Vermont Organization of Nurse Leaders (VONL)
Position Statement on Mandated Staffing Ratios for Acute Care Settings
Background
The Vermont Organization of Nurse Leaders (VONL) and the Vermont State Nurses Association
(VSNA) have the established goals to support nursing and nurses in practice and to promote
optimal patient care. We believe that every person deserves access to quality healthcare. The
nursing shortage has stressed our Nation’s and Vermont’s healthcare systems; however,
mandatory staffing ratios do not create nurses.
Position
The VONL and VSNA support the provision of safe, high quality patient care. However, we do not
support mandated ratios as the means to achieve it.
VONL and VSNA strongly hold the following tenets:

Nursing leadership has the responsibility to ensure patient safety and quality patient
outcomes and safe practice conditions for nurses.

Our increasingly dynamic healthcare environment requires flexibility to provide staffing
based on patient needs, not by fixed numbers or ratios. Shortened lengths of stay and
observation patients add to the complexity of ensuring appropriate staffing levels to meet
patient needs, since the level of acuity of patients can change from shift to shift and hour
to hour.

Mandated nurse staffing ratios are based on a fixed number of patients per nurse.
Mandated nurse staffing ratios fail to consider the following:
o The needs of the specific patient populations and specific needs of each patient.
o The environment in which the care is delivered.
o Nurses with varied education and experience bring different skills to each patient’s
bedside. Nurse to patient ratios do not consider the impact that these differences
have in determining the level of care versus the number of nurses that are needed
to provide that care.
o The impact of technology.
o The variability of patient needs throughout a 24 hour period of time.
o The availability of support staff and services.

Staffing decisions require critical thinking, judgment and flexibility of nurses who best
understand the patients and their healthcare needs. This needs to be a collaborative
process between nursing management and direct care staff.

Unintended consequences of mandated staffing ratios could include cutbacks in services,
bed closures, emergency room diversions, layoffs of LPNs and LNAs and increased
healthcare costs. In addition, minimum staffing ratios easily translate into maximum ratios
which potentially contradict the needs of both the patients and staff.

Mandatory staffing ratios will increase the stress on our already burdened healthcare
system and potentially create a greater public risk.

We recognize that research demonstrates that it is the registered nurse who strongly
impacts quality of care; and that all proposed staffing ratio legislation identifies only the
registered nurse in the nurse patient ratio. However, such ratios fail to consider the
impact and valuable contributions of both the LNA and LPN members of the nursing team.
VONL and VSNA hereby issue the following position statement on staffing:
Nurse staffing is critical to the delivery of quality patient care;
Staff nurses are the essential resource in identifying patient characteristics and the number of
patients for whom care may be safely provided by available staff;
Identifying and maintaining appropriate numbers and skill mix of nursing staff is a challenge
experienced by staff nurses and nurse managers in all settings;
Staffing levels should be based on achieving quality patient care outcomes and meeting
organizational goals, while providing for an organizational environment that supports the quality
of nurses’ work life;
Therefore be it resolved, that the VONL and VSNA are in support of the following principles* as a
framework for nurse staffing for Vermont’s providers of healthcare:
I.
Patient Care Unit Related

Appropriate staffing levels for a patient care unit reflect analysis of individual and
aggregate patient needs.

Staffing is most appropriate and meaningful when organizations identify a measure or unit
of intensity that takes into consideration the aggregate population and the associated roles
and responsibilities of nursing staff.

Unit functions necessary to support the delivery of quality patient care must also be
considered in determining staffing levels.
II. Staff Related

The specific needs of various patient populations should determine the appropriate clinical
competencies required of the nurse practicing in that area.

Registered nurses must have nursing management support and representation at both the
operational and executive level.

Clinical support from experienced, expert RNs should be readily available to those novice
RNs with less proficiency.

Educational preparation and experience must be considered when transitioning newly
hired nurses into the workforce.
III. Institutional/Organizational Related

Organizational culture and policies should reflect a climate that values registered nurses
and other employees as strategic assets and exhibits a true commitment to recruiting for
budgeted positions.

Organizational culture and policies should reflect a commitment to the retention of
registered nurses and all employees.

All institutions should have documented competencies for nursing staff, including agency
and traveling RNs, for those activities that they are authorized to perform.

Organizational policies should recognize the myriad needs of both patients and nursing
staff.

Organizational culture should reflect a commitment to safety where staff nurses’ voices are
solicited and influential in staffing decisions.
Date of Origin: March 10, 2003
Updated: July 2010
Approved by Membership 9/17/2010
*
Based on principles adopted by the American Nurses Association.
jill/vonl/positionstatement