Unlike other states, North Carolina does not support nurse-to-patient ratio laws. North Carolina has no clear action plan to resolve this difficult situation. Many studies have been conducted to help solve the nationwide nursing shortage, but the shortage persists and attempts to recruit new nurses are failing. The 2002 study that preceded California's 2004 mandate to change nurse-to-patient ratios by Aiken et al titled: Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. The study was published in 2002 by the Journal of the American Medical Association (JAMA) and hospitals in 3 states were studied. The study results implemented new standards for nurses. Facilities have been forced to reduce the number of patients cared for by a nurse; therefore, improve nursing practice with better patients