Ratios – it’s a life saver

Our health system is desperate for reform

Nurses and midwives are essential for building healthy communities. The efforts of these highly skilled clinicians are fundamental to solving the healthcare crisis present in NSW.

Our public hospitals are faced with increased admissions of patients, without an increase in staffing to meet the demand. There are not enough nurses and midwives being rostered to deliver care and it’s putting patients’ lives at risk.

The most efficient way to resolve the crisis is to phase in a transparent, shift by shift nursing and midwifery ratios system, with an appropriate skill mix, and staffing levels based on the number of patients in each ward, unit or department.

We’re standing up for patients. Safe ratios are a priority for everyone. The government must put the care of NSW patients first.

About nurse/midwife-to-patient ratios

Poor staffing and unmanageable workloads have obstructed the delivery of quality public healthcare in NSW for many years.

When there are not enough nurses or midwives rostered on each shift, workplace fatigue and dangerous working conditions set in and can easily risk patients’ lives.

Increasing the number of adequately skilled clinicians on a shift by shift basis enables better outcomes for public health patients and reduces adverse events.

We need ratios in NSW to safeguard the future of our public health system. Peer-reviewed evidence indicates an enforceable nursing and midwifery ratios system delivers safe care and saves money.

What are safe nurse/midwife-to-patient ratios?

A nurse/midwife-to-patient ratio is the minimum number of nurses or midwives working on a ward or unit in relation to the number of patients they care for. 

Good nurse/midwife-to-patient ratios ensure a safe level of care and decrease the risk of poor patient outcomes, and unnecessary deaths. Without the right ratios, patients across NSW miss out on thousands of hours of much needed nursing and midwifery care. 

After years of campaigning, the NSW Nurses and Midwives’ Association (NSWNMA) secured a commitment, prior to the 2023 state election, for ratios to be phased in across five key areas: 

  • 1:4 shift by shift ratios in current ‘Nursing Hours Per Patient Day’ wards 
  • 1:3 in Emergency Departments 
  • 1:3 in postnatal maternity and a review of Birthrate Plus® 
  • Intensive Care Units staffed to the latest Professional Standard outlined by the ACCCN 
  • 3 nurses on each shift in Multi-Purpose Services, where the ED is open 24/7 

These minimum ratios will be enforceable under the Public Health System Nurses’ and Midwives’ (State) Award 

The NSWNMA remains resolute to continue campaigning until every specialty area requiring ratios gets them. 

Ratios save lives – and money

International studies from the past 20 years have shown a direct correlation between nurse and midwife staffing levels and improved patient outcomes. 

Research conducted on ratios implemented in Queensland showed 145 lives were saved within two years of the policy coming into effect. A further 255 readmissions were prevented. 

Further, the state saved a projected $80 million as a result of the improvements in patient outcomes.  

What’s happening in other states?

Victoria, Queensland, South Australia and the ACT have made nurse/midwife-to-patient ratios law. Western Australia is progressing the implementation of ratios.  

Thanks to the collective activism of members, and strong negotiations by NSWNMA leaders, to secure support from Labor and crossbench members of parliament, NSW is the last mainland state committed to introducing nurse/midwife-to-patient ratios. 


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