Tennessee PBJ Nursing Home StaffingTennessee PBJ Staffing
296 providers • 24,564 residents • 3.77 HPRD
3.77 HPRD (rank: 31)3.77 HPRD · Rk 310.56 RN HPRD3.6% contract
Tennessee's statewide staffing ratio is 3.77 HPRD in Q4 2025. Tennessee's statewide staffing ratio remains in line with Q4 2024 (3.77 HPRD). This level is near the national ratio of 3.76 HPRD and ranks #31 out of 51 states.
Tennessee
Direct staff excludes Admin/DON. State min. (~2.06 HPRD) may reflect calculated equivalents by MACPAC. Direct staff excludes Admin/DON. State min. (~2.06 HPRD) may reflect calculated equivalents by MACPAC.
Tennessee
Tennessee
Tennessee
TN Staffing Stats
| Metric | Tennessee | CMS Region 4CMS Region 4 includes Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.Regional figures are calculated from facility-level data using the same methodology as the state figures. | U.S. | State rankRanks compare the 50 states and D.C. by the displayed metric value. A higher or lower rank is not inherently positive or negative for every metric, including contract staffing share and rural-facility share. |
|---|---|---|---|---|
| Total Nurse Staffing HPRD | 3.77 | 3.76-0.01 vs TN | 3.76Same as TN | #31 of 51 |
| Direct Care Nurse HPRD | 3.47 | 3.49+0.02 vs TN | 3.50+0.02 vs TN | #33 of 51 |
| RN HPRD | 0.56 | 0.60+0.04 vs TN | 0.62+0.06 vs TN | #42 of 51 |
| RN Direct Care HPRD | 0.37 | 0.41+0.04 vs TN | 0.43+0.07 vs TN | #42 of 51 |
| Nurse Aide HPRD | 2.13 | 2.28+0.15 vs TN | 2.28+0.15 vs TN | #43 of 51 |
| Contract Staff Percentage | 3.6% | 3.4%-0.2 pts vs TN | 5.3%+1.6 pts vs TN | #37 of 51 |
| Median Case-Mix HPRD (Acuity) | 4.32 | 3.70-0.63 vs TN | 3.74-0.58 vs TN | #5 of 51 |
| Rural Facilities (Share) | 36% | 29%-6.3 pts vs TN | 27%-8.3 pts vs TN | #24 of 51 |
PBJ320 High-Risk (70)
PBJ320 high-risk PBJ320 high-risk uses CMS-assigned indicators only (PBJ320 does not assign them): Special Focus Facility or SFF Candidate; abuse icon; one-star overall; one-star staffing. nursing homes in Tennessee (70 facilities).
| Facility | Census | CMS ratings | Indicators | Total HPRD |
|---|---|---|---|---|
| Loading facilities… | ||||
Methodology
Staffing from CMS Payroll-Based Journal (PBJ) public files (2017–2025), plus Provider Information and chain data where shown. State staffing context via MACPAC (2022). Methodology · PBJ explained.
Metrics
- Hours Per Resident Day (HPRD): Total staff hours ÷ average residents. Example: 350 hours for 100 residents = 3.5 HPRD.
- Direct Care (excl. Admin, DON): Hours per resident day for direct care staff only (RN, LPN, CNA, NAtrn, MedAide), excluding administrative and supervisory roles.
- Contract Staff %: Share of hours provided by contract staff.
- Census: Average number of residents during the period.
Note: Some states set minimums (e.g., NJ, CA, NY at 3.5 HPRD); a federal 3.48 minimum was recently overturned (2025). A 2001 federal study linked 4.1 HPRD to better outcomes in that study. Staffing needs vary by resident acuity (case-mix), day, and shift. Estimates on PBJ Takeaway assume roughly 60% of staff are CNAs.
Data transparency
The PBJ Dashboard pulls directly from CMS data and is carefully vetted for accuracy. Still, sometimes a bug sneaks into the jelly. That could mean: a systemic CMS data reporting issue (e.g., Q2 2017 contract staffing, missing data in 2020 due to COVID) or there could be a coding error on our part. If you spot something that looks off, please let me know via the contact form so I can set things right.
Trend charts omit quarters with implausible submitted HPRD (total/direct below 0.25; RN, LPN, and aide use role floors and neighbor-quarter rules). Full criteria.
Rankings, within-state percentiles, CMS flags (including abuse icon): How metrics are calculated.