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OBJECTIVE: The aimof this studywas to project the impact of legislated nurse staffing ratios on patient-, staff-, and system-level outcomes for Prospective Payment System (PPS) hospitals in Montana. BACKGROUND: In 2023, House Bill 568 was introduced inMontana focused on legislating hospital safe nursing standards. METHODS: A quantitative designwas used for a convenience sample of Montana PPS hospitals. Data were gathered through a newly developed survey and from other publicly available sources for the years 2018 to 2022. Independent t testswere conductedwhen appropriate with the significance threshold set at 0.05. RESULTS: Projections indicate no significant change in patient outcome metrics accompanied by increases in labor requirements, slower emergency department throughput times, and decreases in hospital operating margins. CONCLUSIONS: InMontana, legislating nurse staffing ratios would have downstream implications inconsistent with the intended impact on patient safety, emphasizing the complexity of variables within and external to the healthcare systemthat drive patient-, staff-, and system-level outcomes. [ABSTRACT FROM AUTHOR]