Every hospital that takes Medicare surveys a random sample of discharged adult patients about their stay, and the results are published by hospital, state and nationally. Three of the questions are about nurses specifically, which makes this the only nationally comparable measure of nursing as patients experience it.
The figures here cover discharges from October 2024 to September 2025, published in July 2026.
The national picture
- 80 percent of patients said nurses always communicated well, the composite of the three nurse questions.
- 86 percent said nurses always treated them with courtesy and respect.
- 77 percent said nurses always listened carefully to them.
- 76 percent said nurses always explained things in a way they could understand.
- 71 percent would definitely recommend the hospital, and 72 percent rated it 9 or 10 out of 10.
- 60 percent said the area around their room was always quiet at night, the lowest-scoring item on the survey.
The interesting gap is inside the composite
Courtesy scores ten points higher than explanation. Patients almost universally experience nurses as respectful, and a quarter of them do not come away understanding what they were told.
That gap is the measurable trace of time. Being courteous costs seconds; explaining a medication, a procedure or a discharge plan until someone actually understands it costs minutes that a nurse carrying too many patients does not have. The same pattern shows up in the staffing literature, where the tasks left undone under pressure are the cognitive and educational ones rather than the technical ones. See nurse staffing and patient outcomes and patient acuity and staffing systems.
By state
| State | Nurses always communicated well | Nurses always listened | Nurses always explained | Would definitely recommend |
|---|---|---|---|---|
| Alabama | 80% | 78% | 76% | 71% |
| Alaska | 81% | 77% | 76% | 74% |
| Arizona | 77% | 74% | 73% | 68% |
| Arkansas | 81% | 79% | 76% | 71% |
| California | 76% | 73% | 71% | 69% |
| Colorado | 80% | 77% | 75% | 75% |
| Connecticut | 78% | 75% | 74% | 68% |
| Delaware | 77% | 74% | 73% | 64% |
| District of Columbia | 72% | 69% | 67% | 65% |
| Florida | 76% | 73% | 72% | 69% |
| Georgia | 79% | 76% | 75% | 71% |
| Hawaii | 79% | 77% | 75% | 72% |
| Idaho | 82% | 79% | 77% | 75% |
| Illinois | 79% | 77% | 75% | 69% |
| Indiana | 80% | 77% | 75% | 71% |
| Iowa | 83% | 81% | 78% | 76% |
| Kansas | 83% | 81% | 78% | 78% |
| Kentucky | 82% | 80% | 78% | 71% |
| Louisiana | 84% | 81% | 80% | 75% |
| Maine | 83% | 80% | 78% | 72% |
| Maryland | 75% | 73% | 71% | 66% |
| Massachusetts | 79% | 77% | 76% | 70% |
| Michigan | 80% | 77% | 75% | 69% |
| Minnesota | 82% | 80% | 77% | 74% |
| Mississippi | 83% | 81% | 79% | 72% |
| Missouri | 79% | 77% | 75% | 71% |
| Montana | 82% | 80% | 76% | 75% |
| Nebraska | 84% | 82% | 78% | 78% |
| Nevada | 76% | 73% | 71% | 69% |
| New Hampshire | 82% | 80% | 77% | 73% |
| New Jersey | 76% | 74% | 72% | 65% |
| New Mexico | 78% | 75% | 73% | 66% |
| New York | 77% | 74% | 73% | 67% |
| North Carolina | 80% | 78% | 76% | 70% |
| North Dakota | 83% | 80% | 77% | 77% |
| Ohio | 81% | 79% | 77% | 71% |
| Oklahoma | 81% | 78% | 76% | 74% |
| Oregon | 81% | 78% | 77% | 74% |
| Pennsylvania | 81% | 79% | 77% | 70% |
| Rhode Island | 80% | 78% | 75% | 70% |
| South Carolina | 81% | 79% | 77% | 70% |
| South Dakota | 83% | 81% | 79% | 77% |
| Tennessee | 80% | 78% | 77% | 70% |
| Texas | 80% | 77% | 76% | 73% |
| Utah | 81% | 79% | 76% | 77% |
| Vermont | 83% | 80% | 78% | 73% |
| Virginia | 81% | 78% | 76% | 70% |
| Washington | 78% | 75% | 74% | 71% |
| West Virginia | 84% | 81% | 79% | 73% |
| Wisconsin | 83% | 81% | 78% | 75% |
| Wyoming | 82% | 79% | 78% | 72% |
What the ranking does not mean
The states at the top are Louisiana, Nebraska and West Virginia at 84 percent, followed by Iowa, Kansas, Maine, Mississippi, North Dakota, South Dakota, Vermont and Wisconsin at 83. The bottom is the District of Columbia at 72, Maryland at 75, and California, Florida, Nevada and New Jersey at 76.
That is close to the inverse of what nurse pay and staffing regulation would predict. California pays registered nurses more than any state and is the only one with legislated ratios across every unit, and it sits near the bottom. Louisiana, which appears elsewhere on this wiki for having 95 percent of its nursing homes below the registered nurse staffing threshold the repealed federal rule would have set, is at the top here.
Three explanations matter more than any nursing-quality reading.
Hospital size and case mix. Smaller and rural hospitals score higher on patient experience almost everywhere, and the states at the top are dominated by them. Large urban teaching hospitals treat more complex patients, in noisier buildings, and score lower on nearly every item.
Patient expectation and response patterns differ by region, which is why the survey publishes adjusted results and why comparing two states is weaker than comparing two similar hospitals.
The survey measures experience, not clinical outcome. It reports what patients recall about communication, not whether their care was correct. Those correlate, but loosely.
The quiet-at-night item shows the same pattern more starkly: 69 percent in Nebraska against 48 percent in California, Connecticut and Massachusetts. That is a fact about building age, occupancy and urban density, not about nurses.
Why nurses should care about it anyway
The scores are used. They feed hospital value-based payment, they appear in public comparison tools, and hospital leadership tracks them monthly. When a unit is pushed to improve patient experience, the nurse questions are usually where the pressure lands, since nurses are the staff patients see most.
The useful defence, when a manager presents a falling score, is that the composite's weakest components are the ones that need time at the bedside rather than another scripted phrase. That is a staffing argument supported by the hospital's own data, and it can be made with the same file a manager is quoting from.
Related
- Nurse staffing and patient outcomes
- Patient acuity and staffing systems
- Nurse burnout
- Nursing home staffing by the numbers
- Where the nursing numbers come from
Sources
- Patient survey (HCAHPS) state results, covering October 2024 to September 2025, published July 2026. Centers for Medicare and Medicaid Services. Figures compiled 9 September 2026.
- Patient survey (HCAHPS) national results. Centers for Medicare and Medicaid Services. Accessed September 9, 2026.
- Hospital datasets. Centers for Medicare and Medicaid Services, for the hospital-level version of the same measures. Accessed September 9, 2026.