Compliance guideRead at source, 28 September 2026
Nurse to Patient Ratio by State (2026): California, Oregon and the Staffing Committee Laws
The nurse to patient ratio by state is set in two very different ways. California sets minimum licensed nurse-to-patient ratios for every hospital unit, at all times (1:2 in critical care, 1:5 on medical-surgical units), and Oregon wrote RN ratios by unit into statute in 2023. Massachusetts and New York set intensive care ratios. Most other states that act at all require a hospital staffing committee and a written staffing plan instead of a number. There is no federal hospital ratio: the Medicare rule asks for “adequate numbers” of nurses.
Nurse to patient ratio by state: the short version
“Ratio law” covers three kinds of rule, and they put very different pressure on a recruiting plan:
- Fixed ratios by unit. A maximum number of patients per nurse, unit by unit. California does this for every hospital unit in regulation. Oregon does it in statute, through each hospital’s nurse staffing plan.
- Ratios for one kind of unit. Massachusetts and New York set intensive care ratios and leave other units to hospital policy.
- Staffing committee laws. The hospital must form a committee with a set share of direct care nurses, which writes a unit-by-unit staffing plan. Washington, New York, Connecticut, Nevada, Ohio, Texas and Colorado all use this model; Minnesota requires published core staffing plans. No number is fixed in law, but the plan the committee adopts becomes the standard you are held to.
A fixed ratio applies at all times: California’s regulation says there “shall be no averaging” across a shift or any period of time.
State nurse staffing laws, by state
Each row was read at the primary source listed on 28 September 2026. It covers acute care hospitals; nursing homes are a separate set of rules, covered on our nursing home staffing ratios page.
| State | Type of law | What it requires | Citation |
|---|---|---|---|
| California | Fixed ratios, every unit | Minimum licensed nurse-to-patient ratios for each unit type “at all times,” plus a patient classification system for staffing above the minimum | 22 CCR 70217; Health & Safety Code 1276.4 |
| Oregon | Fixed ratios in statute, applied through a staffing plan | Direct care RN ratios by unit, CNA limits of 7 patients (day and evening) and 11 (night), and a hospital nurse staffing committee with equal numbers of nurse managers and direct care staff | ORS 441.762 to 441.768 (HB 2697, 2023) |
| Massachusetts | ICU ratio | RN patient assignment of 1:1 or 1:2 in all intensive care units, depending on patient stability under a certified acuity tool | M.G.L. c.111, §231 |
| New York | ICU ratio plus staffing committee | At least one RN for every two patients an attending practitioner determines need intensive or critical care; every general hospital keeps a clinical staffing committee that produces an annual plan by July 1 | 10 NYCRR 405.22; Public Health Law 2805-t |
| Washington | Staffing committee | Committee in place by January 1, 2024, at least 50% nonsupervisory direct care nursing staff; plan filed with the Department of Health from January 1, 2025; hospitals staff to the plan from July 1, 2025 | RCW 70.41.420 |
| Connecticut | Staffing committee | Staffing plan developed by the hospital staffing committee, certified to DPH by January 1 and July 1; since October 1, 2025, reports due January 15 and July 15 on whether the hospital met at least 80% of plan assignments | C.G.S. 19a-89e (as amended by P.A. 25-97) |
| Nevada | Staffing committee | Hospitals in counties of 100,000 or more licensed for more than 70 beds: committee at least half licensed nurses and CNAs in direct care, and a documented staffing plan | NRS 449.242 |
| Ohio | Staffing committee | Hospital-wide nursing care committee, at least 50% RNs in direct care; an evidence-based written nursing services staffing plan | Ohio Rev. Code 3727.51 to 3727.53 |
| Texas | Staffing committee | Nurse staffing committee, at least 60% RNs who spend at least half their time in direct care; meets at least quarterly and recommends the staffing plan | Tex. Health & Safety Code 257.004 |
| Minnesota | Published staffing plans | A core staffing plan for each inpatient unit, submitted to the Minnesota Hospital Association for publication, plus quarterly actual direct patient care hours | Minn. Stat. 144.7055 |
| Colorado | Staffing committee | Committee by September 1, 2022 with at least 60% clinical staff nurses; annual master staffing plan submitted to the health department and posted on the hospital’s website | HB22-1401 |
Illinois is often listed as a staffing committee state; we could not reach its statute at source for this update, so it is left out rather than guessed at.
California nurse to patient ratios (22 CCR 70217)
California’s ratios are the maximum number of patients assigned to one licensed nurse “at any one time.” “Licensed nurse” means an RN or LVN (and, in psychiatric units only, a psychiatric technician). The unit ratios in the regulation:
| Unit | Ratio | Notes |
|---|---|---|
| Critical care (ICU, burn, coronary care, acute respiratory) | 1:2 or fewer | Intensive care newborn nursery: 1 RN to 2 or fewer, RNs only |
| Operating room | 1 RN circulator per occupied room | Plus at least one scrub assistant per room |
| Labor and delivery | 1:2 active labor | 1:4 for antepartum patients not in active labor |
| Postpartum | 1:4 mother-baby couplets | 1:6 when the assignment is mothers only; multiple births never over 8 mothers plus infants |
| Combined labor/delivery/postpartum | 1:3 | When caring for one woman in active labor and a postpartum mother and infant |
| Pediatrics | 1:4 | |
| Postanesthesia recovery | 1:2 | Regardless of type of anesthesia |
| Emergency department | 1:4 | 1:2 for critical care patients; 1:1 RN for critical trauma patients; triage RN not counted |
| Step-down | 1:3 | From January 1, 2008 |
| Telemetry | 1:4 | From January 1, 2008 |
| Medical-surgical | 1:5 | From January 1, 2005 |
| Specialty care | 1:4 | From January 1, 2008 |
| Psychiatric | 1:6 | LVNs and psychiatric technicians no more than 50% of licensed nurses |
The counting rules that catch hospitals out
- No averaging. The ratio applies at every moment, not across the shift.
- Managers count only while giving direct care. A charge nurse, supervisor or manager counts toward the ratio only when providing direct patient care, though they may cover breaks if they have shown competence on that unit.
- LVN share. LVNs may make up to 50% of the licensed nurses on a unit, except where the regulation or the patient classification system requires RNs.
- Names don’t matter. Calling a unit something else does not change the ratio for the level of care it provides.
- Ratios are a floor. Health and Safety Code 1276.4 says additional staff must be assigned under a documented patient classification system.
One change to watch: a 2025 amendment to Health and Safety Code 1276.4 (AB 116) directs the Department of Public Health to set ratios for acute psychiatric hospitals, with emergency regulations due by January 31, 2026 and permanent regulations by July 31, 2027 at the latest.
Oregon nurse staffing ratios under HB 2697
Oregon’s 2023 law took effect on September 1, 2023. According to the Oregon Health Authority, hospitals had to adopt a compliant nurse staffing plan by June 1, 2024, and hospitals may face civil penalties for violations occurring on or after June 1, 2025. The direct care RN limits in ORS 441.765:
- Emergency department: no more than one trauma patient per RN; otherwise an average of no more than 1:4 over a 12-hour shift, and never more than five patients at once.
- Intensive care, post-anesthesia care: no more than two patients.
- Labor and delivery: two patients not in active labor, or one patient in active labor or with complications.
- Operating room: one patient.
- Intermediate care: three patients.
- Medical-surgical, oncology, cardiac telemetry, pediatrics: four patients.
- Postpartum, antepartum and well-baby nursery: six patients; mother-baby: eight, counting mother and baby as separate patients.
Four details matter for workforce planning. The ratios don’t apply to psychiatric units, swing beds, outpatient units and some other patients listed in ORS 441.766; the staffing committee sets those plans. With a majority vote of the committee, a unit can let other clinical staff make up to 50% of the RNs needed under an innovative care model. A unit may deviate from its plan within a 12-hour period no more than six times in a rolling 30 days. And the Oregon Health Authority says it can enforce the ratios only when they are incorporated into the hospital’s approved nurse staffing plan, but a hospital must have a plan and cannot simply rely on the statute.
Massachusetts and New York: ICU nurse staffing ratios
Massachusetts General Laws chapter 111, section 231 sets the RN patient assignment in all intensive care units at 1:1 or 1:2, “depending on the stability of the patient” as assessed by the acuity tool and the unit’s staff nurses. Each hospital develops or chooses its acuity tool with its staff nurses, and the state health department certifies it.
New York’s rule at 10 NYCRR 405.22 requires at least one registered professional nurse for every two patients an attending practitioner determines require intensive or critical care. It follows the patient’s acuity, not the room, and does not apply to a patient placed in the ICU only because no other bed was free.
What a staffing committee law asks of you
Committee laws don’t hand you a number, but they are not soft. Washington requires hospitals to assign nursing staff according to the adopted plan from July 1, 2025, except in unforeseeable emergent circumstances. Connecticut now asks hospitals to report twice a year whether they met at least 80% of the assignments in their plan. Colorado requires the plan to be posted on the hospital’s website. In each case the committee sets the standard, and a large share of it must be direct care nurses: at least half in Washington, Nevada and Ohio, and at least 60% in Texas and Colorado.
Once a unit plan says four patients per RN on nights, every unfilled night shift is a documented gap.
Federal nurse staffing rules: hospitals and nursing homes
There is no federal nurse-to-patient ratio for hospitals. The Medicare condition of participation at 42 CFR 482.23(b) requires “adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel,” 24-hour nursing services furnished or supervised by an RN, and an LPN or RN on duty at all times (with a waiver route for some rural hospitals). The director of nursing decides the types and numbers of nursing staff.
For nursing homes, the 2024 CMS minimum staffing rule (3.48 total nurse staffing hours per resident day and a 24/7 RN) no longer applies. CMS repealed it in an interim final rule published December 3, 2025, effective February 2, 2026, after federal law barred HHS from enforcing it until September 30, 2034. The current eCFR text of 42 CFR 483.35 has no hours-per-resident-day minimum. Nursing homes are measured in hours per resident day rather than patients per nurse; that is covered in full on the nursing home staffing ratios page.
Turning a nurse staffing ratio into a hiring number
An illustration, using California’s medical-surgical ratio and a full 30-bed unit. At 1:5, the unit needs 6 licensed nurses on duty at every moment. On 12-hour shifts that is 12 nurse-shifts a day and 84 a week. A full-time nurse working three 12-hour shifts a week covers 3 of them, so the unit needs 28 full-time nurses just to hold the floor, before:
- Paid time off, sick calls, orientation and education days.
- Break relief. California’s ratios apply at all times, so meals and breaks need a nurse who can take the assignment.
- Turnover. Every nurse who leaves is a vacancy until a replacement finishes orientation; see nurse turnover rate.
That headcount has to come from somewhere: your own hiring, a float pool, or agency. The trade-offs are on PRN staffing and nurse staffing agency costs. For multistate hiring, compact nursing states lists where an RN can start on one license.
What it costs to recruit the nurses a ratio requires
Our nurse recruitment guide covers the campaign side, RN vs. LPN vs. CNA recruiting cost breaks the numbers down by role, and nursing shortage solutions has the workforce data.
In Boostpoint’s 2026 Social Job Advertising Benchmark, registered nurse campaigns had a median cost per applicant of $19.08, with a middle 50% of $12.76 to $34.84 and an 11% apply rate, across 173 campaign-months on Meta (benchmark data). Cost per applicant is not cost per hire.
Related: registered nurse job description, ICU nurse job description and charge nurse interview questions.
Frequently asked questions
What is the nurse to patient ratio by state?
California sets minimum licensed nurse-to-patient ratios for every hospital unit, such as 1:2 in critical care and 1:5 on medical-surgical units. Oregon sets direct care RN ratios by unit in statute. Massachusetts and New York set intensive care ratios. Washington, Connecticut, Nevada, Ohio, Texas and Colorado require staffing committees and written plans instead of fixed numbers.
Which states have mandated nurse to patient ratios?
Of the states we read at source, California and Oregon set ratios by hospital unit. California does it in regulation (22 CCR 70217) and Oregon in statute (ORS 441.765), applied through each hospital’s nurse staffing plan. Massachusetts and New York set ratios for intensive care only. Other states use staffing committee laws.
What is the nurse to patient ratio in California?
Under 22 CCR 70217, 1:2 in critical care, labor and delivery (active labor) and post-anesthesia recovery; 1:3 in step-down; 1:4 in telemetry, pediatrics, specialty care and the emergency department; 1:5 in medical-surgical units; and 1:6 in psychiatric units. The ratios apply at all times with no averaging, and count RNs and LVNs.
What is the ICU nurse to patient ratio?
In California, New York and Oregon, no more than two patients per nurse in intensive care. Massachusetts requires a 1:1 or 1:2 RN assignment depending on patient stability under a certified acuity tool. New York applies its 1:2 ratio to patients an attending practitioner determines need intensive or critical care.
Is there a federal nurse to patient ratio?
No. For hospitals, 42 CFR 482.23 requires adequate numbers of RNs, LPNs and other personnel and 24-hour nursing services supervised by an RN, without a number. For nursing homes, the 2024 CMS minimum staffing rule was repealed effective February 2, 2026.
What are Oregon’s nurse staffing ratios?
ORS 441.765 limits direct care RNs to two patients in intensive care, four on medical-surgical, oncology, telemetry and pediatric units, three in intermediate care and one in the operating room, with an emergency department average of 1:4 over 12 hours. CNAs may have no more than 7 patients on day or evening shifts and 11 at night.
What is a hospital staffing committee law?
A law requiring each hospital to form a committee, with a set share of direct care nurses, that writes a unit-by-unit staffing plan. Washington requires at least 50% nonsupervisory direct care nursing staff and Texas at least 60% direct care RNs. The plan then becomes the standard the hospital must staff to or report against.
Do nurse to patient ratios apply to nursing homes?
Not the hospital ratios on this page. Nursing homes follow federal rules at 42 CFR 483.35, which require sufficient staff and an RN 8 consecutive hours a day, 7 days a week, plus state minimums usually set in hours per resident day. Our nursing home staffing ratios page covers those rules.
Ratios set the floor. Applicants decide whether you reach it.
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Book a DemoSources: 22 CCR 70217 (via Cornell LII); California Health and Safety Code 1276.4; ORS 441.762 to 441.768 and Oregon Health Authority HB 2697 FAQ (revised 9 September 2024); M.G.L. c.111, §231; 10 NYCRR 405.22 (via Cornell LII); New York Public Health Law 2805-t; RCW 70.41.420; Connecticut DPH Blast Fax 2026-7; NRS 449.242; Ohio Rev. Code 3727.51 and 3727.53; Tex. Health & Safety Code 257.004; Minn. Stat. 144.7055; Colorado HB22-1401 bill summary; 42 CFR 482.23 and 483.35 (eCFR); Federal Register, December 3, 2025; Boostpoint 2026 Social Job Advertising Benchmark. General information, not legal advice. Read at source 28 September 2026.