I am a nursing supervisor at a San Francisco Bay Area hospital, and I've observed firsthand the implementation of California's nurse-patient ratio law, which was completed last January (AJN Reports, "California's Ratio Law, Four Years Later," March). But rather than seeing patient care improve, I've seen the opposite. On a daily basis, nurses frantically run around with little time to read their patients' charts. I have asked my charge nurses why the situation hasn't improved if they are caring for fewer patients, and they tell me they have sicker patients, less help from ancillary providers, and increased paperwork and are dealing with a host of broken systems. Is it safe to assume that California's nurse-patient ratio law has not been as effective as initially thought?

Your article on this topic confirmed that better ratios alone will not improve our work environment. As Marilyn Chow of Kaiser Permanente says in the article, there isn't just one factor that will lead to improved job satisfaction.

I am all for the ratios if they lead to safer, higher-quality care, but the result can't be closed hospitals, fewer resources, or a dissatisfied nursing workforce.

Kimberly Scott, RN

Hayward, CA

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