Registered Nurse-to-Patient Ratios by State Guide 2024

Registered Nurse-to-Patient Ratios

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This ultimate guide to registered nurse-to-patient ratios provides specific regulations by state to help one understand the current laws in their area.

BOUNTIFUL, UTAH, UNITED STATES, June 3, 2024 / — Find State’s Current Nurse-to-Patient Ratios
One might have seen nurses protest, demanding better working conditions. One may have 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 one understand the current laws in their 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 their state.

Find state in the following table to learn about RN-to-patient staffing ratio laws that may apply to listed in the original article.

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, one can create an account to begin posting or picking up PRN nursing jobs.

If one is also interested in staffing ratios for certified nursing assistants (CNAs) Read CNA-to-Patient Staffing Ratios by State Guide.


Centers for Medicare & Medicaid Services

American Nurses Association

Matthew Frand
+1 833-543-5441
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