Nursing Home Staffing Rankings
U.S. nursing homes report an average of 0.685 registered-nurse hours per resident per day, and CMS gives their staffing an average of 3 of 5 stars. Hawaii has the highest state average, 1.761; Louisiana the lowest, 0.300. Below: the 100 best-staffed homes and every state.
This page uses 14,693 Medicare-certified nursing-home records from CMS Care Compare, with NPPES context where available. Every figure is traceable in the methodology.
Most RN hours per resident, by state
Source: State averages of reported RN hours per resident per day, states with 25 or more reporting homes; CMS file processed Jul 1, 2026.
Fewest RN hours per resident
The 100 best-staffed nursing homes
Source: Reported RN hours per resident per day; CMS nursing home file processed Jul 1, 2026. Small homes can swing sharply between quarters.
Staffing by state
Small sample: Puerto Rico (7 facilities), Guam (1 facility), Alaska (16 facilities), District of Columbia (15 facilities) each rest on fewer than 25 homes with RN hours reported, so one home moves the average. Read their position as indicative.
| State | Homes reporting | Average RN hours | Average staffing rating | Rated 4 or 5 |
|---|---|---|---|---|
| Puerto Rico (small sample) | 7 | 3.215 | 3.9 | 57.1% |
| Guam (small sample) | 1 | 2.480 | 5 | 100% |
| Alaska (small sample) | 16 | 2.083 | 4.5 | 100% |
| Hawaii | 42 | 1.761 | 4.5 | 92.9% |
| District of Columbia (small sample) | 15 | 1.609 | 4.4 | 86.7% |
| Utah | 90 | 1.248 | 3.2 | 41.1% |
| Nevada | 63 | 1.095 | 3.4 | 52.4% |
| Minnesota | 331 | 1.058 | 4.2 | 85.5% |
| Maine | 77 | 1.055 | 4.1 | 81.8% |
| Wisconsin | 319 | 0.992 | 3.7 | 58.3% |
| Montana | 58 | 0.978 | 3.7 | 65.5% |
| Delaware | 43 | 0.965 | 4 | 74.4% |
| Washington | 189 | 0.941 | 3.6 | 55.6% |
| Wyoming | 35 | 0.939 | 3.6 | 60% |
| North Dakota | 70 | 0.932 | 4.3 | 82.9% |
| Idaho | 79 | 0.856 | 3.1 | 39.2% |
| Maryland | 216 | 0.846 | 3.2 | 39.8% |
| Colorado | 202 | 0.827 | 3.2 | 44.6% |
| South Dakota | 92 | 0.801 | 3.6 | 56.5% |
| Vermont | 31 | 0.800 | 3.5 | 51.6% |
| Pennsylvania | 631 | 0.790 | 3.1 | 38.8% |
| New Hampshire | 71 | 0.785 | 3.3 | 47.9% |
| Michigan | 415 | 0.781 | 3.6 | 56.6% |
| Kentucky | 260 | 0.776 | 2.7 | 30.8% |
| Rhode Island | 69 | 0.763 | 3.3 | 43.5% |
| Iowa | 376 | 0.741 | 3.7 | 62.8% |
| Oregon | 122 | 0.731 | 3.9 | 76.2% |
| Florida | 676 | 0.730 | 3.4 | 46.9% |
| West Virginia | 120 | 0.730 | 2.7 | 25.8% |
| Illinois | 651 | 0.715 | 2.1 | 17.8% |
| Kansas | 282 | 0.714 | 3.6 | 57.8% |
| New York | 582 | 0.710 | 2.8 | 28.4% |
| Arizona | 136 | 0.699 | 2.9 | 32.4% |
| Virginia | 283 | 0.694 | 2.5 | 22.3% |
| Connecticut | 185 | 0.685 | 3.2 | 39.5% |
| New Jersey | 342 | 0.684 | 3.1 | 36% |
| California | 1,129 | 0.668 | 3.3 | 44.7% |
| Nebraska | 172 | 0.666 | 3.3 | 51.7% |
| Indiana | 501 | 0.664 | 2.5 | 20.6% |
| Massachusetts | 335 | 0.655 | 3.1 | 39.4% |
| Alabama | 220 | 0.652 | 3.7 | 62.7% |
| Ohio | 903 | 0.642 | 2.4 | 19.2% |
| Mississippi | 198 | 0.641 | 3.9 | 69.7% |
| South Carolina | 184 | 0.629 | 3 | 41.8% |
| New Mexico | 66 | 0.628 | 2.9 | 22.7% |
| North Carolina | 405 | 0.611 | 2.7 | 24.9% |
| Tennessee | 301 | 0.598 | 2.4 | 19.6% |
| Georgia | 346 | 0.502 | 2.4 | 20.2% |
| Missouri | 467 | 0.461 | 2.2 | 21.2% |
| Texas | 1,142 | 0.434 | 1.9 | 8.9% |
| Arkansas | 217 | 0.408 | 3.3 | 40.6% |
| Oklahoma | 257 | 0.338 | 2.8 | 27.6% |
| Louisiana | 253 | 0.300 | 2.4 | 13.4% |
Common questions
What are RN hours per resident per day?
RN hours per resident per day measures how many hours a registered nurse spends caring for each resident on average each day. The national average across Medicare-certified nursing homes is 0.685 hours. This metric comes from the CMS Payroll-Based Journal (PBJ) system, which facilities are required to submit quarterly.
Why does RN staffing matter for nursing home quality?
Research consistently shows that higher RN staffing correlates with fewer pressure ulcers, lower rehospitalization rates, fewer falls with injury, and better medication management. Registered nurses perform clinical assessments, wound care, and medication administration that LPNs and CNAs cannot legally provide.
How often does CMS update staffing data?
CMS updates the Payroll-Based Journal staffing data quarterly, with roughly a six-month lag from the reporting period. The star ratings derived from staffing data are refreshed monthly.
Does a higher RN hour count always mean better care?
Not necessarily. Facility acuity mix matters, post-acute facilities taking hospital discharges need more RN hours than long-stay facilities with stable residents. Small facilities can also swing dramatically quarter-to-quarter. Always review staffing alongside health inspection results, quality measures, and an in-person visit.
What is the national average RN staffing rating?
The national average CMS Staffing Rating is 3/5 stars. This rating is one of three components (alongside Health Inspection and Quality Measures) that make up a facility's Overall Star Rating.
Source: CMS Five-Star Quality Rating System, Nursing Home Provider Information, processed Jul 1, 2026 (data.cms.gov). RN hours are reported by the homes through CMS Payroll-Based Journal. Not medical advice.