Staffing ratios are yesterday’s approach

Nursing unions have long-proposed instituting nurse staff-to-patient ratios to improve working conditions for nurses, which they erroneously claim will improve patient care. However, this approach is antiquated and actually harms patient care. There are not enough nurses to fill the current vacancies in Washington State, much less the number of vacancies that mandated ratios would create. Hospitals that cannot meet ratios at all times will be forced to cut services. (Many hospitals have already begun cutting services due to dire financial situations.1 Skilled Nursing Facilities across the state have closed at least 2,000 beds since the start of the pandemic.) Ratios do not increase nurse compensation or address the nursing shortage.

Adequate hospital staffing is a complex process that changes on a shift-by-shift basis and requires close coordination between management and staff based on a variety of factors, such as patient acuity, nurse expertise and experience level. It also requires day-to-day adjustments when staff members are out sick or on leave or when the patient census changes.

California is the only state requiring nurse-to-patient ratios and it has failed to keep nurses at the bedside. Since its adoption in 2004, it has not increased nurse recruitment or retention and has not proven to increase the quality of care delivered to patients.


  1. The following hospitals have already begun cutting the following services:
    • St. Michael Medical Center in Bremerton closed its emergency department in 2022.
    • MultiCare Covington closed its birth center in September 2022.
    • Central Washington Hospital closed its progressive care unit in November 2022.
    • Astria Sunnyside Hospital stopped performing heart procedures and interventional cardiology in December 2022
    • Harborview Medical Center went on divert on January 5-7, 2023 due to high patient volumes.
    • Astria Toppenish Hospital permanently closed its labor and delivery unit in January 2023.