Generally speaking, there are no federal rules that states must abide by regarding the ratio of nurses to patients. With this being said, federal ratios are suggested to be used as a standard, and all states, counties, and municipalities can choose to accept them or use them as a model for their purposes.
The largest federally-suggested ratio is 1:6 for Well Baby Nurseries. This means that one nurse can be responsible for six patients. The lowest suggested ratio of 1:1 is for extremely intensive tasks, such as caring for an ER trauma patient and patients in the operating room. Other severe issues, such as intensive care and neonatal intensive care, have low ratio suggestions of 1:2. However, many hospitals may require that the ratio is lowered to 1:1, especially for patients with a high risk.
Currently, only two states have set a determined number of patients that can be cared for by a nurse; California and, most recently, Massachusetts. California is the largest state by population size and often has specific rules regulating professional industries, such as healthcare. There are many nurses and other bright minds in this field, so the state is proud to be a leader in enabling its workforce to be protected in many different scenarios.
California has the highest recorded range of ratios, with as many as six patients to one nurse for psychiatric care. To put this in perspective, New York's average nurse-to-patient ratio for psychiatric care is around 3:6.
Massachusetts has recently passed laws that mimic the California model. Notably, it not only presents the nurse-patient ratio in terms of number but also the stability of the patients. Generally speaking, Massachusetts has set a ratio of between 1:1 and 1:2 depending on the severity. This has reduced the number of patients each nurse is responsible for, which the government of Massachusetts hopes to help increase wages, increase demand and increase the number of nursing jobs available. Additionally, nurses with a low patient ratio will take better care of their patients.
In addition to California and Massachusetts, 11 other states have taken steps forward to attempt to enact guidance regarding ratios. These are:
State governments require that the hospitals within their jurisdiction form committees or tribunals to determine the correct nurse-patient ratio depending on their circumstances. Each hospital's policies and procedures must be well-documented to be extremely tenable in case of a malpractice suit against their practitioners. It must also justify this number to the workforce, as nurses must understand what is expected of them in each hospital.
This controversial topic has always been discussed but quickly moved along during the pandemic. It shined a light on the situation, and pressure is being put on governments and hospitals equally to share the burden of enacting proper legislation.
Nurse Ratio (per 1k)