FAQs on nurse-to-patient ratios

The Lamp November10

Got questions about our campaign for mandated nurse-to-patient ratios and skill mix? Check out our Frequently Asked Questions for the answers.

How has the ratio claim been determined?

Our claim for nurse-to-patient ratios is tailored to the nursing requirements of patients in a number of specialties: medical, surgical, emergency, palliative care, rehabilitation, inpatient mental health, critical care, community health and community mental health, and operating theatres.

The claim was developed after extensive research conducted by the NSWNA.

The NSWNA engaged leading nurse workforce and industrial relations academics to conduct empirical research on what is the current status of staffing numbers and skill mix.

We also spoke with expert clinicians (NUMs and some CNCs) from each of the nursing specialties we had decided to develop ratios models for.

We also carried out a literature review and examined the Victorian experience, where ratios have been in place for more than a decade.

The resulting draft claim was then discussed by NSWNA members in over 55 meetings across NSW and then endorsed by NSWNA Branch vote.

How do we ensure skill mix and that we have enough senior nurses to supervise new grads?

The recommended skill mix levels in the claim are based on academic literature that suggests a high RN level delivers superior patient outcomes against nursing-sensitive indicators.

The introduction of nurse-to-patient ratios would ensure a mandated level of RNs on every shift.

The claim also includes specific additional requirements to ensure a skill mix. This includes an increased number of CNEs across the State. The CNE role is critical in supporting the development of all nurses and new grads.

What will the skill mix mean for ENs/EENs?

Enrolled Nurses play a very important role in the delivery of health care. The claim is not intended to disadvantage any nurse, and ratios will result in more funded nursing positions across the state.  The announcement this month that more beds are being opened in 2011/2012 confirms that more ENs will be needed.

While NSW Health is trying to reduce the number of ENs by changing to pre-employment education, the Association is securing a place for all nurses, now and into the future.

What’s happening with Birthrate Plus for midwives?

The NSWNA is still waiting for a final offer from NSW Health to implement the trial permanently.

Where will the extra nurses come from?

There are a lot of new graduate nurses who haven’t been able to get jobs in public hospitals.

For example, in 2010 2,749 RNs are expected to graduate, but NSW Health is only offering 1,700 positions in the public health system (NSW Health, Nursing and Midwifery Branch 2010).

Experienced nurses will also return to the workforce once mandated ratios are in place. Nurses will return to the public health system if the conditions are right.

This was proven in Victoria where experienced nurses returned to the workforce once ratios were introduced. 2,650 nurses returned to the workforce within the first year that ratios were introduced in Victoria in 2000/2001.

Where will the money come from to fund ratios and can we afford it?

Funding must be provided for ratios to ensure safe patient care in NSW.

Victoria has a similar health system to NSW and it had a similar staffing crisis to that being experienced in NSW. In 2001, the Victorian Government acknowledged it had a major staffing crisis, with safe patient care in jeopardy, and prioritised introducing nurse ratios as a solution. It allocated the necessary resources for the adoption of nurse ratios.

Ten years later, the cost of introducing ratios has not crippled the health system in Victoria. In fact, according to many indicators, Victoria now has the most efficient health system in Australia.

In September 2010, the Victorian Health Minister Daniel Andrews told Parliament that: ‘Victoria’s public hospitals have recorded a combined financial surplus for the sixth successive year.’

If Victoria can afford ratios, then so can NSW.

How long will the claim take to finalise? 

The Award will be finalised when the Government makes an offer that NSWNA Branches decide is acceptable.

We can accelerate the process by participating in activities to put pressure on the Government to listen to nurses and deliver ratios.

Are ratios and better skill mix really achievable?

Yes. But don’t expect that the Government will fund ratios just because the Association has asked. We will need to work together to inform the community and convince the Government that safe patient care is important and that mandated nurse-to-patient ratios are the answer.

What can I do to help win ratios? 

Attend local Branch meetings – keep up to date with the campaign and local activities.

Set up or join an existing Workplace Campaign Committee (WCC) to organise events to publicise the campaign.

A full report on the outcomes of these talks will be presented to NSWNA Committee of Delegates meeting on 16 November. Tell your Branch delegates what you think of this offer so they can bring your views to the delegates’ meeting.

Delegates will then report back to members after their meeting.