Ensuring good patient outcomes in hospitals is increasingly challenging as national economic concerns, austerity spending and health system reforms converge to create hard choices in resource allocation. At its core, hospital care is labour intensive. Health reforms have made it more so by reducing hospital length of stay and diverting discretionary admissions to outpatient settings, such that the remaining inpatients have more complex care needs. Medical advances and new technologies have been more likely to increase hospital nurse staffing requirements than to decrease them. The growing use of intensive care beds where professional nurse staffing is highest is but one example.