The number of patients assigned per nurse has been directly linked to nurse job satisfaction and patient outcomes; with an ideal ratio of four patients to one nurse (7). Research has shown that adding just one patient per nurse has been associated with a higher risk of death for patients and an increase in nurses' job dissatisfaction and burnout (2). This is significant because nurses want to provide the best quality of care to patients, and as the patient-to-nurse ratio increases, nurses are unable to maintain their ideal quality of care; leading to job dissatisfaction and burnout among nurses. Originally, after the passage of the California Nurse Staffing Act, which established mandatory nurse-to-patient rations, overall job satisfaction appeared to increase (1). However, several longitudinal studies have suggested that direct care nurses are still dissatisfied despite increasing nurse-to-patient ratios (1). From the results of these longitudinal studies, it was found that some shortcomings still exist in staffing systems based solely on nurse-patient ratios. Therefore, although the staff ratio system takes into account adequate patient care, it does not take into account the different complexities of patients and nursing care needs (10). Gravity staffing is the third and final staffing system to consider when examining burnout and nurse work
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