How much nurse staffing should a nursing home have?
Key takeaways
- There is no federal minimum number of nursing hours per resident. A 2024 federal standard of 3.48 hours was repealed, effective February 2, 2026.
- Federal rules do require enough staff to meet residents' needs, a licensed nurse on duty around the clock, and a registered nurse at least 8 hours in a row every day.
- The national average is 3.86 nursing hours per resident per day. Half of homes report 3.68 hours or less.
- Some states set their own minimums, so the rule depends on where the home is.
Staffing is one of the first things families look at, and it has no simple answer. There is no single federal number a nursing home must meet. There are federal rules about who must be on duty, state rules that vary, a national average, and a research benchmark. Here is each one, and how to use them when you read a home's page.
What does "hours per resident per day" mean?
It is the total hours worked by nursing staff in a day, divided by the number of residents. A home with 100 residents whose nurses and aides work 380 hours in a day reports 3.8 hours per resident per day. The total counts registered nurses, licensed practical nurses and nurse aides together.
The figures come from payroll. Homes submit the hours their staff were paid to work to CMS every quarter, and CMS publishes the results. CMS audits homes to verify what they report.
What do federal rules require?
Federal rules (42 CFR § 483.35) require every certified nursing home to have:
- enough nursing staff to meet the needs of its residents;
- a licensed nurse on duty 24 hours a day;
- a registered nurse for at least 8 hours in a row, 7 days a week.
A home that cannot hire enough nurses despite real effort can be granted a waiver of the two nurse requirements in limited cases.
In 2024 CMS adopted a rule that would have set minimum hours for the first time: 3.48 total nursing hours per resident per day, including 0.55 from registered nurses and 2.45 from nurse aides, and a registered nurse on site around the clock. CMS repealed those requirements in December 2025, effective February 2, 2026. The older rules listed above remain in force.
What do states require?
Some states set their own minimums, as hours per resident or as a ratio of staff to residents. Others have none beyond the federal rules.
Differs by stateMinimum staffing rules by state
- Maine
- Maine sets staffing by shift: one direct-care worker for every 5 residents on the day shift, every 10 on the evening shift and every 15 at night. A registered nurse must be on duty at least 8 hours in a row every day.
- New Hampshire
- New Hampshire sets no minimum number of hours per resident. Homes must have a licensed nurse on duty 24 hours a day, a registered nurse at least 8 hours in a row every day, and enough staff to meet residents' needs.
- Rhode Island
- Rhode Island law requires an average of 3.58 hours of direct nursing care per resident per day, measured each quarter, starting January 1, 2026.
- Vermont
- Vermont requires at least 3 hours of direct care per resident per day, averaged over a week, including at least 2 hours of nursing-assistant care. A registered nurse must be on duty at least 8 hours in a row every day.
Checked against state sources in Oct 2026. State rules are added here as each state is added to this site.
What is the national average?
- National average, all nursing staff3.86 hours
- Half of homes report this or less3.68 hours
- National average, registered nurses0.69 hours
- National average, weekends3.42 hours
- Nursing staff turnover in a year45.8%
Averages are published by CMS in the data processed Aug 1, 2026. The middle value is this site's calculation from the hours each home reported.
Is there a benchmark?
A study prepared for CMS in 2001 found that the quality of care for long-stay residents was more likely to suffer when nursing time fell below about 4.1 hours per resident per day: 2.8 hours from nurse aides and 1.3 from licensed nurses. The study made no recommendation, and the figure was never made a requirement, but it has been used as a reference point ever since. In the current data, 28 percent of homes that reported hours were at 4.1 or above. The comparison is rough, because the study left out management staff and the payroll figures include them.
Residents' needs differ from home to home, so no single number fits every home. A unit where most residents need help from two people needs more staff than one where most residents walk on their own.
How do you read a home's staffing on this site?
- All nursing staff. The home's total, with a line marking the state average.
- Registered nurses. The staff who assess residents and direct their care.
- Weekends. Compare it with the overall figure.
- Turnover. The share of nursing staff who left within a year.
The site shows whether each figure is above or below the state average. It does not grade the home.
What should you ask on a tour?
- How many residents does one aide look after on the day shift, the evening shift and at night?
- Is a registered nurse in the building overnight and on weekends?
- How much of the staffing comes from temporary agency workers?
- Will the same aides care for my relative most days?
More in what to ask on a nursing home tour and how to read CMS star ratings.