With greater attention and legislation directed toward nursing shortages and patient-to-nurse ratios, this study describes relevant associations between staffing and outcomes in 168 Pennsylvania hospitals. Findings include detailed analysis from cross-sectional surveys and associated administrative data, which illustrate greater patient mortality and nursing burnout in hospitals with high staffing ratios. The outcomes are risk-adjusted and representative of a diverse collection of hospitals and surgical patients (eg, general, orthopedic, and vascular). The authors conclude that a commitment to adequate nursing care may prevent adverse patient outcomes and improve nurse retention and satisfaction.