Closing beds won ratios in Victoria

Strong action by nurses, especially closing beds, was an important component of the Victorian nurses campaign to win mandated nurse-to-patient ratios.

Julie Jones, an Associate Nurse Unit Manager at Ballarat Base Hospital, is a veteran of the Victorian nurses’ campaign for nurse-to-patient ratios. An ANF Victoria Delegate since 1993, she sees mandated nurse-to-patient ratios as necessary for quality patient care.

Julie says winning ratios was hard fought and could not have been achieved without action by nurses. Over the years Victorian nurses have honed the tactic of closing beds and Julie says this was a key to their historic ratios win.

‘In Victoria we were actually closing beds in the ’90s to a certain degree, but more determinedly since 2000 when we brought in the nurse-to-patient ratios. Since then, we’ve had two more Enterprise Agreements and both times the Government wanted to either reduce or remove the ratios. Each time we went into discussion with the Government it was pretty much a foregone conclusion that at some time we would have to close beds to focus the Government’s attention on meaningful discussion,’ she said.

‘Closing beds is not something nurses take lightly and to proceed was an indication of the importance Victorian nurses give to nurse-to-patient ratios.

‘When we first started this type of action the prospect of closing beds was daunting and members had to be convinced. The nursing fraternity usually baulks at disruption to patients, but closing beds was the only means of getting mandated nurse-to-patient ratios. Surprisingly, we found that most hospital managements were reasonably co-operative,’ she said.

‘Patient safety is paramount and patients requiring emergency admission can’t be turned away. Bed closures are primarily obtained by cutting elective admissions from operating lists. Our aim was for one in four beds closed.

‘As they were vacated, beds to be closed were not remade and a notice, like “Closed to save the health care system”, was put on the end of the bed. Full bed closures might not happen for several days as you wait for discharges, but once the momentum starts, it happens.’

Another Victorian nurse, Pauline North, agrees that bed closures were pivotal in putting pressure on the Government.

‘When you close beds it makes such a difference to patient flow, and to hospital KPIs. The public are very supportive of the nurses; the backlash is against the Government not against the nurses. Once you start closing beds and it affects the patient flow through the hospital it takes no time for the Government to go to the negotiating table,’ she said.

Pauline says now ratios are in place it would be very difficult to return to the old ways.

‘Working without ratios now would be very hard. I think mandated minimum nurse-to-patient ratios are attractive to nurses because they can give better care, and better quality of care. Nurses will want to come and work; people will return to work and stay in the workforce longer.’