Op-Ed: Nurse-Patient Ratios Aren’t Just a Numbers Game—They’re About Safety

The challenges of 2020 have not been singular. The hardships engendered by the global pandemic have impacted financial frameworks, educational systems, both private and public entities, religious structures, and altruistic enterprises.

Perhaps not surprisingly, it is again the marginalized and underrepresented communities that have felt this impact the most.

Santa Clara County has seen a disproportionate rise of infection among communities of color and the homeless. East San Jose, which has a large Latinx population, has become a hotspot for Covid-19 sparking public health outreach for door-to-door testing.

High infection rates in downtown San Jose have been traced back to our homeless population. The individuals of these communities rely heavily on healthcare providers to deliver compassionate and quality care to them and their loved ones, now more than ever, during these unprecedented times.

Meanwhile, it’s no secret that healthcare systems have been taxed across the country.

State and local governments have been faced with difficult decisions that weigh evenly with their calling and choice of profession and service. The demand to meet the needs of the community while balancing the bottom line and navigating the political circus of 2020 is fraught with difficulties indeed.

However, isn’t this the calling of elected officials and the upper echelon of hospital administrators? This is the time in which the public expects you to rise, to protect, and make decisions that will ensure our safety.

Just as those trained and assuming a profession in nursing would never assume to understand the logistics of balancing a state budget independently, my colleagues and I find it alarming that a political science major would propose a two-day critical care training program as the answer for ICU nurse shortages.

The appalling lack of understanding toward our profession should be embarrassing. Nurses are the backbone of any healthcare system, and we are not fooled by what may appear as a well meaning solution.

Once again, we see that those making decisions that will impact the health and wellbeing of our communities do not understand the complexity of medical care in the 21st century.

Now, the issue of nursing ratios is being placed on the auction block of necessity.

With such laughable two-day-training solutions being floated around previously, we wonder if those making the decisions really understand what goes into nurse ratios.

For example, do our elected officials and hospital administrators realize that it is not just a matter of the number of warm bodies to the number of nurses that’s the issue when talking about ratios? What about acuity? Since the beginning of the surge in California, has anyone at a board meeting pulled up the acuity rating data?

At the Santa Clara Valley Medical Center, nurses are already working out of ratio based on patient acuity. And yet, it continues to be a number’s game when the state government and hospital administration speak about ratios.

Let’s throw out the fact that we need our nurses to work (and come in for overtime) and the fact that we know California’s ratio law has resulted in lower rates of nurse burnout and a 30 percent reduction in job-related injuries. And let’s pretend that research hasn’t shown patients feel less safe in hospitals with higher ratios.

Instead, let’s take a look at the vision of Santa Clara Valley Medical Center, the largest public healthcare system in northern California: better health for all.

Better health for all. That includes all communities and all peoples in our community. It includes our underrepresented populations. It includes the lost and forgotten. It includes our CEOs and those out of work. It includes our politicians and migrant workers.

And it includes our physicians, custodians, transporters, pharmacists, techs, volunteers, and yes, even us nurses.

Now is not the time to make ratios into a numbers game. Now is the time for hospital administration to protect their workers, to prevent burnout and illness, so that nurses can continue to provide this vital work—work that directly impacts the health, wellbeing and futures of all communities across our diverse state. Now is not the time for politicians to come up with meaningless solutions to complex problems.

I invite anyone of you to don an N-95 and come shadow me at work. Come wash the feet of our homeless. Come administer blood and toxic medications to critically ill patients. Come to a world where math, psychology, physiology, pharmacology, sociology, critical thinking, physicality, and humanity are a necessity.

Nurse-patient ratios are not about numbers and how many people we can admit to hospital beds. They’re about safety—safety for our patients and safety for our nurses.

Jessica Smits is a nurse at the Santa Clara Valley Medical Center and member of the Registered Nurses Professional Association. Opinions are the author’s own and do not necessarily reflect those of San Jose Inside. Send op-ed pitches to [email protected].


  1. > Perhaps not surprisingly, it is again the marginalized and underrepresented communities that have felt this impact the most.

    Pure “postmodernism” blather.

    White Christian males are a “marginalized and underrepresented community” in California.

    Asians are a “marginalized and underrepresented community” in Ivy League universities.

    Taxpayers are a “marginalized and underrepresented community” in the California Democratic Party.

    Jews are a “marginalized and underrepresented community” in the National Football League and the National Basketball Association.

    Trump supporters are a “marginalized and underrepresented community” on corporate social media quasi-monopolies Google/YouTube, Facebook, and Twitter.

  2. More study findings…

    Mean staffing in adult medical and surgical units in NY and IL hospitals varied from 3.36 patients-per-nurse to 9.7 patients per nurse and in ICUs from 1.5 to 4 patients per nurse.

    California law stipulates 1:2

  3. > California law stipulates 1:2

    Probably why there is a shortage of ICU beds in California.

    Could be fixed with a stroke of the pen. Or by voting out the governor and the legislature.

    Lockdowns are a politician and bureaucrat created problem.

  4. If all you have is a hammer, everything looks like a nail.

    If all you have are supremacist racial insecurities and talking points from Glenn Beck, everything looks like postmodernism (https://www.glennbeck.com/radio/deep-state-exposed-your-tax-dollars-are-funding-critical-race-theory-seminars-for-u-s-teachers; https://www.glennbeck.com/radio/teacher-speaks-out-five-outrageous-critical-race-theory-lessons-unions-want-to-teach-your-kids).

    If all you have is a libertarian obsession, everywhere looks like Grafton, NH (https://washingtonmonthly.com/magazine/september-october-2020/libertarians-took-control-of-this-small-town-it-didnt-end-well/)

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