California In 1999, California became the first state to pass legislation regarding ratio laws. The law went into effect on January 1, 2004, and soon other states looked to follow this landmark precedent.

Massachusetts RNs and health care advocacy groups have backed HB 1282, which would ensure quality care for patients and adequate staffing for registered nurses. The bill, which was introduced last year, is presently before the House Ways and Means Committee.

Maine State legislators have directed the Maine Quality Forum Advisory Council to examine direct-care registered nurse staffing levels in general, acute and specialty care hospitals, as well as the issue of minimum staffing ratios for direct-care RNs in hospitals and the rules of the Department of Human Services on direct-care RN staffing. The council must report its findings to a health and human services committee by January 15, 2005.

Iowa RNs in Iowa lobbied members of the state legislature in February 2004 seeking support for their state’s "Safe Staffing and Quality Care Act," which specifies the maximum hours a nurse may be on duty and sets RN-to-patient ratios for emergency rooms, operating rooms and maternity wards.

New Jersey RNs are sponsoring SB 2523 which would establish minimum professional nurse staffing standards for hospitals and ambulatory surgery facilities and certain Department of Human Services facilities. Introduced in January 2004, the bill is now before the Assembly Health and Human Services Committee.

Pennsylvania The state legislature has a staffing ratio bill on the table. Introduced in both houses, the bill would mandate RN-to-patient ratios in the state’s hospitals, modeled after California’s staffing law.

Wisconsin Legislation was passed last year requiring set nurse-to-patient ratios.

Washington State legislators recently passed HB 2712, creating a task force on nurses’ work environment and patient safety.

Oregon RNs in Oregon have been successful in establishing a starting point for specific nurse-to-patient ratios. In 2002, legislators passed a bill requiring staffing based on the severity of patients’ conditions (acuity), and although this bill does not mandate definite ratios, it is a step in the right direction.

Nevada Statistics show that Nevada ranks last in the nation regarding the number of RNs per 100,000 people. Nurses in Nevada called for better working conditions through state established ratios and appeared before a state legislature subcommittee to testify, urging the committee to institute ratios and guidelines for staffing. Despite the information provided to them, the subcommittee rejected mandatory ratios after several nurse managers and hospital association executives testified that ratios would not improve the quality of care and would cost both hospitals and patients.

New York There are two ratio bills in the New York state legislature. A07200 is called the "Safe Staffing for Quality Care Act and would eliminate mandatory overtime and mandate a higher RN-to-patient staffing ratio. However, due to the fact that the bills seem to be going nowhere, unionized RNs are taking matters into their own hands and are building exact ratios into their contracts.