What’s in the nurse staffing ratio claim

Summary of the 2010 Claim for Nurse Staffing Ratios and Skill Mix for Safe Patient Care.

The NSWNA submitted an interim claim for nurse staffing ratios and skill mix to NSW Health in June, and has been visiting members in workplaces across NSW to consult and validate the claim.

The nurse staffing ratios claim is part of the 2010 Claim for a new Award for public health system nurses and midwives.

The claim contains models developed by the NSWNA for nurse-to-patient ratios and tools for the following specialties: medical, surgical, emergency, palliative care, rehabilitation, inpatient mental health, community health, community mental health and operating theatres.

The claim for each nursing specialty is tailored to the particular nursing requirements of patients and relevant environmental factors.

The nurse-to-patient ratios claim replaces the current Award mechanism to regulate workloads – ‘the General Workload Calculation Tool’ (GWCT), which now only covers 30% of medical/surgical wards and does not provide a comprehensive model to ensure the right numbers of nurses and skills are available on all shifts and wards.

NSWNA General Secretary Brett Holmes said: ‘When we developed the General Workload Tool in 2004 we were clear that if it didn’t work we would pursue nurse-to-patient ratios. With the Award coming to an end, we sought to seize the opportunity to find a way to ensure our members have enough resources with the right skill mix to provide safe patient care.’

Ensuring adequate staffing and skill mix for safe patient care

The nurse staffing ratios claim would ensure a mandated base number of nurses on a shift but it also has sufficient flexibility to factor in skill mix and acuity.

The claim provides the ratio of nurses to patients for each morning, afternoon and evening shift, with variations according to your ward or unit’s specialty area and peer group (these are set by NSW Health).

With nurse-to-patient ratios, all absences from the roster of clinical nursing staff will be replaced or backfilled by an employee of the same Award classification to ensure the quality and safety of patient care, and the necessary budget provision for this to occur should be made.

There may be situations where a ward has staffing above that suggested by our claim. In these cases, the claim states that those numbers cannot be reduced.

The staffing ratio does not include support positions or classifications such as: Nursing Unit Manager, Clinical Nurse Educator, Clinical Nurse Consultant, Nurse Practitioner, administrative support staff and wardspersons. These would be employed in addition to the nurses ratio.

In addition to the RN ratio, the claim provides that a proportion of CNEs must be employed for a certain number of nurses. CNEs should be rostered on seven days of the week over each roster period.

The claim also provides a consultation process regarding the introduction of AiNs to the roster for any ward or unit. It includes provision to ensure Nursing Unit Managers have the delegated authority to make the ?nal decision about whether patient care can be maintained with an AiN role as part of the unit’s skill mix. This means if the NUM believes AiNs can enhance the nursing care for that unit then they can employ one but there cannot be more than one AiN per shift. No AiNs are to be rostered in emergency, palliative care or inpatient mental health units or wards.

The Safety in Numbers document on the NSWNA website explains which peer group your hospital belongs to, and provides the complete details of the nurse staffing ratio claim for your specialty area and peer group.

Mandated staff ratios

  • For each specialty and peer group, the claim provides:
    • the ratio of nurses to patients for morning shift;
    • the ratio of nurses to patients for afternoon shift;
    • the ratio of nurses to patients for night shift.
  • All absences from the roster of clinical nursing staff will be replaced or backfilled by an employee of the same Award classification.
  • In situations where a ward has staffing above that suggested in the claim, those numbers cannot be reduced.

Ensuring adequate skill mix

The claim includes provisions for skill mix to ensure the delivery of safe patient care:

  • For each ward or unit a certain percentage of RNs must be rostered on each shift to ensure adequate skill mix.
  • There are limitations on the maximum number of AiNs that can be performing work on any shift.
  • The decision to roster an AiN is subject to the Nursing Unit Manager’s professional judgement.

Ensuring adequate clinical support

  • The staffing ratio does not include support positions or classifications such as: Nursing Unit Manager, Clinical Nurse Educator, Clinical Nurse Consultant, Nurse Practitioner, dedicated administrative support staff and wardspersons. These would be employed in addition to the nurse staffing ratio.
  • A proportion of CNEs must be employed for a certain number of nurses.
  • CNEs should be rostered on seven days of the week over each roster period.