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Find Your State’s Current Nurse-to-Patient Ratios
You’ve seen nurses protest, demanding better working conditions. You’ve read the headlines announcing the introduction of numerous bills aiming to regulate nurse-to-patient ratios once and for all.
Have these efforts borne fruit?
What is the current state of RN-to-patient staffing ratio laws?
This ultimate guide to registered nurse-to-patient ratios provides specific regulations by state to help you understand the current laws in your area.
Why Are Nurse-to-Patient Ratios Important?
With physicians spending only 30 to 45 minutes a day with even critically ill patients, nurses stand out as essential healthcare providers, responsible for monitoring patients’ status, providing potentially lifesaving care, and acting as liaisons between physicians, pharmacists, patients, their families, and all other members of the healthcare team.
However, the quality of care nurses are able to provide is directly related to the number of patients they must take care of.
If nurses must care for more patients than they realistically can, considering the setting and level of acuity of their patients, their ability to provide safe care naturally decreases. For example, a British study found that a higher number of patients per nurse was strongly associated with episodes of missed nursing care. The consequences of missed nursing care for patients include medication errors, infections, falls, pressure injuries, readmissions, and failure to rescue.
Furthermore, a systematic review published in 2007 found that a higher RN-to-patient ratio was associated with:
- lower hospital-related mortality,
- death from complications,
- cardiac arrest, and
- healthcare-associated infections.
More recent studies have supported these findings with evidence of associations between staffing ratios and healthcare-associated infections, medication errors, and patient falls.
What Are Safe Nurse Staffing Ratios?
A nurse staffing ratio is the minimum number of nurses required to provide nursing care safely. Nurse staffing ratios can vary significantly from one healthcare setting to the next. For example, a safe nurse-to-patient ratio in an intensive care unit (ICU) differs from a safe ratio in a long-term care setting.
The Nursing Home Reform Act of 1987 required that nursing homes participating in Medicare and Medicaid have a minimum of eight hours per day of registered nursing (RN) service and 24 hours per day of licensed nursing (LN) service. Additionally, federal regulations require nursing homes to provide “sufficient nursing staff to attain or maintain the highest practicable...well-being of each resident.” However, the Nursing Home Reform Act did not mandate a specific staff-to-resident ratio or minimum hours per resident day for resident care.
Fast forward to September 1, 2023.
The Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting proposed rule. This proposed rule establishes comprehensive nurse staffing requirements to hold nursing homes accountable for providing safe and high-quality care daily for the over 1.2 million people in Medicare- and Medicaid-certified long-term care facilities.
The rule’s three main staffing proposals are as follows:
- Minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for registered nurses and 2.45 HPRD for nurse aides (NAs)
- A requirement to have an RN onsite 24 hours a day, seven days a week
- Enhanced facility assessment requirements
What Are the Nurse-to-Patient Staffing Ratios by State?
In 2003, the Office of Disability, Aging and Long-Term Care Policy of the U.S. Department of Health and Human Services identified 36 states with established minimum nursing staff ratios in nursing facilities based on a review of published and unpublished literature on state standards.
According to the American Nurses Association, as of March 2022, only 16 states addressed hospital nurse staffing through either laws or regulations. Although 2022 may seem pretty close in the past, nurse-to-patient staffing ratios have come a long way since then, with additional states mandating specific ratios and others requiring disclosure and/or reporting of actual ratios. In numerous states, bills have been introduced to address this pressing issue, so stay tuned for updates on nurse-to-patient staffing ratios in your state.
Find your state in the following table to learn about RN-to-patient staffing ratio laws that may apply to you.
RN-to-Patient Staffing Ratios by State
| State | RN Staffing Requirements | Regulatory Language | Source |
|---|---|---|---|
| Alabama | Hospitals must ensure that registered nurses provide or supervise 24-hour nursing services. The nursing service must have adequate numbers of licensed RNs, licensed practical nurses (LPNs), and other personnel to provide necessary nursing care to all patients. There must be supervisory and staff personnel for each department or nursing unit to ensure the immediate availability of an RN for the bedside care of any patient. |
Rule 420-5-7-.11 - Nursing Services | |
| Alaska | The Nurse Practice Act does not specify nurse-to-patient ratios or nurse staffing levels in any patient care setting in this state. | State of Alaska Board of Nursing | |
| Arizona | Sufficient personnel members must be present on a hospital’s premises with the qualifications, skills, and knowledge necessary to provide the services in the hospital’s scope of services, meet the needs of a patient, and ensure the health and safety of a patient. There must be at least one registered nurse for every two patients in intensive care units (ICUs). |
A.A.C. 10, Article 2 Hospitals ARIZONA DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH LICENSING SERVICES MEDICAL FACILITIES LICENSING #SP-028-PHL-MED |
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| Arkansas | Each certified nursing facility must provide each month direct care services by direct care staff equivalent to an average of at least 3.36 direct care hours per resident day. Arkansas Code § 20-10-1402(e) does not require or advise any specific or minimum number of nursing staff hours, direct care staff hours, or hours of other services for any nursing facility resident. The following are nurse-to-patient staffing ratios for nursing facilities: Day Shift: One direct-care staff to every seven residents, of which there must be one licensed nurse to every 40 residents Evening Shift: One direct-care staff to every 10 residents, of which there shall be one licensed nurse to every 40 residents Night Shift: One direct-care staff to every 16 residents, of which there shall be one licensed nurse to every 80 residents |
“Direct care staff” refers to a person who provides any direct care services to a nursing facility resident through interpersonal contact with residents or resident care management, including a licensed nurse, nurse aide, medication assistant, physician, physician assistant, licensed physical or occupational therapist or licensed therapy assistant, registered respiratory therapist, licensed speech-language pathologist, infection preventionist, and other healthcare professionals licensed or certified in Arkansas. “Licensed nurse” means any registered nurse, licensed practical nurse, advanced practice registered nurse, or registered nurse practitioner licensed in the state of Arkansas. |
DIRECT CARE STAFFING REQUIREMENTS AND FLEXIBILITIES FOR NURSING FACILITIES 016.06.01 Ark. Code R. § 054 - Minimum Direct-Care Staffing Requirements |
| California | The following are minimum nurse-to-patient staffing ratios in hospitals: Critical care unit: 1:2 Labor and delivery suite of the perinatal service: 1:2 (active labor patients) and 1:4 (antepartum patients who are not in active labor) Postpartum area of the perinatal service: 1:4 (mother-baby couplets) Postpartum areas: 1:6 (mothers only) Combined Labor/delivery/postpartum area of the perinatal service: 1:3 (patient combination of one woman in active labor and a postpartum mother and infant) Intensive care newborn nursery service units (only RNs): 1:1 Pediatric service unit: 1:4 Postanesthesia recovery unit of the anesthesia service: 1:2 Emergency department: 1:4 (only registered nurses can triage patients) Critical trauma patients in the emergency department (only registered nurses): 1:1 Step-down units:1:3 Telemetry units: 1:4 Specialty care units: 1:4 Medical/surgical care units: 1:5 Psychiatric units: 1:6 |
Licensed vocational nurses may constitute up to 50 percent of the licensed nurses assigned to patient care on any unit except where registered nurses are required. | State of California—Health and Human Services Agency California Department of Public Health § 70217. Nursing Service Staff. 22 CA ADC § 70217 |
| Colorado | There must be sufficient personnel qualified by education and experience in each department or service for proper operation. | DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Health Facilities Regulation Division STANDARDS FOR HOSPITALS AND HEALTH FACILITIES CHAPTER IV - GENERAL HOSPITALS |
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| Connecticut | Connecticut applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing. Connecticut’s Public Health Code requires each nursing home to “employ sufficient nurses and nurse aides to provide appropriate care of patients housed in the facility 24 hours per day, seven days a week.” The Public Health Code requires each type of nursing home to have at least one registered nurse on duty 24 hours per day, seven days a week. In a chronic and convalescent nursing home (CCNH), at all times, there must be at least one licensed nurse on duty on each resident-occupied floor. In CCNHs, the minimum time licensed nursing personnel must spend with each patient is the following: 7 a.m. to 9 p.m.: 28 minutes 9 p.m. to 7 a.m.: 10 minutes In a rest home with nursing supervision, the minimum time licensed nursing personnel must spend with each patient is the following: 7 a.m. to 9 p.m.: 14 minutes 9 p.m. to 7 a.m.: 5 minutes |
American Nurses Association Nurse Staffing Regulatory Requirements in Connecticut |
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| Delaware | The minimum staffing level for nursing services direct caregivers must be sufficient to provide 3.67 hours of direct care per resident per day. Nursing staff, rounded to the nearest whole person, must be distributed to meet the following minimum shift ratios for RNs/LPNs: Day: 1:15 Evening: 1:20 Night: 1:30 |
“Nursing services direct caregivers” means certified nursing assistants, licensed practical nurses, registered nurses, advanced practice nurses, and nursing supervisors when providing direct care to residential health facility residents. | TITLE 16 Health and Safety Regulatory Provisions Concerning Public Health CHAPTER 11. Long-Term Care Facilities and Services Subchapter VII. Minimum Staffing Levels for Residential Health Facilities |
| State | RN Staffing Requirements | Regulatory Language | Source |
|---|---|---|---|
| Florida | The following are the minimum staffing requirements for each facility: A weekly average of 3.6 hours of care by direct care staff per resident per day (Sunday through Saturday) One hour of direct care by a licensed nurse per resident daily (A facility must staff at least one licensed nurse per 40 residents.) The following are the minimum staffing requirements for persons under 21 years of age who require skilled care: A combined average of 3.9 hours of direct care per resident per day must be provided by licensed nurses, respiratory therapists, respiratory care practitioners, and certified nursing assistants. Licensed nursing staff must provide one hour of direct care per resident daily. One registered nurse must be on the site 24 hours per day in units where children reside. The following are the minimum staffing requirements for persons under 21 years of age who are medically fragile: A combined average of five hours of direct care per resident per day must be provided by licensed nurses, respiratory therapists, respiratory care practitioners, and certified nursing assistants. Licensed nursing staff must provide 1.7 hours of direct care per resident daily. One registered nurse must be on the site 24 hours per day in units where children reside. |
“Direct care staff” means persons who, through interpersonal contact with residents or management of resident care, provide care and services to allow residents to attain or maintain the highest practicable physical, mental, and psychosocial well-being, including disciplines and professions in the categories of direct care services of nursing, dietary, therapeutic, and mental health. The term does not include a person whose primary duty is maintaining the facility’s physical environment, including food preparation, laundry, and housekeeping. | Fla. Stat. § 400.23 |
| Georgia | End-stage renal disease facilities must have one nurse for every 10 patients. Personal care homes with 25 or more beds and assisted living communities must maintain an average monthly minimum onsite staffing ratio of one direct care staff person for every 15 residents during all waking hours and one direct care staff person for every 20 residents during all non-waking hours. In addition to the onsite staffing ratio requirement, assisted living communities must have at least two onsite direct care staff persons at all times. Moreover, they must have a registered professional nurse or licensed practical nurse on site, according to the following guidelines: One to 30 residents: a minimum of eight hours per week 31–60 residents: a minimum of 16 hours per week 61–90 residents: a minimum of 24 hours per week More than 90 residents: a minimum of 40 hours per week In memory care centers, HB 987 requires one registered professional nurse, licensed practical nurse or certified medication aide, and two onsite direct care staff persons at all times. In addition, one registered professional nurse or licensed practical nurse must be onsite or available in the building at all times to meet the following requirements: One to 12 residents: a minimum of eight hours per week 13–30 residents: a minimum of 16 hours per week 31–40 residents: a minimum of 24 hours per week More than 40 residents: a minimum of 40 hours per week |
A personal care home is a “dwelling, whether operated for profit or not, which undertakes through its ownership or management to provide or arrange for the provision of housing, food service, and one or more personal services for two or more adults.” An assisted living community is “a personal care home with a minimum of 25 beds that is licensed as an assisted living Community.” A memory care center is “a freestanding or incorporated specialized unit within an assisted living community or personal care home that either holds itself out as providing additional or specialized memory” care or charges a higher rate for such care. |
Georgia Department of Community Health Requirements for Georgia Long-Term Care Facilities |
| Hawaii | Hospital-based ambulance services must include one emergency medical technician and one registered nurse licensed in Hawaii. | Haw. Code R. § 11-72-29 - Staffing | |
| Idaho | A licensed registered nurse must be on duty eight hours daily in skilled nursing facilities (SNFs) with an average occupancy rate of 59 residents or less. RNs can be on duty no less than a licensed practical nurse is on duty for each of the other two shifts. Minimum staffing corresponds to 2.4 nursing hours per resident per day. Staffing hours do not include the director of nursing services (DNS), but the supervising nurse on each shift counts toward the calculations of the 2.4 hours per resident per day. In SNFs with an average occupancy rate of 60 to 89 residents, a licensed registered nurse is on duty for each a.m. shift (approximately 7:00 a.m. to 3:00 p.m.) and p.m. shift (approximately 3:00 p.m. to 11:00 p.m.) and no less than a licensed practical nurse on the night shift. Minimum staffing corresponds to 2.4 nursing hours per resident per day. Hours do not include the DNS or supervising nurse. A licensed registered nurse must always be on duty in SNFs with an average occupancy rate of 90 or more residents. |
Nursing hours per resident per day are required seven days a week with provision for relief personnel. SNFs are considered in compliance with the minimum staffing ratios if, on Monday of each week, the total hours worked by nursing personnel for the previous seven days equal or exceed the minimum staffing ratio for the same period when averaged daily and the facility has received prior approval from the Licensing Agency to calculate nursing hours in this manner. | IDAPA 16 – IDAHO DEPARTMENT OF HEALTH AND WELFARE Division of Licensing and Certification 16.03.02 – Skilled Nursing Facilities |
| Illinois | Illinois applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing. The state also mandates disclosure and/or reporting of nurse staffing ratios. |
American Nurses Association | |
| Indiana | With certain exceptions, facilities must provide a licensed nurse hour-to-resident ratio of 0.5 licensed nurse hours per resident per day, averaged over a one-week period. The hours worked by the director of nursing do not count as staffing hours. Facilities must use the services of a registered nurse for at least eight consecutive hours a day, seven days a week. |
410 IAC 16.2-3.1-17 - Nursing services | |
| Iowa | There are no RN-to-patient staffing regulations. | Iowa Admin. Code r. 481-58.11 - [Effective until7/5/2023] Personnel | |
| Kansas | A registered nurse must be on duty at least eight consecutive hours per day, seven days per week. The facility may include the director of nursing to meet this requirement. A licensed nurse must be on duty 24 hours a day, seven days a week. On the day shift, there must be the same number of licensed nurses on duty as nursing units. If a licensed practical nurse is the only licensed nurse on duty, a registered nurse must be immediately available by telephone. Per facility, there must be a weekly average of two hours of direct care staff time per resident and a daily average of not fewer than 1.85 hours during any 24-hour period. The director of nursing does not count in this computation in facilities with more than 60 beds. The ratio of nursing personnel to residents per nursing unit must be at least one nursing staff member for every 30 residents or for each fraction of that number of residents. |
Kan. Admin. Regs. § 28-39-154 - Nursing services |
| State | RN Staffing Requirements | Regulatory Language | Source |
|---|---|---|---|
| Kentucky | The Kentucky Board of Nursing does not establish a ratio for the number of patients a nurse may be responsible for. The Cabinet for Health and Family Services requires healthcare facilities to employ a sufficient number of qualified personnel to meet the needs of the patients. A patient-to-nurse ratio should depend on the qualifications of each nursing staff member, the nursing care needs of the patient, and the patient’s prescribed medical and nursing care requirements outlined in a care plan. |
KENTUCKY BOARD OF NURSING | |
| Louisiana | There are no RN-to-patient staffing regulations. | La. Admin. Code tit. 48, § I-11907 - Registered Nurses | |
| Maine | Each licensed nursing facility must have a full-time registered nurse responsible for directing all nursing services delivered in the facility. A registered nurse must be on duty for at least eight consecutive hours each day of the week. The following are regulations by shift type: Day Shift Each facility must have a licensed nurse on duty seven days a week. There must be one direct-care provider for every five residents. Each facility must designate an RN or LPN as the charge nurse. In facilities with 20 beds or less, the director of nursing may also be the charge nurse. In facilities with more than 20 beds, in addition to the director of nursing, there must also be another licensed nurse on duty. Facilities must provide an additional licensed nurse for each 50 beds above 50. In facilities of 100 beds and over, the additional licensed nurse must be an RN for each multiple of 100 beds. Evening Shift There must be a licensed nurse on duty for eight hours each evening. There must be one direct-care provider for every 10 residents. Facilities must provide an additional licensed nurse for each 70 beds. In facilities of 100 beds and over, one of the additional licensed nurses must be an RN. Night Shift There must be a licensed nurse on duty eight hours each night. There must be one direct-care provider for every 15 residents. Facilities must provide an additional licensed nurse for each 100 beds. There must be an RN on duty in facilities of 100 beds and over. All licensed nursing facilities must always have an RN on duty or on call, regardless of size. |
10-144 C.M.R. ch. 110, § 9 - Resident Care Staffing | |
| Maryland | Nursing homes must provide at least the following registered nurses as supervisory personnel by number of residents: Two to 99 residents: One full-time RN 100–199 residents: Two full-time RNs 200–299 residents: Three full-time RNs 300–399 residents: Four full-time RNs A nursing home must employ sufficient supervisory and support personnel to provide at least three hours of bedside care per occupied bed per day, seven days per week. A nursing home must be staffed with at least one registered nurse, 24 hours per day and seven days per week. Additional registered nurses, licensed practical nurses, and support personnel must be employed to meet the needs of all the residents admitted. |
Bedside hours include the care provided by RNs, LPNs, and support personnel. | Md. Code Regs. 10.07.02.19 - Nursing Services - Staffing |
| Massachusetts | The RN-to-patient staffing ratio in all intensive care units must be 1:1 or 1:2 depending on the patient’s stability as assessed by the acuity tool and by the staff nurses in the unit. | General Laws - Part I - Title XVI - Chapter 111 - Section 231 | |
| Michigan | Nursing homes must employ sufficient nursing personnel to provide continuous 24-hour nursing care and services to meet the needs of each patient. There must be sufficient nursing home staff to provide not less than 2.25 hours of nursing care by employed nursing care personnel per patient per day. The minimum ratio of nursing care personnel to patients is the following by shift type: Morning shift: 1:8 Afternoon shift: 1:12 Nighttime shift: 1:15 Psychiatric hospitals or units must have at least one licensed registered nurse with one year of psychiatric nursing experience on duty on each work shift. Psychiatric hospitals or units must provide ratios of clinical nursing personnel to patients 24 hours a day to carry out the individual service plan for each patient. Nursing program requirements for each nursing unit of the psychiatric hospital or psychiatric unit determine the exact ratio. |
PUBLIC HEALTH CODE (EXCERPT) Act 368 of 1978 Mich. Admin. Code R. 330.1285 - Nursing |
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| Minnesota | A Chief Nursing Officer develops a core staffing plan determining hospital RN-to-patient ratios. | American Nurses Association | |
| Mississippi | The evaluation of the nurse’s educational preparation, experience, and competencies; acuity of the patients; layout of the facility and equipment; and other resources available for patient care should determine the number of patients a nurse may care for with reasonable skill and safety. Personal care homes/assisted living facilities must have a licensed nurse on the premises for eight hours daily. When a resident cannot self-administer prescription medication, a licensed nurse must be present to administer the prescription medication. An Opioid Treatment Program must employ at least one full-time registered nurse for the first 100 or fewer people. In addition to the one full-time registered nurse, programs must maintain additional registered nurses to provide nursing services at least one hour per week per five people enrolled over 100. |
Mississippi Board of Nursing 15 Miss. Code. R. § 16-1-47.11.4 - Other Personnel 24 Miss. Code. R. § 2-53.2 - Staffing for Opioid Treatment Programs |
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| Missouri | All hospitals, ambulatory surgical centers, and abortion facilities must develop and implement a methodology that ensures adequate nurse staffing ratios to meet the needs of patients. At a minimum, there must be a sufficient number of licensed registered nurses on duty at all times to provide patient care that requires the judgment and skills of a licensed registered nurse and to oversee the activities of all nursing personnel. There must be sufficient licensed and ancillary nursing personnel on duty in each nursing unit to meet the needs of each patient by accepted standards of quality patient care. |
Title XII PUBLIC HEALTH AND WELFARE - Chapter 197 | |
| Montana | There are no RN-to-patient staffing regulations. | ||
| Nebraska | The facility must provide sufficient nursing staff on a 24-hour basis to provide nursing care to all residents following resident care plans. The facility must employ an RN to serve as director of nursing services full-time, who may serve only one facility in this capacity. With certain exceptions, skilled nursing facilities and nursing facilities must use the services of a registered nurse for at least eight consecutive hours a day, seven days a week. |
175 Neb. Admin. Code, ch. 12, § 006 - STANDARDS OF OPERATION, CARE, AND TREATMENT |
| State | RN Staffing Requirements | Regulatory Language | Source |
|---|---|---|---|
| Nebraska | The facility must provide sufficient nursing staff on a 24-hour basis to provide nursing care to all residents following resident care plans. The facility must employ an RN to serve as director of nursing services full-time, who may serve only one facility in this capacity. With certain exceptions, skilled nursing facilities and nursing facilities must use the services of a registered nurse for at least eight consecutive hours a day, seven days a week. |
175 Neb. Admin. Code, ch. 12, § 006 - STANDARDS OF OPERATION, CARE, AND TREATMENT | |
| Nevada | Nevada applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing. A registered nurse must be on duty at a facility for skilled nursing for at least eight consecutive hours per day, seven days a week. |
American Nurses Association State of Nevada: Department of Health and Human Services: Nurse Staffing Ratios |
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| New Hampshire | There are no RN-to-patient staffing regulations. | ||
| New Jersey | New Jersey mandates disclosure and/or reporting of nurse staffing ratios in hospitals and nursing homes. | American Nurses Association State of New Jersey Department of Health: Nurse to Patient Staffing |
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| New Mexico | Facilities must employ sufficient staff to provide basic care, resident assistance, and the required supervision based on assessing the residents’ needs. The following is the minimum staff-to-resident ratio during resident waking hours based on facility size: Facilities with 15 or fewer residents: 1:15 Facilities with 16 to 30 residents: At least one direct care staff person on duty and awake at all times and at least one additional staff person available on the premises Facilities with 31 to 60 residents: At least two direct care staff persons on duty and awake at all times and at least one additional staff person available on the premises During resident sleeping hours, facilities with more than 61 residents must have at least three direct care staff persons on duty and awake at all times and one additional staff person immediately available on the premises for each additional 30 residents or fraction thereof in the facility. Hospitals must provide a 24-hour nursing service supervised by a registered nurse and always have a licensed practical nurse or professional registered nurse on duty. An adequate number of professional registered nurses must be on duty at all times to meet the nursing care needs of the patients. Each service or unit must have qualified supervisory personnel to ensure adequate patient care management. |
N.M. Code R. § 7.8.2.19 - STAFFING RATIOS N.M. Code R. § 7.7.2.27 - NURSING SERVICES |
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| New York | New York applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing and mandates disclosure and/or reporting of nurse staffing ratios. The minimum RN-to-patient staffing ratio is 1:2 for patients requiring intensive or critical care regardless of location. Nursing homes must maintain daily average staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide, registered professional nurse, or licensed practical nurse, of which an RN or LPN must provide no less than 1.1 hours of care per resident per day. Facilities must use the services of a registered professional nurse for at least eight consecutive hours a day, seven days a week, or more often as necessary to comply with minimum staffing requirements. |
American Nurses Association Becker’s Hospital Review: New York mandates 1-2 nurse-patient ratio for critical care Minimum Staffing Requirements for Nursing Homes |
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| North Carolina | Registered nurses, licensed practical nurses, and nurse managers are accountable for providing safe nursing care to their patients. Nursing law and rules mandate that RNs and LPNs accept only assignments they can safely and competently perform. | North Carolina Healthcare Foundation | |
| North Dakota | There are no RN-to-patient staffing regulations. | ||
| Ohio | Ohio applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing. Nursing-to-patient ratios in the pediatric intensive care unit (PICU) service must be sufficient to accommodate the acuity level and volume of patients, usually ranging from two nurses to one patient to one nurse to three patients and adjusted as needed. In surgical settings, nursing staff must include appropriate numbers of scrub nurses or technicians and circulating nurses or technicians. A minimum of one scrub nurse and one circulating nurse is necessary based on the needs of the surgeons and the patient. At least two staff members must be present for each procedure, including a circulating nurse and one scrub nurse or technician. A cardiac surgical intensive care unit must have the appropriate nurse-to-patient ratio commensurate with the acuity of the patients and the amount of time following surgery that such care is necessary. |
American Nurses Association Ohio Admin. Code 3701-84-62 - Personnel and staffing standards - pediatric intensive care service Ohio Admin. Code 3701-84-37 - Personnel/staffing - open heart surgery service Ohio Admin. Code 3701-84-82 - Personnel/staffing - pediatric cardiovascular surgery service |
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| Oklahoma | In nursing and specialized facilities, a licensed nurse must be on duty eight hours a day, seven days a week, on the day shift. If the director of nursing is a licensed practical nurse, a registered nurse must be employed for at least eight hours per week as a consultant. There must be a licensed nurse on duty 24 hours per day. However, a facility licensed as a specialized facility for the developmentally disabled is only required to provide 24-hour nursing when it has a resident who has a medical care plan. |
Okla. Admin. Code § 310:675-13-12 - Direct care staffing |
| State | RN Staffing Requirements | Regulatory Language | Source |
|---|---|---|---|
| Oregon | Oregon applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing. Furthermore, Oregon passed a law, which came into effect in September 2023, requiring the following minimum RN-to-patient ratios: Emergency department: 1:1 trauma patient; an average of 1:4 over a 12-hour shift; maximum 1:5 at one time (Direct care registered nurses assigned to trauma patients may not be taken into account in determining the average ratio.) Intensive care unit: 1:2 Labor and delivery unit: 1:2 (if the patients are not in active labor or experiencing complications) or 1:1 (if the patient is in active labor or if the patient is at any stage of labor and is experiencing complications) Postpartum, antepartum, and well-baby nursery: 1:6 (counting mother and baby each as separate patients) Mother-baby unit: 1:8 (counting mother and baby each as separate patients) Operating room: 1:1 Oncology unit: 1:4 Postanesthesia care unit: 1:2 Intermediate care unit: 1:3 Medical-surgical unit: 1:5 Cardiac telemetry unit: 1:4 Pediatric unit: 1:4 |
The direct care registered nurse-to-patient ratio for an individual patient shall be based on a licensed independent practitioner’s classification of the patient, as indicated in the patient’s medical record, regardless of the unit where the patient is being cared for. With the approval of a majority of the members of the hospital nurse staffing committee, a unit can deviate from the direct care registered nurse-to-patient ratios in pursuit of innovative care models considered by the committee by allowing other clinical care staff to constitute up to 50 percent of the registered nurses needed to comply with the applicable nurse-to-patient ratio. The committee must reapprove the staffing in an innovative care model every two years. |
American Nurses Association House Bill 2697: HOSPITAL STAFFING PLANS |
| Pennsylvania | Adult partial hospitalization programs must have a minimum of one full-time equivalent (FTE) clinical staff member for every six patients. Children and youth partial hospitalization programs require at least one FTE clinical staff member for every five patients. In both types of programs, staff should be of appropriate disciplines and must include at least one member, other than the program director, who is a mental health professional or one member who is a psychiatric nurse. All clinical staff time explicitly devoted to the partial program, including that of the program director and medical staff, is included when calculating the patient-to-staff ratio. |
55 Pa. Code § 5210.21 - Staffing and personnel 55 Pa. Code § 5210.31 - Staffing and personnel |
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| Rhode Island | Rhode Island mandates disclosure and/or reporting of nurse staffing ratios. Each nursing facility must have the necessary nursing service personnel (licensed and non-licensed) in sufficient numbers on a 24-hour basis to assess the needs of residents, develop and implement resident care plans, provide direct resident care services, and perform other related activities to maintain the health, safety, and welfare of residents. The facility shall have a registered nurse on the premises 24 hours a day. |
American Nurses Association R.I. Gen. Laws § 23-17.5-32 |
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| South Carolina | Minimum staffing for a hospice facility must consist of one registered nurse and one additional direct care staff member on duty at all times. Additionally, hospice facilities must follow the following minimum staffing ratio: Facilities with zero to 10 patients: Two staff members per shift Facilities with 11 to 20 patients: Three staff members for shift one and two staff members for shifts two and three Facilities with 21 to 30 patients: Four staff members for shift one and three staff members for shifts two and three If facilities use two 12-hour shifts, the minimum staffing ratios would be those determined for shifts one and two. Hospice facilities with more than 30 patients must include additional staff at a ratio of 1:10. Staffing for outpatient services must consist of a sufficient number of direct care staff on duty at all times to provide care to meet the needs of the patient population in all areas providing direct care. |
S.C. Code Regs. 61-78.600.604 - Staffing (I) | |
| South Dakota | An ambulatory surgery center must have an organized nursing service under the direction of a registered nurse. At least one RN must always be on duty when a patient is in the facility. When a general anesthetic is used, at least one RN other than the individual administering anesthesia must be available in each operating room during surgical procedures. The perioperative registered nurse monitoring the patient receiving moderate sedation or analgesic cannot have other responsibilities that would require leaving the patient unattended or compromise continuous monitoring during the procedure. |
S.D. Admin. R. 44:76:06:01 - Nursing services | |
| Tennessee | In crisis stabilization unit facilities, at least one registered nurse, nurse practitioner, or physician assistant must be on duty and in the program 24 hours per day, seven days per week. The onsite and in-program ratio of mental health personnel must not be less than one full-time equivalent staff member for every five service recipients present. There must always be at least two staff members present, one of whom must be staff as identified above. |
Tenn. Comp. R. & Regs. 0940-05-18-.04 | |
| Texas | Texas applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing. The Texas Board of Nursing has no authority over staffing ratios. However, Board Rule 217.11, Standards of Nursing Practice, holds the nurse accountable for accepting only assignments within the nurse’s educational preparation, experience, knowledge, and physical and emotional ability. |
American Nurses Association Texas Board of Nursing: Frequently Asked Questions - Nursing Practice |
| State | RN Staffing Requirements | Regulatory Language | Source |
|---|---|---|---|
| Utah | In a skilled nursing facility, a registered nurse must be on duty at least 16 hours per 24-hour period, seven days a week, to plan, assign, supervise, provide, and evaluate the nursing care needs of the residents. The following is the minimum nursing care (by RN or LPN) required per resident: Skilled nursing care: 45 minutes Intermediate nursing care: 36 minutes Each end-stage renal disease (ESRD) facility must provide sufficient qualified clinical staff to meet patient care needs. A minimum of two clinical staff personnel, one a registered nurse for supervision of patient clinical care, must be on duty whenever patients receive dialysis services. A registered nurse may not supervise the clinical care of more than 10 patients if arranged in an open setting or 12 patients in three pods of four patients. |
Utah Admin. Code 432-151-20 Utah Admin. Code 432-650-7 |
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| Vermont | Vermont mandates disclosure and/or reporting of nurse staffing ratios. Nursing homes must use the services of a registered nurse for at least eight consecutive hours a day, seven days a week. Each facility must designate a registered nurse to serve as the director of nursing full-time. The director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents. The facility must maintain staffing levels adequate to meet resident needs. At a minimum, nursing homes must provide at least three hours of direct care per resident per day, on a weekly average, including nursing care, personal care, and restorative nursing care, but not including administration or supervision of staff. |
American Nurses Association 13-005 Code Vt. R. 13-110-005-X - LICENSING AND OPERATING RULES FOR NURSING HOMES |
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| Virginia | Nursing facilities must provide qualified nurses and certified nurse aides on all shifts, seven days per week, in sufficient numbers to meet all residents’ assessed nursing care needs. Assisted living facilities must have a written staffing plan that specifies the number and type of staff required to meet the direct care needs of their residents. |
12VAC5-371-210. Nurse staffing. Staff Ratios of Assisted Living Facilities |
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| Washington | Washington applies hospital-based committees (comprised of at least 50 percent direct care nurses) to address nurse staffing. Beginning July 1, 2025, hospitals must monitor and document their compliance rate with the existing requirement to assign nursing staff to each patient care unit following the adopted staffing plan. Hospitals must adopt written policies and procedures to document compliance by October 1, 2024. These new compliance reporting requirements do not apply to acute care hospitals characterized by the following: Are certified as critical access hospitals Have fewer than 25 acute care licensed beds Are certified as sole community hospitals and are not owned by a system that owns more than one acute care hospital These requirements do not apply to Island Hospital (previously certified as a Medicare-dependent hospital). |
American Nurses Association Washington State Hospital Association: New Requirements for Hospital Staffing (2023 SB 5236) |
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| West Virginia | Nursing homes must ensure that residents receive the necessary care and services to attain or maintain the highest practicable physical, spiritual, mental, and psychosocial well-being following the comprehensive assessment and plan of care. Neonatal Abstinence Centers must always have one registered professional nurse for every four patients. There must be a minimum of two licensed nurses on each shift, one of whom must be a registered professional nurse. |
West Virginia Code of State Rules Agency 69 - Health And Human Resources Title 69 - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES Series 69-09 - Neonatal Abstinence Centers Section 69-9-9 - STAFFING |
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| Wisconsin | There are no RN-to-patient staffing regulations. | ||
| Wyoming | In critical access hospitals, a registered nurse must be on duty at least eight hours per day, and the director of nursing or another registered nurse designated as the director’s alternate must be on call and available within 20 minutes at all times. Hospitals must provide nursing services 24 hours daily, seven days a week. A registered nurse must supervise these services. |
Wyoming Administrative Rules: Chapter 17: Licensure of Critical Access Hospitals Wyoming Administrative Rules: Chapter 12: Licensure of Hospitals |
How Can Facilities Maintain Safe Nurse-to-Patient Ratios?
Federal and state regulations mandating safe nurse-to-patient ratios only partially solve staffing challenges. Many hospitals and other healthcare facilities struggle to hire and retain sufficient nursing professionals to meet their patients’ or residents’ needs.
In this context, PRN nursing jobs can be valuable solutions for immediate problems. Short-staffed hospitals and other facilities can turn to PRN nurses to maintain safe nurse-to-patient ratios. Nurses also benefit from this work model since PRN jobs offer clinicians flexibility and high hourly pay.
Nursa offers healthcare facilities and nurses a way to connect directly and reach the common goal of safe nurse-to-patient ratios. Within minutes, you can create an account to begin posting or picking up PRN nursing jobs.
Are you also interested in staffing ratios for certified nursing assistants (CNAs)? Read our CNA-to-Patient Staffing Ratios by State Guide.
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