They could see that nursing staffs were spread more thinly in some hospitals than others. They knew that nurses believe they provide valuable, sometimes life-saving services. The authors connected their issue directly to nursing practice and the quality of patient care. They found that when nurses were responsible for more than six patients, mortality rose 7% and nurse burnout rose 25%. Based on their research, they predicted that 20,000 more patients would die if nursing ratios in hospitals rose from 4:1 to 8:1.

The authors predict that nursing will have to be seen as the vitally important role it truly is before hospitals will realize that cutting nursing staff cannot save money without putting patients at risk. They noted some changes going on in the nursing profession right now including significant numbers of nurses approaching retirement age and technological advances,...

In particular they noted that when nurses are told the hospital cannot "afford" raises for nursing staff, it makes the nurses feel under-appreciated and probably contributes to job dissatisfaction.
Suggesting solutions for this complex problem was not really part of the authors' intent. Nonetheless, they point out that other good research supports their findings. In light of the fact that a body of research exists supporting low nurse-to-patient ratios, they view decisions to cut nursing staff to save money as a callous and inappropriate way to achieve that goal. They note that overworking nurses rather than hiring more staff will be counter-productive in the long run, since