What Are the 2024 Required Nurse-Patient Ratios by State? 987839088534212 [9:30 AM] Katie Iglewski

Have you ever wondered which states have mandated average nurse-to-patient ratios?

If you have, you’ve likely realized just how difficult it can be to find the information you need. Besides, you have plenty of other things to do other than researching minimum nurse staffing requirements by state.

Lucky for you — we did the research for you!

Keep reading to find out more about nurse-patient ratios by state and the impact they can have on the quality of care.


nursing ratios


Table of Contents



What Is the Recommended Average Nurse-Patient Ratio?

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

However, according to a National Nurses United report, there are currently no federal mandates regulating the number of patients a registered nurse (RN) can care for at one time.

As a result of the lack of mandated nurse-patient ratios, it’s not uncommon for nurses to be required to care for more patients than is safe — which compromises patient care and can cause negative outcomes.


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

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

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

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Average Nurse-Patient Ratios By State

Currently, there are no mandated nurse-patient ratios by state. 

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

Below, we take an in-depth look at the 11 states that are currently operating under average nurse-to-patient ratio laws.



At this time, California is the only state with mandated nurse-patient ratios that vary based on the nursing specialty. 

For example, some specific nursing ratios in California include:

  • Operating room – 1:1
  • Step-down – 1:3
  • Pediatric – 1:4
  • Psychiatric – 1:6
  • Labor and delivery – 1:2
  • Intensive critical care – 1:2

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



Connecticut does not have a mandated nurse-patient ratio.

However, it passed Public Act 08-79 (An Act Concerning Hospital Staffing) on July 1, 2009. This policy 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.



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

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

This legislation should improve patient safety as well as ensure that critically ill patients receive exceptional care.



According to the Nurse Staffing Plan Disclosure Act, hospital nurse staffing plans in this state must be posted publicly on the Minnesota Hospital Association website each quarter.

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.



The state of Nevada passed the Patient Protection and Safe Staffing Bill (SB 362) in 2009. This legislation 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, however, 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 Senate Bill S1168A. This piece of legislation requires hospitals to adhere to average nurse-to-patient ratios that are established by specialty units.

Also, hospitals must disclose their staffing ratios to the public via their websites. This information is also made available to the State Department of Health.

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





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

These committees make sure that nurses have the resources and training they need to provide the highest quality of care to their patients.

Additionally, these committees monitor the average nurse-to-patient ratios and ensure that each hospital maintains a safe and appropriate staffing level at all times.



The state of Oregon 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 that:

  • Nurses receive adequate staffing and training
  • Hospitals are held accountable for their average nurse-to-patient ratios; and
  • Patients receive high-quality care



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

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

  • Nursing
  • Patient care; and
  • Business administration

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



The state of Washington’s policy, RCW § 70.41.420, requires hospitals to have staff committees to oversee their nursing staff and implement policies.

50% of the makeup of these committees must be nurses who provide direct care to patients, with the remaining half consisting of:

  • Administration
  • Patients; and
  • The public

The committee must develop a plan for average nurse-to-patient ratios for each unit and shift, and provide public notice of this information.


average nurse to patient ratio in the united states


Alternatives to Average Nurse-Patient Ratio Laws

In the absence of mandated staffing ratios, some states have chosen to hold facilities accountable via alternate methods. These include public reporting systems and hospital-based staffing committees. 


Public Reporting Systems for Minimum Nurse Staffing Requirements By State

The subject of average nurse-to-patient ratio mandates can be controversial in some states and can require multiple years to take effect once they’re finally agreed upon. For example, from the time the California RN Staffing Ratio Law passed, it took five years for it to be enforced.

Even without legal requirements, a few states still choose to mandate hospital accountability for nurse-patient staffing ratios through public reporting. 

Currently, hospitals in these five states must provide disclosure about their staffing ratios:

  • Illinois
  • New Jersey
  • New York
  • Rhode Island; and 
  • Vermont 

These public reporting systems provide much-needed transparency to hospital patrons, allowing them to make informed decisions about where they choose to receive care.


Hospital-Based Staffing Committees

Another avenue some hospitals are utilizing to provide accountability for safe average nurse-to-patient ratios is the use of nurse-driven staffing committees.

These groups consist of a team of hospital stakeholders who collaborate to evaluate their facility’s staffing challenges. Hospital-based staffing committees can be an effective brainstorming option for hospital leaders who want to connect with their nursing staff to determine what is and is not working.

And since the current nursing shortage impacts each state differently, hospital-based staffing committees enable staff to address staffing needs on a state-by-state basis.

These eight states have hospital-based committees comprised of at least 50% direct care nursing staff: 

  • Connecticut
  • Illinois
  • Nevada 
  • New York
  • Ohio
  • Oregon
  • Texas
  • Washington


Why Should Every State Consider Average Nurse-to-Patient Ratios?

Average nurse-to-patient ratios are beneficial across the board, for nurses, patients, and hospitals for these reasons:

  • Improved patient safety and outcomes. According to a study by the International Archives of Occupational and Environmental Health, the law passed in California was effective in the reduction of occupational injury and illness rates for both registered nurses and LPNs.
  • Lower costs for hospitals. Nurses are critical to hospital finances. One study found hospitals staffed at a one-to-four nurse-patient ratio, as proposed in legislation, saved an estimated $720 million in revenue, as well as 4370 patients’ lives.
  • Happier patients. 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. This may help prevent nurses from feeling overworked and stressed.
  • 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 and fellow nursing staff to provide the best possible care.
  • Fewer burned-out nurses. Nurses who are suffering from burnout may make mistakes that can lead to miscommunication and mistakes.
  • Less staff turnover. When nurses feel appreciated and taken care of, they’ll be more likely to stay with your facility.


staffing ratios in healthcare


How Trusted Nurse Staffing Travel Nurses Are Helping Balance Nursing Ratios Nationwide

Nurse staffing ratios are an important issue for medical facilities across the nation. 

Many hospitals have to scramble to find enough registered nurses to cover their shifts — and the situation has only gotten worse in the last decade as the shortage of nursing staff marches on.

That’s one of the reasons hospitals rely 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 can quickly fill their vacant positions with highly qualified nursing staff.

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

We offer amazing benefits such as:

  • Competitive pay with tons of bonus opportunities (including sign-on, completion, and referrals)
  • License, certification, and CEU reimbursement
  • Retirement and insurance plans
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  • And much more

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

Simply take advantage of Trust Nurse Staffing’s Pronto job search to get started today.