Sign Up for Updates

RATIOS: Planning

< Click to our Safe Patient Ratios homepage

Assess how California won safe patient ratios. Diagnose good ratio bills from bad ones. Help plan safe patient ratios in your state. TAKE ACTION, get involved, support legislation! Evaluate safe patient ratios research. See and share ratios news and press.


DC RNs take ratios fight from the bedside to curbside.   Planning for safe staffing ratios in your state.

Planning for Success

State-By-State: Nurses want safe staffing

Lessons from California: Five years after ratios

Ratios in your state: How strong is your bill?

How can we improve this website?


Australian RNs campaigning for ratios rented a train, picking up RNs at each stop on their way to a huge rally for safe staffing standards.
Australian RNs on board for safe staffing too.

Global Nurses United

Ratios Around The World: A Global Perspective

Learn about Global Nurses United (GNU)

Help win safe RN staffing ratios in your state!

Join the patient advocay coalition for safe staffing!

Nurses from coast-to-coast campaign for state-based legislation
modeled after the success of the California law.

District of Columbia

Washington, DC


“Patients in our nation’s capital deserve world-class care. Unfortunately, hospital corporations continue to place an emphasis on the bottom line, and care suffers. As patient advocates, nurses in the District of Columbia fight daily battles with hospital management to ensure that there are enough nurses to care for patients. Management consistently opposes our efforts to win better staffing for our patients. It’s time for a legislative solution; it’s time for statutorily enforced RN-to-patient ratios.”

— Lori Marlowe, RN, Washington, D.C.




The Florida Hospital Patient Protection Act has been introduced in the Florida legislature every year since 2009. It would mandate RN-to-patient ratios at all times, guarantee the right of patient advocacy, and provide whistle-blower protection. Over 3,000 community supporters have signed pledges to support the legislation and 22 municipalities have passed resolutions calling on their legislative delegations to pass this important life-saving law.

“When patients are denied access to a medically-appropriate level of nursing care, their outcomes suffer. It’s that simple, and it is totally preventable. Many hospitals understaff their units, denying access to RNs, and undermining patient safety in the name of hospital profits. The Florida Hospital Patient Protection Act will extend to my patients the level of care they deserve.”

— Barbra Rivera, RN, St. Petersburg, Florida



“It is the hope and dream of hospital RNs across Missouri to have safe staffing levels so that when you need one of us, we can be there for you. Our NNOC/NNU campaign for RN-to-patient ratios in Missouri continues. When we set limits on how many patients RNs are required to care for, patients have better outcomes and receive the safe, therapeutic care that we all expect in a hospital. When a call light goes on, medications are needed, and very personal questions need to be answered. We want the time to be there.”

— Cathy Stephenson, RN, Kansas City, Missouri



The Patient Safety Act calls upon the Department of Public Health to set a safe limit on the number of patients assigned to a nurse at one time, based on an evaluation of evidenced-based research. In addition, the bill calls for staffing to be adjusted based on acuity and the patient’s needs, bans the practice of mandatory overtime, and includes language to improve reporting of nurse-sensitive measures so that meaningful quality of care comparison can be made.

“Understaffing is part of the healthcare crisis facing this nation and the state of Massachusetts. Registered nurses are being forced to care for too many patients at one time, and patients endure the consequences in the form of preventable medical errors, avoidable complications, increased length of stay, and readmissions. We need to pass safe staffing legislation to protect our patients and the integrity of our nursing practice.”

— Donna Kelly-Williams, RN, president, Massachusetts Nurses Association



The 2012 Nursing Care and Quality Improvement Act, H.B. 2548.

“When nurses are short staffed, our patients suffer. Ratios are key to the quality care our patients deserve.”

— Dorothy Ahmad, RN, Chicago, Illinois



S.B. 438/H.B. 1874 would establish minimum RN-to-patient ratios, based on the California law, along with whistle-blower protections. Only direct-care nurses can be counted in the ratios, and the ratios would cover all shifts. Nothing would preclude any facility from implementing higher nurse staffing levels.

“Many of the issues we are faced with on the job are a direct result of poor staffing levels. When there is not enough staff, workplace violence against nurses is harder to prevent, talented RNs leave the profession because they simply burn out, and the quality of patient care is at risk because we just don’t have the time to do everything we would if we had safe ratios.”

— Patricia Eakin, RN, president, Pennsylvania Association of Staff Nurses and Allied Professionals