Crossbench members of the parliamentary committee that conducted the year-long upper house inquiry into rural, regional and remote health have criticised the government and opposition for voting against the recommendation.
Nurses and midwives went on strike in March, calling for mandated nurse-to patient-ratios.
Health Minister Brad Hazzard said Labor voted against recommending ratios despite leading the union to believe it was supporting them.
"This is a major backflip and what it shows is they've been telling porkies and when it comes to the crunch they've now done a major, major turnaround," he told Sydney radio 2GB on Thursday.
Opposition Leader Chris Minns was asked about legislating ratios on the day nurses went on strike and said he was not in a position to release policies a year out from an election.
"The taxpayers would expect us to scrutinise both the budget envelope and the full cost associated with a promise of that magnitude," he said.
Premier Dominic Perrottet said there were already mandated ratios for nursing hours per patient.
"The form of nurse-to-patient ratios that the union are advocating for actually creates more problems in the health system," he said on Thursday.
"When nurses are sick under that ratio, wards have to close."
Nurses are also seeking pay rises above the 2.5 per cent cap on public sector wages, in line with other frontline workers, including public transport staff and teachers, who went on strike on Wednesday.
Mr Perrottet had previously indicated public sector wages would be addressed in next month's state budget.
Greens MP Cate Faehrmann, who was on the health committee inquiry that did not include ratios among its 44 recommendations, said healthcare staff and patients had been let down.
"Nurses, midwives and their union know that ratios are essential to creating a safe workplace and ensuring the safety of their patients," she said.
Chronic understaffing caused horrific situations, where understaffed regional hospitals sometimes had one nurse caring for dozens of patients.
"The solution to this problem must include safe nurse-to-patient ratios," Ms Faehrmann said.
As a consequence, more nurses would resign and regional NSW hospitals would be even worse off, she said.
Fellow committee member Emma Hurst, of the Animal Justice Party, said it was disappointing the government and Labor had did not support a recommendation on staffing ratios, calling it a major failure of the inquiry.
The report coincides with International Day of the Midwife, and the NSW Nurses and Midwives Association says many of them will spend the day grappling with staffing challenges.
"Highly skilled, professional midwives are flat-out trying to work in a broken health system and we're seeing them reduce their hours or move interstate where conditions and pay is better," NSWNMA assistant general secretary Shaye Candish said.
Queensland and Victoria have legislated nurse-patient ratios and South Australia is considering them.
