AONL Press Releases

AONL explains why mandated staffing ratios are not the answer



Press Release

Chicago (July 17, 2023)

Safe staffing is a dynamic process requiring flexibility and nursing clinical judgment to determine the right type and level of care for patients. Staffing is a complex decision based on the experience and clinical expertise of the nurse, care team, resources and patient needs. Organizational leaders, nurse managers and direct care nurses, not policymakers, should collaboratively align staffing with patient needs.

Mandated nurse staffing standards remove real-time clinical judgment and flexibility from nurses. Government-mandated ratios do not account for an individual patient or the health care team’s needs in an ever-changing environment nor do they account for the variability among health care organizations. Mandated approaches to staffing do not consider these differences and requires organizations to staff nurses to the number of patients rather than a patient’s needs.

Typically based on traditional nursing care models, static mandated ratios limit innovation and do not utilize advanced capabilities in technology or interprofessional care teams to support data-driven-decision making and collaborative practice.

Health care systems are taxed and face an escalating shortage of nurses. The National Council of State Boards of Nursing and National Forum of State Nursing Workforce Centers estimate nearly 900,000 nurses intend to leave the nursing workforce by 2027. Mandated staffing does not create more nurses or guarantee improvements in safety, patient outcomes or ensure a positive practice environment. Mandatory ratios compound the strain health care systems are already facing, potentially forcing hospitals who do not have enough nurses to meet the nurse-to-patient ratio, to turn patients away or delay care, threatening the patient’s ability to access care in their community.

AONL is committed to safe staffing, fostering a positive work environment, improving patient care and reducing workload inefficiencies so clinicians have more time to do what brings them joy – caring for their patients. AONL supports the Nurse Staffing Taskforce’s definition of appropriate staffing, as well as the majority of their systematic recommendations to shape nurse staffing including reforming the work environment, innovating models of care, improving regulatory efficiency and valuing the unique contribution of nursing.

As an independent profession, nurses are best suited to determine staffing. Asking policymakers to mandate nurse staffing ratios for our patients relinquishes nurses’ professional autonomy; it is short-sighted and counterproductive. By speaking as a unified nursing voice, we can collectively build a better future for our patients, communities and profession.

About the American Organization for Nursing Leadership

As the national professional organization of more than 12,000 nurse leaders, the American Organization for Nursing Leadership (AONL) is the voice of nursing leadership. Our membership encompasses nurse leaders working in hospitals, health systems, academia and other care settings across the care continuum. Since 1967, the organization has led the field of nursing leadership through professional development, advocacy and research that advances nursing leadership practice and patient care. AONL is an affiliate of the American Hospital Association. For more information, visit