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Nurse-to-Patient Staffing Ratio Laws and Regulations by State

Published September 15, 2022 · 2 Min Read

Nurse-to-patient ratios vary by state. Find out which states have laws and regulations in place for safe staffing ratios.
Nurse-to-Patient Staffing Ratio Laws and Regulations by State
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  • Nurse-to-patient ratios lead to better patient outcomes.
  • Laws and regulations can ensure safe staffing ratios.
  • States without staffing mandates have other ways to hold hospitals accountable for safe patient ratios.

The nurse-to-patient ratio represents the number of patients a registered nurse (RN) cares for during a shift. Most hospitals have guidelines to ensure safe staffing ratios. However, staffing shortages have led to heavier nursing workloads.

Discover which states have staffing ratio laws or regulations to help ensure patient safety.

Nurse-to-Patient Staffing Ratio Laws and Regulations

Several factors contribute to a nurse's assignment, including:

  • Patient location within the unit
  • Patient health condition
  • Nurse skill set

Each hospital has protocols for deciding how many patients a nurse can care for at a time. When staffing is low, nurse-to-patient ratios often exceed the guidelines. In some states, hospitals must be transparent about this — and they can face legal action for not abiding by mandated ratios.

Hospitals are urged to carry out safe staffing ratios because they're directly linked to better patient outcomes. When nurses have extra patients added to their workloads, the risk for hospital-acquired problems increases, including medication errors, pressure ulcers, and infections.

Depending on the state, hospitals are held accountable for safe staffing through:

  • Legally mandated nurse-to-patient ratios
  • Public reporting systems
  • Hospital-based staffing committees

Legally Mandated Nurse-to-Patient Ratios

California and Massachusetts have laws about nurse-to-patient ratios in hospitals. Laws in Massachusetts limit nurses to one patient in the intensive care unit (ICU). Exceptions may be made as long as nurses follow an acuity tool to determine that a patient is stable enough to be paired.

The California RN Staffing Ratio Law defines the number of patients nurses may oversee in each hospital unit. For example, a nurse in the postanesthesia care unit may care for two patients at a time. California law also states that patients' severity of illness must be documented using an acuity tool.

Public Reporting Systems

Nurse staffing mandates are controversial in many states and can take years to materialize when agreed upon. The California RN Staffing Ratio Law took five years to be enforced from the time it was introduced.

In the absence of legal mandates, some states require hospitals to be accountable for staffing ratios through public reporting. Currently, hospitals in Illinois, New Jersey, New York, Rhode Island, and Vermont must provide disclosure about their staffing ratios. Public reporting systems provide transparency to the public so patients can make informed decisions about where to receive care.

Hospital-Based Staffing Committees

Another way hospitals are accountable for safe staffing ratios is through the use of nurse-driven staffing committees.

A team of hospital stakeholders collaborates to review staffing challenges. It can be an effective way for hospital leaders to connect with nursing staff to brainstorm what's working and what's not.

The nursing shortage impacts each state differently. Hospital-based committees allow staff to address the needs at individual facilities.

The following states participate in hospital-based staffing committees:

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

These staffing committees must consist of at least 50% direct care nurses. In Minnesota, the chief nursing officer develops the core staffing plan.

Nurse-to-Patient Staffing Ratio Laws and Regulations by State

There is no one-size-fits-all solution to the nationwide nursing shortage. Individual states are prioritizing patient safety through different nurse staffing ratio rules. Below is a more in-depth look into the nurse staffing laws and regulations in these states:

  • California is the only state in the U.S. to legally require a specific nurse-to-patient ratio in every hospital unit.
  • Hospitals in Connecticut must use staffing committees made up of at least 50% clinical nurses.
  • Hospitals in Illinois are mandated by the state to present a staffing plan or have a committee. And they must report staffing to the public once a month.
  • Massachusetts mandates a 1:1 nurse-to-patient ratio in the ICU. Nurses may take a second patient based on their clinical judgment and use of an acuity tool. (958 CMR 8.00)
  • In Minnesota, the chief nursing officer develops the core staffing plan. Hospitals must use staffing committees of at least 50% clinical nurses.
  • New Jersey hospitals must report hospital staffing to the public once a month.
  • Hospitals in Nevada determine staffing needs through staffing committees made up of at least 50% clinical nurses.
  • New York hospitals must report hospital staffing upon request from the state.
  • Ohio hospitals must use staffing committees of at least 50% clinical nurses.
  • Hospitals in Oregon must use staffing committees of at least 50% clinical nurses.
  • Rhode Island hospitals are required to report hospital staffing to the public once a year. They must also use staffing committees of at least 50% clinical nurses.
  • Texas hospitals must use staffing committees of at least 50% clinical nurses.
  • Vermont hospitals must report staffing to the public once a quarter.
  • Hospitals in Washington must submit a staffing plan annually and use staffing committees or report a staffing plan.

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