I appreciated the points raised in "Nurse Staffing and Patient, Nurse, and Financial Outcomes" (January). Much of the presented research doesn't address how patients are assigned to nurses in most hospitals, and the author's suggestion that balanced workloads are essential was right on mark. Even on the same unit, where patients' acuity may be assumed to be similar, workloads can be dramatically different. Currently, assignments are typically based on room location. One nurse may have patients with more acute medical needs while another may have patients who are less critically ill and going for tests or awaiting discharge. This process is dangerous to patients because it leads to burnout in nurses and questionable financial outcomes.

Patients need to be assigned according to the amount of nursing care they need. This could be done manually with a simple checklist or with a computerized system that collects various patient information and provides a score for each patient. Assignments would then be based on a maximum score. So on the same unit one nurse may have three patients and another nurse six patients. Nurse-patient ratios would be irrelevant. I wonder how patient safety, nurse burnout, and financial outcomes would be affected.

Ro Jones, MBA, RN

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