Every CE requirement verified against official state nursing board sources. How RenewRN verifies the data →
Every CE requirement verified against official state nursing board sources. How RenewRN verifies the data →
Verified July 2026
The honest version, straight from the statutes. Only one state sets hard ratios in every unit. About 14 states have some staffing law; the other 37 have none. Here is exactly what each of the 14 requires, with the citation, so you know where your state actually stands.
3
states with mandated ratios
9
states requiring staffing committees
5
states requiring public disclosure
A hard, enforceable ceiling on patients per nurse. The strongest form of staffing law, and the rarest.
Comprehensive minimum nurse-to-patient ratios in every hospital unit, enforced at all times: ICU/NICU 1:2, ER 1:4 (1:2 for critical/trauma), L&D 1:2, med-surg 1:5, step-down 1:3, telemetry 1:4, psych 1:6.
California Safe Staffing Law (AB 394, 1999); minimum ratios in effect since 2004 (22 CCR §70217).
ICU-only ratio: 1:1 or 1:2 depending on patient stability. A 2018 ballot measure (Question 1) to extend ratios to all units was rejected by voters.
Massachusetts ICU nurse staffing law (2014).
Minimum nurse-to-patient ratios phasing in from June 2025 through 2026 (e.g., ICU 1:2, med-surg 1:5, ER by acuity), layered on top of hospital staffing committees.
Or. HB 2697 (2023).
No fixed numbers, but hospitals must convene a committee, usually at least half direct-care nurses, to build and review the staffing plan.
Minimum nurse-to-patient ratios phasing in from June 2025 through 2026 (e.g., ICU 1:2, med-surg 1:5, ER by acuity), layered on top of hospital staffing committees.
Or. HB 2697 (2023).
Requires hospitals to form nurse staffing committees that build and review staffing plans.
Connecticut hospital nurse staffing committee law.
Nurse Staffing by Patient Acuity Act: hospital staffing committees plus public reporting of staffing.
Illinois Nurse Staffing by Patient Acuity Act.
Hospital nurse staffing committees (2023 Nurse & Patient Safety Act); chief nursing officers develop and report a core staffing plan.
Minnesota nurse staffing law (2013), expanded by the 2023 Nurse and Patient Safety Act.
Requires hospital staffing committees with at least 50% direct-care nurses.
Nevada hospital nurse staffing committee law.
Clinical staffing committees (2021) plus public posting of each hospital's staffing plan.
New York clinical staffing committee law (2021).
Requires hospital nurse staffing committees to develop written staffing plans.
Ohio hospital nurse staffing committee law.
Requires hospital nurse staffing committees with a majority of direct-care nurses.
Texas nurse staffing committee law (Health & Safety Code ch. 257).
Hospital staffing committees with enforceable staffing plans; 2023 law (SSB 5236) strengthened enforcement and meal/rest-break rules.
Washington hospital staffing committee law (RCW 70.41.420), strengthened by SSB 5236 (2023).
Hospitals must report staffing levels publicly. Transparency, not a mandated minimum. Some of these overlap with the committee states above.
Nurse Staffing by Patient Acuity Act: hospital staffing committees plus public reporting of staffing.
Illinois Nurse Staffing by Patient Acuity Act.
Clinical staffing committees (2021) plus public posting of each hospital's staffing plan.
New York clinical staffing committee law (2021).
Public disclosure of staffing ratios, with certain unit-specific minimums (e.g., critical care) set by regulation.
New Jersey nurse staffing disclosure law.
Requires hospitals to publicly report nurse staffing information.
Rhode Island hospital nurse staffing public-reporting law.
Requires hospitals to report nurse staffing data publicly.
Vermont nurse staffing reporting law.
Most of the country has no staffing-ratio, committee, or disclosure statute. In those states, staffing is set by hospital policy within the general federal requirement that a hospital have “adequate” licensed nursing, a standard with no number attached. That is why the federal Nurse Staffing Standards bill keeps returning to Congress, and why staffing remains a state-by-state patchwork.
A staffing law does not, by itself, tell you what to do in the moment. A few states have a formal safe-harbor or assignment-despite-objection (ADO) process that lets you document an unsafe assignment while protecting your license. Where that exists, it is usually the protected route, refusing outright can raise patient-abandonment questions under your board's practice act. Our protect-your-license guide covers how board discipline actually works, and each state renewal page links its board's practice act.
Sources & currency
Categorization follows the American Nurses Association state staffing-law summary plus the cited state statutes, current as of July 2026. Staffing bills change every legislative session, always confirm the current text with your state legislature or board before relying on it.
Three. California is the only state with comprehensive minimum ratios in every hospital unit (ICU 1:2, ER 1:4, med-surg 1:5, and so on), in force since 2004. Massachusetts mandates ratios in intensive care only. Oregon enacted ratios in 2023 (HB 2697) that phase in from June 2025. Every other state relies on staffing committees, disclosure rules, or nothing at all.
About 14 states have some form of enacted hospital nurse-staffing law: three with ratios, nine requiring staffing committees, and five requiring public disclosure (several overlap). The rest of the country has no staffing-ratio, committee, or disclosure statute. Use the categorized lists on this page to check yours, then confirm the current text with your state, since bills change every legislative session.
A ratio law sets a hard, enforceable maximum number of patients per nurse by unit (California's model). A staffing-committee law instead requires the hospital to convene a committee, usually at least half direct-care nurses, to write and review a staffing plan, but it does not set fixed numbers. Committee laws give nurses a formal voice in staffing decisions; ratio laws set a floor no unit can go below.
No. Federal Medicare rules require hospitals to have 'adequate' numbers of licensed nurses but set no specific ratio. A federal bill to mandate ratios (the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act) has been reintroduced repeatedly but has not become law. Staffing minimums are set state by state.
It depends on your state and employer. A few states have a formal 'safe harbor' or assignment-despite-objection (ADO) process that lets you document an unsafe assignment while protecting your license, and your board's practice act governs your duty when accepting an assignment. Refusing outright can raise patient-abandonment questions, so the documented ADO/safe-harbor route, where it exists, is usually the protected path. Confirm your state's specific process before you are in the moment.