PILLAR RANKING • November 11, 2026
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Best Staffing: State Rankings
Ranked by RN hours, total nurse hours and staff turnover in nursing homes (CMS payroll data).
Top 3 States
Browse Other Pillars
All 51 States Ranked
Higher score = better| Rank | State | Grade | Score | Details | |
|---|---|---|---|---|---|
| #1 | District of Columbia | A | 100.0 | 1.58 RN hrs · 5.08 total nurse hrs / resident day · 36% turnover | View → |
| #2 | Hawaii | A | 99.3 | 1.73 RN hrs · 4.99 total nurse hrs / resident day · 34% turnover | View → |
| #3 | Alaska | A | 84.3 | 2.03 RN hrs · 6.57 total nurse hrs / resident day · 48% turnover | View → |
| #4 | Nevada | A | 65.6 | 1.13 RN hrs · 4.33 total nurse hrs / resident day · 43% turnover | View → |
| #5 | Delaware | A | 65.0 | 1.00 RN hrs · 4.48 total nurse hrs / resident day · 40% turnover | View → |
| #6 | Minnesota | A | 63.3 | 1.08 RN hrs · 4.27 total nurse hrs / resident day · 42% turnover | View → |
| #7 | Maine | B | 59.4 | 1.06 RN hrs · 4.39 total nurse hrs / resident day · 45% turnover | View → |
| #8 | Washington | B | 58.7 | 0.99 RN hrs · 4.42 total nurse hrs / resident day · 44% turnover | View → |
| #9 | Oregon | B | 57.8 | 0.76 RN hrs · 5.13 total nurse hrs / resident day · 44% turnover | View → |
| #10 | Utah | B | 57.1 | 1.24 RN hrs · 4.08 total nurse hrs / resident day · 50% turnover | View → |
| #11 | California | B | 54.6 | 0.68 RN hrs · 4.54 total nurse hrs / resident day · 37% turnover | View → |
| #12 | Wisconsin | B | 51.4 | 0.98 RN hrs · 4.25 total nurse hrs / resident day · 47% turnover | View → |
| #13 | North Dakota | B | 51.2 | 0.93 RN hrs · 4.47 total nurse hrs / resident day · 48% turnover | View → |
| #14 | Maryland | B | 50.0 | 0.88 RN hrs · 3.93 total nurse hrs / resident day · 40% turnover | View → |
| #15 | Connecticut | C | 45.0 | 0.71 RN hrs · 3.90 total nurse hrs / resident day · 37% turnover | View → |
| #16 | Massachusetts | C | 42.4 | 0.66 RN hrs · 3.94 total nurse hrs / resident day · 38% turnover | View → |
| #17 | Rhode Island | C | 42.3 | 0.77 RN hrs · 3.78 total nurse hrs / resident day · 40% turnover | View → |
| #18 | New Jersey | C | 41.7 | 0.70 RN hrs · 3.90 total nurse hrs / resident day · 39% turnover | View → |
| #19 | Michigan | C | 40.4 | 0.78 RN hrs · 4.03 total nurse hrs / resident day · 45% turnover | View → |
| #20 | New Hampshire | C | 39.6 | 0.78 RN hrs · 3.87 total nurse hrs / resident day · 43% turnover | View → |
| #21 | Kentucky | C | 39.6 | 0.80 RN hrs · 3.99 total nurse hrs / resident day · 45% turnover | View → |
| #22 | Florida | C | 39.3 | 0.73 RN hrs · 3.86 total nurse hrs / resident day · 42% turnover | View → |
| #23 | Arizona | C | 38.8 | 0.74 RN hrs · 4.08 total nurse hrs / resident day · 45% turnover | View → |
| #24 | New York | C | 38.3 | 0.73 RN hrs · 3.69 total nurse hrs / resident day · 40% turnover | View → |
| #25 | Pennsylvania | C | 38.0 | 0.78 RN hrs · 3.90 total nurse hrs / resident day · 45% turnover | View → |
| #26 | Wyoming | C | 38.0 | 0.96 RN hrs · 3.98 total nurse hrs / resident day · 52% turnover | View → |
| #27 | Iowa | C | 36.5 | 0.74 RN hrs · 3.86 total nurse hrs / resident day · 44% turnover | View → |
| #28 | Idaho | C | 36.1 | 0.84 RN hrs · 3.99 total nurse hrs / resident day · 50% turnover | View → |
| #29 | Mississippi | C | 35.9 | 0.63 RN hrs · 4.20 total nurse hrs / resident day · 44% turnover | View → |
| #30 | Kansas | C | 34.7 | 0.73 RN hrs · 4.13 total nurse hrs / resident day · 48% turnover | View → |
| #31 | West Virginia | C | 34.5 | 0.74 RN hrs · 3.71 total nurse hrs / resident day · 44% turnover | View → |
| #32 | Vermont | C | 33.4 | 0.83 RN hrs · 4.30 total nurse hrs / resident day · 55% turnover | View → |
| #33 | Montana | C | 33.3 | 0.92 RN hrs · 4.02 total nurse hrs / resident day · 55% turnover | View → |
| #34 | Colorado | C | 33.2 | 0.81 RN hrs · 3.69 total nurse hrs / resident day · 47% turnover | View → |
| #35 | Nebraska | C | 32.1 | 0.69 RN hrs · 4.12 total nurse hrs / resident day · 48% turnover | View → |
| #36 | South Dakota | C | 31.9 | 0.78 RN hrs · 3.86 total nurse hrs / resident day · 49% turnover | View → |
| #37 | Virginia | D | 30.1 | 0.71 RN hrs · 3.88 total nurse hrs / resident day · 48% turnover | View → |
| #38 | Illinois | D | 30.0 | 0.71 RN hrs · 3.47 total nurse hrs / resident day · 44% turnover | View → |
| #39 | Alabama | D | 29.2 | 0.66 RN hrs · 3.90 total nurse hrs / resident day · 47% turnover | View → |
| #40 | Indiana | D | 28.4 | 0.68 RN hrs · 3.73 total nurse hrs / resident day · 46% turnover | View → |
| #41 | South Carolina | D | 27.8 | 0.62 RN hrs · 3.87 total nurse hrs / resident day · 46% turnover | View → |
| #42 | North Carolina | D | 24.0 | 0.62 RN hrs · 3.87 total nurse hrs / resident day · 49% turnover | View → |
| #43 | Ohio | D | 22.1 | 0.64 RN hrs · 3.71 total nurse hrs / resident day · 49% turnover | View → |
| #44 | Tennessee | D | 22.0 | 0.60 RN hrs · 3.82 total nurse hrs / resident day · 49% turnover | View → |
| #45 | Arkansas | F | 17.2 | 0.41 RN hrs · 4.08 total nurse hrs / resident day · 49% turnover | View → |
| #46 | Georgia | F | 16.3 | 0.50 RN hrs · 3.61 total nurse hrs / resident day · 47% turnover | View → |
| #47 | Louisiana | F | 15.5 | 0.31 RN hrs · 3.82 total nurse hrs / resident day · 47% turnover | View → |
| #48 | New Mexico | F | 13.9 | 0.65 RN hrs · 3.58 total nurse hrs / resident day · 54% turnover | View → |
| #49 | Texas | F | 6.2 | 0.44 RN hrs · 3.42 total nurse hrs / resident day · 51% turnover | View → |
| #50 | Oklahoma | F | 4.8 | 0.34 RN hrs · 3.82 total nurse hrs / resident day · 55% turnover | View → |
| #51 | Missouri | F | 1.6 | 0.46 RN hrs · 3.40 total nurse hrs / resident day · 57% turnover | View → |
Scores are 0–100 relative to other states. Pillar grades are assigned by within-pillar rank position. Read methodology →