In 2002, a well-publicized study showed that increases in average workloads for registered nurses in 168 Pennsylvania hospitals were associated with significantly higher levels of patient mortality and failure to rescue, and higher levels of job dissatisfaction and burnout in staff nurses. This reflective essay, written by the authors of the 2002 study, reviews the study's design elements, discusses policy implications, and suggests how these results might be incorporated into practice and extended in future research. The authors discuss potential strategies for addressing the nursing shortage, including hospital-level initiatives to improve the professional environment for nurses and legislated nurse staffing ratios. They emphasize the need for higher quality data about nurse staffing levels and the impact of the mix of registered nurses in terms of experience and support systems. The 2002 article brings together the implications of staffing both on patients and on a fragile workforce of nurses by emphasizing the interrelation of the nurse shortage, poor patient outcomes and nurse dissatisfaction. It comes at a time of unprecedented public awareness of patient safety issues and creates important opportunities for policy-makers and the profession to develop fresh solutions to the long-standing problem of nurses' working environments in hospitals worldwide.