The economic impact on health care took a toll on the number of registered nurses providing bedside care to patients, compromising patient safety and increasing dramatically the potential for negative outcomes. Several factors have contributed immensely to nursing shortages over the years, including downsizing of health care organizations, increased workloads, inadequate staffing plans and job dissatisfaction. Mandatory nurse-to-patient ratios have been implemented in several states to date, and many others are attempting to pass some type of legislation. Have these ratios affected the quality of care or is it more realistic to create staffing committees based on each unit's unique situation and different needs? Skyrocketing medical costs are among the challenges hospitals face today, and among their biggest expenses is nursing labor. costs. The burden of reducing spending and managing costs more effectively is increasingly falling on hospital financial leaders, awaiting reduced reimbursements under health care reform (Sanford 38+ ). Health care institutions, particularly hospitals, argued that reducing the number of registered nurses and diluting the skill mix would not lower standards of care, even though nurses expressed the opposite (Hunt 18). Yes, that's right, for years there has been debate among all parties regarding the best mix and numbers and to what extent direct bedside care is considered the responsibility of RNs, but the most critical issue of all is that nurses want to ensure high quality care. and the best possible outcomes for patients. At the height of American hospital restructuring, nurses were deeply concerned about the well-being of their patients as well as their own ability to survive middle of paper......micro file. Internet. January 26, 2011. “Study shows that an increase in nursing staff would improve safety and quality in hospitals. » Scientific letter January 31, 2006: 1391. Reference center on academic health. Web.January 27, 2011.Thrall, Terese Hudson. “Nursing Laws: Should You Be Concerned?” » Hospitals and Health Networks 82.4 (April 2008): 36-39 Nursing & Allied Health Source. Internet. January 23, 2011. United States. Department of Government Affairs. The Registered Nurse Safety Act of 2010. Federal legislation. 2010: HR 5527/S 349. American Nurses Association. Internet. January 13, 2011 Welton, J. "Mandatory Hospital Nurse-to-Patient Ratios: It's Time for a Different Approach." » Online Journal of Nursing Issues September 12.3, 2007: CINAHL Plus Full Text. Internet. January 23, 2011. Wertheim, Bradley. “The doctor can’t see you now.” The Tampa Tribune January 30, 2011. Opinions and news 1. Print.