The number of patients assigned per nurse was directly linked to nurse job satisfaction and patient outcomes ; a ratio of four patients to one nurse being the ideal ratio (7). Research has shown that adding just one patient per nurse was associated with a higher risk of patient death as well as increased nurse dissatisfaction and burnout (2). This is important because nurses want to provide the highest quality of care to patients, and with the increasing patient to nurse ratio, nurses are unable to maintain their ideal quality of care; which leads to job dissatisfaction and burnout among nurses. Initially, after the passage of the California Nurse Act, which established mandatory nurse-to-patient rations, overall job satisfaction appeared to increase (1). However, several longitudinal studies suggest that nurses providing direct care are still dissatisfied despite increasing nurse-to-patient ratios (1). From the results of these longitudinal studies, it was found that staffing systems based solely on nurse-patient ratios still have some shortcomings. Therefore, although the staffing system considers appropriate patient care, it does not take into account the different complexities and nursing needs of patients (10). Acuity-based staffing is the third and final staffing system considered when examining nurse burnout and employment.