at healthcare facilities calls for the integration of reliable plans and distinct legislation to guide the distribution of the workload among registered nursing professionals.

McHugh et al. (2016) also studied the influence of nurse staffing ratios on the survival rates of patients. By conducting cross-sectional research, the researchers found that “each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge” (p. 2). In addition, nurses that provided care to their patients in poor work environments had a “16% lower likelihood of surviving IHCA to discharge” (McHugh et al, 2016, p. 2).

Therefore, there is a direct link between the number of patients assigned to each nurse or the environment in which they work and the chances of patients recovering. This finding is also supported in the International Council of Nurses (2018) Position Statement in which the author mentioned that higher numbers of less-skilled or burned-out staff were linked to higher rates of hospital mortality, lower cost-effectiveness, and the increased occurrence of adverse health events.

The introduction of the Bill on safe staffing in New Jersey was necessary because previous efforts to improve patient outcomes have been unsuccessful (“2018-2019 NJ staffing bills,” 2018). The state has a history of the failed implementation of nurse staffing initiatives in areas such as emergency care, trauma, ICU staffing, cardiac surgery, cardiac Cath labs, intermediate care, and others (“New Jersey’s history of failed staffing bills, 2016). Importantly, New Jersey is not the first state to fail at this, which suggests that the efforts to improve the identifies issues should be more persistent.

In the review of relevant sources on nurse staffing initiatives, it is important to mention the document “Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes” prepared by Avalere Health LLC (2015) for the American Nurses Association. The key findings of the document suggest that the current systems of nurse staffing are predominantly outdated and inflexible, which suggests that greater benefit can be achieved from programs that consider the needs of nurses and nurse-to-patient ratios aligning with unit and shift level factors (Avalere Health LLC, 2015).

Additionally, it was found that appropriate nurse staffing efforts can contribute to the achievement of both economic and clinical improvements in the care for patients, including boosted patient satisfaction, reduced medication errors, decreased mortality, lower costs of patient care, as well as decreased nurse fatigue.

Overall, the exploration of relevant articles on the topic of inadequate nurse staffing at facilities revealed that without effective efforts to establish a beneficial environment in which healthcare offer can care for their patients. Organizations such as the American Nurses Association should support the implementation of relevant programs and the passing of safe staffing bills through promoting flexible plans and transparency while penalizing those institutions that do not comply with the established standards.

Pros and Cons of Both Sides of the Issue

The issue of nurse staffing ratios presents a significant ground for discussion. In the environment of continuous budget cuts, hospital downsizing, and nurse turnover, ensuring that there is a consistent nursing staffing minimum can be challenging. Because of this, discussing the advantages and disadvantages of minimum ratios of nurses-to-patients is imperative. As mentioned in the New Jersey nurse staffing bill, it is required that one registered nurse is assigned for every five patients on either a medical or surgical unit (New Jersey Legislature, 2018).

At critical, intensive, or neonatal care units, one registered nurse should be assigned to every two patients while at pediatric or intermediate care nursery units, one professional is assigned to four patients (New Jersey Legislature, 2018). The benefits of such requirements are vast, which is why the legislation was introduced.

Establishing a requirement on minimum nurse-to-patient ratios can prevent dissatisfaction among workers as well as their burnout since their workload is predetermined. Retention and recruitment can also improve significantly because of the ability of employers to communicate their expectations regarding the responsibilities of nurses while the latter can make more conscious decisions as to whether their job requirements are acceptable to them. Patient mortality and preventable mistakes are also expected to decrease with the minimum nurse-to-patient ratios.

This benefit is linked to the reduced number of patients for which nurses care: the lower the number of patients, the greater the level of attention they pay to the different needs of each individual. Importantly, nurses can address such problems as patient falls, pressure ulcers, urinary tract infections, as well as other complications. Altogether, there is a vast variety of positive outcomes of assigning a set number of patients to each registered nurse. The introduction of the bill that regulates these numbers in New Jersey facilities represents a step forward in the direction of improved health outcomes.

Apart from the positive outcomes, it is also important to discuss the drawbacks of required nurse-to-patient ratios at healthcare facilities. One of the largest concerns regarding requiring such ratios is associated with increased financial costs, and hospitals do not have much to say. For instance, California’s transformational law was a significant investment, and not all states can afford to pay the same amount.

Another challenge to consider is linked to patients having to wait longer to receive their treatment. Ratio requirements laws do not account for emergencies that can take place at hospitals, which is a challenge that leads to changes in the assignment of responsibilities. Lastly, while the requirements on having a specific nurse-to-patient ratio at hospitals benefit nurses, it is unclear how it can impact patients as quality is not guaranteed to improve.

These findings show that despite the expected success of requirements for nurse-to-patient staffing ratios, there may be some adverse outcomes for which it is essential to account. In the instance of New Jersey’s legislation, it is recommended for healthcare facilities to consider the possible ramifications of assigning a set number of patients to each nurse practitioner and attend to their needs and requirements. Given the high rate of failed staffing legislation that used to be implemented in New Jersey, addressing any risks before the occurrence of adverse health outcomes is imperative for success.


With the increased focus on value-based healthcare, establishing optimal nursing at healthcare facilities is considered the key to reaching cost-effective and high-quality services offered to customers. The implementation of a legislative model that will address this issue is expected to encourage transparency and ensure that facilities comply with the established staffing ratios. The imperative for significant quality changes is reflected in decreased nurse effectiveness, increased occurrence of patient mortality and morbidity, as well as low levels of nurse and patient satisfaction.

The current evaluation of relevant articles on the topic of nursing understaffing at facilities showed that healthcare policymakers should pay greater attention to the needs of the registered nurses. The New Jersey Act for regulating the number of patients assigned to nurses in different healthcare settings implies the careful following of rules and requirements. However, there is a lack of recommendations associated with creating positive work environments that will increase the effectiveness of nurses and improve patient outcomes. Due to close relationships between nurse understaffing and patient outcomes, paying attention to this issue is the key to ensuring a high quality of care.


Avalere Health LLC. (2015). Optimal nurse staffing to improve quality of care and patient outcomes: Executive summary. Web.

Calio, V. (2018). Battle lines drawn in debate over nurse-to-patient ratios. NJBIZ. Web.

Hairr, D., Salisbury, H., Johannson, M., & Redfern-Vance, N. (2014). Nurse staffing and the relationship to job satisfaction and retention. Nursing Economics, 32(3), 142-147.

International Council of Nurses. (2018). . Web.

McHugh, M., Rochman, M., Sloane, D., Berg, R., Mancini, M., Nadkarni, V., … Aiken, L. (2016). Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients. Medical Care, 54(1). 74-80.

New Jersey Legislature. (2018). Assembly, no. 1470 state of New Jersey 218th legislature. Pre-filed for introduction in the 2018 session. Web.

. (2016). Web.

2018-2019 NJ staffing bills. (2018). Web.

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