You want to know which states have mandated nurse-to-patient ratios.

Although you are interested in learning more, you’ve realized how difficult it is to find the information you need. Besides, you have a lot of other things to do than research this.

But lucky for you — we did the research for you

Use this blog post to learn more about nurse-to-patient ratios and how they can affect the quality of care.


Table of Contents



What Is the Nurse-to-Patient Ratio Recommendation?

Generally, the nurse-to-patient ratio recommendation is one nurse to every four patients.

According to a National Nurses United report, there are currently no federal mandates that regulate the number of patients registered nurses (RNs) can care for simultaneously.

Nurses are frequently required to care for more patients than is safe, which compromises patient care and can cause negative outcomes.


What Is the Average Nurse-to-Patient Ratio in the United States?

There is still debate on the average nurse-to-patient ratio in the United States. However, average nurse-to-patient ratios can vary depending on the state. 

For example, the nurse-to-patient ratio in New York averages 1 to 6, while nurses in California average 1 to 3.6.


nursing ratios


Nurse-Patient Ratios By State

There is currently no national policy mandating nurse staffing ratios in healthcare.

States with nurse-to-patient ratios vary significantly, with some states having policies in place to enforce staffing ratios. 

There are three approaches many states use for enforcing policies, including:

  1. Nurse-driven staffing committees overseeing ratios
  2. Specific ratios mandated through state legislation; and
  3. Staffing ratios of facilities being disclosed to the public

But what is the nurse-to-patient ratio for each state?

We’ll take an in-depth look at some nurse-patient ratios by state below.



California is currently the only state with mandated nurse-to-patient ratios, which can vary based on the nursing specialty. 

For example, some specific nursing ratios in California include:

  • Pediatric — 1:4
  • Psychiatric — 1:6
  • Labor and delivery — 1:2
  • Intensive critical care — 1:2

The law ensures nurses have enough time to care properly for their patients and no one is overworked.



Connecticut does not have a mandated nurse-to-patient ratio.

However, it passed Public Act 08-79 (An Act Concerning Hospital Staffing) on July 1, 2009, as a policy that requires hospitals to maintain nursing staff committees to oversee their nursing staff’s implementation of:

  • Patient care policies
  • Employment practices for travel nurses
  • Minimum professional credentials; and
  • Other administrative and internal review plans

Hospitals may use an existing committee, but at least half of the members must be registered nurses providing direct care to patients.



Illinois passed a law known as Public Act 095-0401 on January 1, 2008, which states:

  • Facilities must post a staffing plan that will be recommended by a committee of nurses, with broad representation, including at least 50% direct-care nurses.
  • A detailed nursing plan must include the level of nursing judgment required, the number of patients, ongoing assessment, and staffing flexibility.
  • Nursing data must be reviewed by the committee semiannually to ensure the nursing staff is meeting patient care needs.



Massachusetts state legislature passed a law similar to California’s, but it only requires set nurse-to-patient ratios in ICUs, depending on the stability of patients.

According to iMedPub Journals, Massachusetts sets a nurse-to-patient ratio of 1:1 or 1:2, depending on the severity of the patient’s needs.

This legislation should improve patient safety and ensure critically ill patients have exceptional care.



According to the Nurse Staffing Plan Disclosure Act, hospital nurse staffing plans must be posted publicly on the Minnesota Hospital Association website quarterly.

However, most hospitals and health systems voluntarily disclose their staffing ratios to the public more regularly to provide transparency. 

With this information, patients and families are informed about how many nurses and other staff are assigned to each patient’s room.



In Nevada, legislation passed the Patient Protection and Safe Staffing Bill (SB 362) in 2009, which requires hospitals to have staff committees that oversee nursing staff and implement policies to ensure safe and appropriate patient care.

This requirement is meant to improve patient care by increasing the hospital oversight of nursing staff, which has been shown to improve nurse staffing levels and quality of care.


New Jersey

In New Jersey, the requirement that all hospitals disclose staffing ratios to the public was implemented in 2013.

Currently, only a few hospitals are required to disclose their ratios.

The New Jersey Department of Health and Senior Services is proposing regulations that would require all hospitals to publicly disclose their staffing ratios. If passed, this would be one of the few states in the nation to do so after California.


New York

New York passed the Safe Staffing for Quality Care Act S3691A-2013, which requires nursing ratios that are established by specialty units.

Also, hospitals must disclose their staffing ratios to the public on their websites. They also made this information available to the state Department of Health.

New York also has a mandate requiring that hospitals provide on-call coverage for all registered nurses, which ensures that even if a hospital experiences high turnover or an emergency, there will be someone available to provide care for patients.

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In Ohio, hospitals must have committees that oversee nursing staff and implement policies.

These committees make sure that nurses have the resources and training to provide high-quality care to patients.

Additionally, these committees monitor patient ratios and ensure that each hospital maintains a safe and appropriate staffing level.



In Oregon, the legislature has passed the Nurse Practice Act (Oregon Revised Statutes, Chapter 678.010-678.445), which requires hospitals to have staff committees that oversee nursing staff and implement policies.

This law is in place to ensure:

  • Nurses receive adequate staffing and training
  • Hospitals are held accountable for their nursing staff ratios; and
  • Patients receive high-quality care

The nurse-to-patient ratio is an important measure for these committees to overlook, so hospitals can ensure safe and appropriate patient care.



In Texas, the Health and Safety Code, Chapter 257, requires hospitals to have committees that oversee nursing staff and implement policies. 

These committees must be composed of a majority of nurses (60%), as well as other individuals with experience in:

  • Nursing
  • Patient care; and
  • Business administration

By reviewing, assessing, and responding to staffing concerns, the committees recommend improvements in patient care.



Washington has a policy, RCW § 70.41.420, that requires hospitals have staff committees that overlook nursing staff and implement policies.

The committee must have representation from 50% of whom are nurses providing direct care to patients, as well as:

  • Administration
  • Patients; and
  • The public

The committee must develop a plan for nursing ratios for each unit and shift, and provide public notice of this information.


average nurse to patient ratio in the united states


5 Reasons Nursing Ratios Are Important

There’s no denying that nurses are the backbone of the healthcare industry. 

From ensuring patient safety to providing crucial emotional support, nurses are critical to the well-being of patients and their families.

What you may not know, however, is that nurses are also critical to hospital finances. 

A recent study found hospitals staffed at 1 nurse per 4 patients, as proposed in legislation, saved an estimated $720 million, as well as 4370 patients’ lives.

A good nursing ratio ensures that nurses have adequate time to care for each patient, which results in better patient care and lower costs for hospitals.

However, this is only one reason nursing ratios are important.

Let’s look at five more reasons.


#1: Improved Patient Safety and Outcomes

Nurse-to-patient ratios are important to consider when looking at the quality of care hospitals provide because:

  • States with a high nurse-patient ratio may not be providing the best possible care for their patients; and
  • States with a low nurse-patient ratio may provide better care for their patients

In addition, nurses are better able to identify and respond to changes in a patient’s condition when they have fewer patients to care for.

Currently, California is the only state with true nursing ratios, which have played a role in improving patient safety and outcomes.

According to a 2014 study by the International Archives of Occupational and Environmental Health, the law passed in California “was effective in reducing occupational injury and illness rates for both RNs and LPNs.”

Overall, nursing ratios play an important role in improving patient safety and outcomes. Hospitals should use nursing ratios to provide the best possible care for each patient.


#2: Happier Patients

An upset, angry, or even agonizing patient is more challenging and takes more time to manage, which only makes the situation worse.

Nurses play a crucial role in ensuring that patients feel comfortable and respected.

When ratios are properly adjusted, not only will patients be happier, but nurses will also have more time to focus on the tasks at hand.

When ratios are too high, nurses are often forced to spend their time dealing with agitated or unruly patients rather than taking care of their patients.

Sometimes, this can lead to nurses feeling overworked and stressed.

Proper nurse-patient ratios can help alleviate these issues while also ensuring that the patient receives the best possible care.


#3: Better Communication on the Ward

Nurses are often responsible for taking care of multiple patients simultaneously and must be able to communicate effectively with each patient to provide the best possible care.

To ensure that all patients receive the attention they need, hospitals need to ensure a smooth flow of communication between nurses and patients.

By creating a system where all nurses have a reasonable number of patients to care for, hospitals can ensure that every patient receives high-quality care.


#4: Fewer Burned-Out Nurses

Nurses who are burned out may make mistakes that can lead to problems in the hospital.

According to Workforce Hub, many states, such as …

  • Oregon
  • Minnesota; and
  • Connecticut

… have implemented policies that limit the number of overtime hours nurses can take in a week.

This has helped reduce the number of burned-out nurses and has made it easier for hospitals to recruit new ones.


#5: Less Staff Turnover

When nurses feel appreciated and taken care of, they’ll be more likely to stay with your facility.

No one wants to be overworked.

As much as nurses demonstrate modern-day heroes’ abilities, nurses are people, too.

Ensuring a reasonable nurse-to-patient ratio can reduce staff turnover, which can also help to keep costs down.


staffing ratios in healthcare


How TNS Travel Nurses Are Helping Balance Nursing Ratios Nationwide

Nurse staffing ratios are an important issue for hospitals and nursing homes nationwide. 

Many hospitals have to scramble to find enough registered nurses (RNs) to cover their shifts, and the situation has only gotten worse in the last decade or so as the nursing profession has become more competitive.

One way that hospitals have attempted to address this problem is by relying on professional nurse staffing agencies, like Trusted Nurse Staffing, to provide temporary nurses for short-term assignments.

Trusted Nurse Staffing is a valuable resource for hospitals because we can help balance nursing ratios.

When a hospital contracts with our nurse staffing agency, we help to fill a vacant position with a qualified nurse quickly.

Why should you consider Travel Nurse Staffing to help you find your next contract?

We offer benefits such as:

  • Weekly pay
  • Sign-on bonuses
  • Flexible contracts
  • Housing & travel stipends; and
  • Certifications, License & CEU reimbursements

Our professional team can help you advance in your position and achieve high pay rates as well as travel throughout the country.

We are eager to help you start a traveling job in health care.

Contact us at Trust Nurse Staffing today.