Free · State law + specialty society recs · Sources cited

Pick your state & unit — see what applies.

Only one US state (California) has codified RN:patient ratios in law for every unit. A few others (Oregon, Massachusetts) have partial laws. Everywhere else, ratios are set by hospital committee under state safe-staffing laws, or by professional-society recommendations. This tool shows you which of the three applies where you work, with citations.

The three kinds of ratio you'll see below

1. Codified law (green): Written into state statute. Enforceable by the state health department. Hospital can be cited and fined for non-compliance.

2. Committee/safe-staffing law (orange): State requires hospitals to operate a staffing committee with RN input and publish staffing plans. No numeric minimum in state law — the committee sets it.

3. Specialty-society recommendation (blue): AACN, AWHONN, ENA, ANA published recommendations based on the research. NOT legally enforceable but cited in literature and frequently used in hospital staffing policy.

Codified lawCommittee/safe-staffingSpecialty recommendation

Your state

Your unit (optional)

References (APA)

American Nurses Association. (2024). Nurse staffing standards: 50-state legislative tracker. American Nurses Association. https://www.nursingworld.org/practice-policy/nurse-staffing/

American Association of Critical-Care Nurses. (2022). AACN standards for establishing and sustaining healthy work environments (2nd ed.). AACN.

Association of Women's Health, Obstetric and Neonatal Nurses. (2022). Standards for professional registered nurse staffing for perinatal units (2nd ed.). AWHONN.

Emergency Nurses Association. (2020). Position statement: Staffing and productivity in the emergency care setting. ENA. https://www.ena.org/practice-resources/resource-library/position-statements

California Code of Regulations, Title 22, § 70217 (2004, as amended).

Oregon Revised Statutes § 441.155 (HB 2697, 2023).

Massachusetts General Laws Chapter 111, § 231 (2014).

Aiken, L. H., Sloane, D. M., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., …Sermeus, W. (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 26(7), 559-568. https://doi.org/10.1136/bmjqs-2016-005567

Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Martin, B., Reneau, K., …McHugh, M. D. (2021). Chronic hospital nurse understaffing meets COVID-19. BMJ Quality & Safety, 30(8), 639-647. https://doi.org/10.1136/bmjqs-2020-011512

Disclaimer: This tool is educational only and not legal advice. Always follow your hospital's published staffing policy. If you believe your facility is in violation of an applicable state law, contact your state Board of Nursing or department of health. If your unit feels unsafe, document and report per your hospital's chain of command and the ANA's "Just Culture" framework — refusing an unsafe assignment is governed by state-specific protections that vary widely.