The ratio of patients to nurses is a worldwide problem. There seems to be a decrease in the number of registered nurses in many countries particularly in the US. The low number of registered nurses affects the nurse patient ratio and this subsequently negatively impacts the delivery and quality of care for patients in many hospitals (Needleman, Buerhaus, Matke, Stewart, & Zelevinsky, 2004). Significance to nursing Low nurse staffing levels has an effect on mortality, patient satisfaction, and occurrence of medical errors, job dissatisfaction and burnout for the nurses (Aiken, Clarke, & Sloane, 2002).