| Course | NUR-8100 Health, Healthcare Policy, and Politics |
|---|---|
| Module | Module 6 |
| Paper type | Advocacy: written legislative testimony |
| Length | About 880 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for NUR 8100 Module 6
Four Patients, Not Six: Written Testimony in Support of Minimum Nurse-to-Patient Ratios in New Jersey Hospitals
Student Name
Doctor of Nursing Practice, Thomas Edison State University
NUR-8100: Health, Healthcare Policy, and Politics
Mentor Name
Month Day, Year
Four Patients, Not Six: Written Testimony in Support of Minimum Nurse-to-Patient Ratios in New Jersey Hospitals
Introduction
Madam Chair and committee members, I am grateful for the chance to put these remarks in writing. I am a registered nurse with a Doctor of Nursing Practice degree, and I direct nursing for three medical-surgical units at a community hospital in Mercer County. I have worked as a staff nurse, a charge nurse and a manager over 22 years. I write in support of the staffing bill now before you, and in particular its limit of four patients for each nurse on medical-surgical units. I speak here for myself, not for the hospital that employs me.
What One More Patient Means
On a night shift with six patients, a nurse may have a patient two days after bowel surgery, a man with heart failure on a diuretic drip, an older woman with delirium who is trying to climb out of bed, two patients awaiting discharge teaching and an admission arriving from the emergency department. Each of these patients needs assessment, medications, teaching and attention to subtle changes. With four patients, the nurse has time to notice that the surgical patient's heart rate has crept up and his urine output has fallen, early signs of a leak or bleeding. With six, those changes are more likely to be found late. Researchers call this failure to rescue: dying from a complication that someone could have caught in time, and it is the outcome most sensitive to how many patients each nurse carries.
The Evidence From Places With Ratios
You do not have to rely on my experience. Queensland set its ratio law in motion in 2016, requiring a group of public hospitals to keep day-shift ward assignments at four patients per nurse. McHugh et al. (2021) compared patients in the 27 hospitals subject to the policy with those in 28 similar hospitals that were not, before and two years after. Mortality fell in the hospitals with ratios and did not fall in the comparison hospitals. Readmissions rose in the comparison hospitals and did not rise in the ratio hospitals, and length of stay fell more where ratios applied. Because the study compared hospitals with and without the policy over the same period, it provides stronger evidence than studies of a single point in time.
The Evidence From Illinois and New Jersey
Closer to home, Lasater et al. (2021) studied 87 hospitals in Illinois, which, like New Jersey, has no mandated ratios. Medical-surgical nurses there cared for between 4.2 and 7.6 patients on average. The Illinois numbers are blunt: add one patient to the average assignment and a patient's chance of dying within the month climbs by roughly a sixth, while the chance of a longer stay rises by a twentieth. Had every hospital in the study staffed at four to one, the authors estimate that over 1,595 deaths would have been avoided in a single year and that shorter stays would have saved hospitals upward of $117 million.
New Jersey nurses were part of earlier evidence as well. Aiken et al. (2010) asked more than 22,000 hospital nurses in three states about their loads; on medical-surgical floors, California nurses under the mandate had two fewer patients than nurses here in New Jersey. Where workloads matched California's ratios in any of the three states, mortality was lower and nurses reported less burnout and better quality of care.
| Study | Setting | Key finding |
|---|---|---|
| McHugh et al. (2021) | Queensland, 55 hospitals | Mortality fell where ratios applied |
| Lasater et al. (2021) | Illinois, 87 hospitals | Each added patient raised odds of death 16 percent |
| Aiken et al. (2010) | California, Pennsylvania, New Jersey | Lower workloads, lower mortality and burnout |
Answering the Objections
You will hear that ratios cost too much. The Illinois analysis found that shorter stays offset much of the cost of added nurses, and the Queensland evaluation found shorter stays as well. Nurse turnover is also expensive, and better staffing reduces the burnout that drives nurses to leave.
You will hear that there are not enough nurses to meet ratios. New Jersey has many licensed nurses who have left hospital work, often because of workloads. California's hospital nurse workforce grew in the years after its ratios took effect, rather than shrinking as opponents had predicted. A phased schedule, with support for hospitals in shortage areas, would give hospitals time to recruit.
You will hear that staffing should be left to hospitals. Hospitals have held that discretion for decades, and in Illinois it has produced loads ranging from about four patients a nurse to well over seven. A minimum standard does not prevent hospitals from staffing better; it prevents them from staffing dangerously.
My Request
I respectfully ask the committee to release the bill with a phased implementation schedule, public reporting of staffing by unit and support for safety-net hospitals during the transition. I would be glad to provide data from my units or answer any questions.
Conclusion
Nurses who care for four patients instead of six catch complications sooner, and their patients are less likely to die. Evidence from Queensland, Illinois and New Jersey itself supports minimum ratios, and the objections about cost and supply can be addressed in how the law is implemented. I urge you to act.
References
Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., Spetz, J., & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-921. https://doi.org/10.1111/j.1475-6773.2010.01114.x
Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., & McHugh, M. D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: An observational study. BMJ Open, 11(12), Article e052899. https://doi.org/10.1136/bmjopen-2021-052899
McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-1913. https://doi.org/10.1016/S0140-6736(21)00768-6
NUR 8100 Module 6 instructions, in plain terms
NUR-8100's catalog text ends with advocacy, and since no outside syllabus exists, this last module asks for written testimony to a legislature. Expect an assignment to write testimony for a real or simulated hearing on a bill, addressed to a committee, combining your professional experience with evidence and ending in a clear request. Some classrooms ask for an op-ed, a letter to a legislator or a recorded statement instead. Check the directions for format and length. Committee staff skim, so say who you are and what you want in the first lines, keep the studies short and pointed, answer the arguments you know are coming and make clear whose views you represent.
Inside the NUR 8100 Module 6 example
The testimony addresses the committee, states the nurse's credentials and position on the bill and separates her views from her employer's. A short section describes a night shift with six patients and explains failure to rescue. The evidence section presents the Queensland comparison and explains why its design is strong, followed by Illinois workload data and the three-state survey that included New Jersey, with a three-row table. Three objections, cost, supply and hospital discretion, are answered in turn. The testimony ends with a specific request for release with phased implementation, reporting and support for safety-net hospitals, and a short conclusion. Margin notes explain the conventions of testimony that differ from a paper.
Where the marks sit in the NUR 8100 Module 6 rubric
Testimony is graded on clarity of the request, credibility of the testifier, accurate and well-chosen evidence, response to opposing arguments and appropriate tone for a legislative audience. Mentors look for a strong opening that states who the speaker is and what she wants, a personal example that illustrates the evidence, and studies described accurately with their settings. Answering objections directly is often what distinguishes strong testimony. The request should be specific, including implementation details. A statement on whether the testifier speaks for herself or an organization shows professional awareness. APA references are still expected for an academic submission, even though real testimony often lists sources more briefly. Length limits set by the committee or classroom should be respected.
Common NUR 8100 Module 6 mistakes, and how to avoid them
Students often write testimony as a research paper with a formal introduction and long literature review. Lead with who you are and what you ask. Another weakness is evidence without context; tell the committee where a study took place and why it applies. Do not ignore the opposition, since committee members will hear its arguments. Avoid exaggeration, which costs credibility. Keep the personal story short and connected to the evidence. Make the request specific and offer to provide more information. Respect any length limit the committee sets. Check that the bill and committee you name are real if your classroom requires it. The desk can write NUR-8100 testimony on the bill your classroom assigns, the first draft free.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 8100 Module 6 questions, answered
Where can I find a free NUR 8100 Module 6 sample paper?
You can read the whole testimony on this page. A DNP nurse director testifies to a New Jersey Senate committee in support of hospital nurse staffing ratios.
Do nurse staffing ratios reduce patient deaths?
Yes, on the best data available: Queensland hospitals under the law lost fewer patients than look-alike hospitals outside it, and heavier Illinois assignments went with higher odds of death.
How should nurses write legislative testimony?
Open with who you are and what you ask, give a short example from practice, present a few strong studies with their settings, answer expected objections and end with a specific request.
What ratio do staffing bills usually propose for medical-surgical units?
Many proposals, including those modeled on California, set one nurse for every four or five patients on medical-surgical units, with lower ratios in intensive care.
Can nurses testify on their own behalf?
Yes. Testimony should state whether the nurse speaks for herself or for an organization, and personal views should be separated from the employer's.