Relationships Between Nurse- and Physician-to-Population Ratios and State Health Rankings


Jeri L. Bigbee, Department of Nursing, Boise State University, 1910 University Dr. Boise, ID 93725-1840. E-mail:


ABSTRACT Objective: To evaluate the relationship between nurse-to-population ratios and population health, as indicated by state health ranking, and to compare the findings with physician-to-population ratios.

Design: Secondary analysis correlational design.

Sample: The sample consisted of all 50 states in the United States. Data sources included the United Health Foundation's 2006 state health rankings, the 2004 National Sample Survey for Registered Nurses, and the U.S. Health Workforce Profile from the New York Center for Health Workforce Studies.

Results: Significant relationships between nurse-to-population ratio and overall state health ranking (ρ=−.446, p=.001) and 11 of the 18 components of that ranking were found. Significant components included motor vehicle death rate, high school graduation rate, violent crime rate, infectious disease rate, percentage of children in poverty, percentage of uninsured residents, immunization rate, adequacy of prenatal care, number of poor mental health days, number of poor physical health days, and premature death rate, with higher nurse-to-population ratios associated with higher health rankings. Specialty (public health and school) nurse-to-population ratios were not as strongly related to state health ranking. Physician-to-population ratios were also significantly related to state health ranking, but were associated with different components than nurses.

Conclusions: These findings suggest that greater nurses per capita may be uniquely associated with healthier communities; however, further multivariate research is needed.