In a Florida nursing home, a certified nursing assistant can be assigned no more than 20 residents at any time, and the facility must also provide at least 2.0 hours of CNA direct care per resident per day. Both rules come from Florida Statute 400.23, and they operate together: the 1-to-20 figure is an absolute cap, but the daily hour requirement usually forces a lower real caseload. How many patients a CNA can have in Florida therefore depends on the shift, the census, and how the facility distributes its required hours across the day.1Florida Senate. Florida Statutes 400.23 – Rules; Evaluation and Deficiencies; Licensure Status
The Three Staffing Minimums Behind the Ratio
Every Florida nursing home has to meet three staffing minimums at the same time. Missing any one of them is a violation, even if the other two are satisfied.
- At least 2.0 hours of direct care from a CNA per resident per day.
- No fewer than one CNA per 20 residents at any given time.
- A weekly average of at least 3.6 hours of total direct care per resident per day from all direct care staff combined, including CNAs and licensed nurses.
Separately, the statute requires at least 1.0 hour of licensed nurse direct care per resident per day, with a floor of one licensed nurse per 40 residents.1Florida Senate. Florida Statutes 400.23 – Rules; Evaluation and Deficiencies; Licensure Status
“Direct care staff” means people who provide hands-on care or resident care management. Food preparation, laundry, and housekeeping workers do not count. The 3.6-hour total is a weekly average measured Sunday through Saturday, so a facility can dip on one day if other days make up for it. The 2.0 CNA hours, on the other hand, are a daily minimum. A CNA pulled to work as a qualified medication aide during a shift cannot be counted toward CNA hours or the CNA-to-resident ratio for that time.1Florida Senate. Florida Statutes 400.23 – Rules; Evaluation and Deficiencies; Licensure Status
Licensed nurses can be counted toward CNA staffing under specific conditions. If the facility already meets its licensed nurse minimums separately, an RN or LPN can fill a CNA slot, but that nurse must perform CNA duties exclusively for the entire shift and cannot be double-counted unless the state agency approves otherwise.1Florida Senate. Florida Statutes 400.23 – Rules; Evaluation and Deficiencies; Licensure Status
What the Ratio Looks Like on Your Shift
The 1-to-20 cap is the ceiling. The hourly requirement is what usually decides the real number.
Take a 60-resident facility. It needs 120 CNA hours of direct care every day (60 × 2.0). Spread across three eight-hour shifts, that is 40 CNA hours per shift, or five CNAs on the floor. Five CNAs for 60 residents works out to 12 residents each, well below the 20-resident cap.
The 1:20 ratio tends to become the binding constraint on overnight shifts, when fewer residents are awake and needing active care. A facility can run lighter staffing overnight, but it still cannot drop below one CNA per 20 residents. During the day, most Florida nursing home CNAs handle somewhere between 8 and 15 residents, with the exact number depending on census and resident acuity.
How the Rules Differ Outside Nursing Homes
The 1:20 cap and the 2.0-hour minimum apply only to nursing homes licensed under Chapter 400. Other Florida care settings work differently, and some have no CNA-specific ratio at all.
Assisted Living Facilities
Assisted living facilities use total staff hours per week, not CNA-to-resident ratios. The minimum scales with facility size: 168 staff hours per week for up to 5 residents, 212 hours for 6 to 15 residents, 253 hours for 16 to 25 residents, and so on, with 42 additional hours added per week for every 20 residents above 95.2Legal Information Institute. Florida Administrative Code 59A-36.010 – Staffing Standards These hours cover all staff, not just CNAs, reflecting that ALF residents generally need help with daily activities rather than intensive medical care.
Hospitals
Florida has no law setting mandatory CNA-to-patient ratios in hospitals. Hospital staffing is set internally by each facility based on patient acuity and unit type. A 2025 bill (SB 332) proposed minimum registered nurse-to-patient ratios in hospitals, but it addressed RN staffing, not CNA assignments. If you work as a CNA in a Florida hospital, your patient load comes from your employer’s staffing plan, not from state statute.
Enforcement and What to Do About Understaffing
The Agency for Health Care Administration (AHCA) oversees nursing home compliance. AHCA conducts unannounced inspections and reviews facility records to verify staffing against the statutory minimums. Nursing homes must keep staffing compliance records for five years and must report staffing data in line with federal requirements.1Florida Senate. Florida Statutes 400.23 – Rules; Evaluation and Deficiencies; Licensure Status
Every nursing home has to post daily the names of the licensed nurses and CNAs on duty so residents and visitors can see who is providing care. A sparse board relative to the number of residents is worth paying attention to.1Florida Senate. Florida Statutes 400.23 – Rules; Evaluation and Deficiencies; Licensure Status
Facilities that fall short face administrative fines of up to $500 per violation per day, and AHCA can deny, suspend, or revoke a license for Chapter 400 violations. Florida’s administrative code also prohibits scheduling any nursing staff member for more than 16 hours in a 24-hour period on three consecutive days except in documented emergencies, so a facility cannot cover a chronic shortage by working the same staff into the ground.3Legal Information Institute. Florida Administrative Code 59A-4.108 – Nursing Services
If a facility is running below the required ratios, AHCA takes complaints from staff, residents, and family members. The complaint hotline is (888) 419-3456, and complaints can also be filed through the Florida Health Care Complaint Portal online. AHCA is required to investigate.
Florida law protects residents’ right to receive adequate care consistent with their care plan, and facilities cannot use physical or chemical restraints as a substitute for adequate staffing.4Online Sunshine. Florida Statutes 400.022 – Residents Rights For CNAs, putting staffing concerns in writing and notifying the supervising nurse creates a paper trail. Retaliation against a CNA for reporting legitimate safety concerns to AHCA may itself violate state and federal whistleblower protections.