Only mandated ratios will guarantee safe staffing   

The Liberal National Coalition has promised 5000 extra nurses and midwives but without mandated ratios how will we know where they will end up?

We need a ratio system that guarantees nurse numbers will grow along with our health system – not a one-off sweetener to get our vote on election day,” says president of NSWNMA and midwife O’Bray Smith.

She says it’s time political parties listened to nurses and midwives on health care issues.

“It’s fine for the government to pull a number out of the air and say, you can have so many nurses, but they’re not actually listening to what we need.

“We are the ones on the hospital floor and we’re the ones who know what we need to do our jobs safely.

“After 17 years in the health system, I have never seen nurses so desperate for safe staffing levels. I have never seen the despair on their faces like I do now.

“We’ve been saying for a long time that only mandated ratios will guarantee safe staffing into the future because governments can’t take them away.

“We have mandatory ratios in child care so I don’t understand why the government refuses to accept we also need them in health care.

“It’s time for us to use our votes to get ratios mandated in law.”

Government’s promise is unclear

O’Bray says it is not clear what the government’s promise of 5000 nurses really means.

“How will we know where the nurses and midwives will end up? Will they be working on the floor or assigned to new projects?

“We don’t know how long these 5000 nurses will stay in the system. Will they be replaced if they leave? Will their positions be maintained?

“Without ratios, there is no guarantee that in five years, funding for the extra 5000 nurses will still be there.

“In the past it’s sometimes been hard to know where the newly-appointed staff have gone. They don’t always work on the floor where they are needed.”

O’Bray points to recent examples of local health districts deliberately keeping staff levels below the nursing hours per patient day (NHPPD) minimum in order to cut costs.

“How can we believe the LHDs will place the extra 5000 nurses where they are needed most when we can’t trust them to follow the current NHPPD system?” she asks.

Make a difference

NSWNMA activists have been pounding the footpaths, staffing the phones, leafleting railway stations and markets, doorknocking and using countless other methods to get our message out to the community about the need for shift-by-shift ratios.

Here some of them talk to The Lamp about what it has been like, the response of the community and how you can get involved.

‘Calling’ parties

“Go for it. It’s easier than you think”

Kylie Tastula, branch secretary at the Royal Prince Alfred Hospital, has been bringing members together for “election call centre parties”.

“We’ve made it a wine and cheese night and we have four to six nurses coming each time for a couple of hours. We’ve been making phone calls to other members across the state in marginal seats.

“It is a lot easier than I thought it would be. Everyone gets really nervous because you are cold calling people, but most nurses are really happy to speak to you. You are ringing people just like yourself, and it is social at the same time.

“So far the calls have been gathering information about who people have voted for in the past and who they are considering voting for in this election.”

Members are also asked if they have heard of the Ratios: It’s a Matter of Life or Death campaign.

The issue of ratios is very important to nurses, Kylie says.

Currently,  ‘A’ hospitals have the highest NHPPD and other hospitals have less.

“What the union wants is for ratios to be the same in all hospitals, and for ratios to be extended to all areas in all hospitals.”

For anyone thinking of getting behind the campaign, Kylie’s message is “go for it. It is a lot easier than you think”.

A call to arms

In the marginal state seat of Coogee, held by the Liberal MP Bruce Notley-Smith by just 2.9 per cent, nurses and midwives have been speaking to the public about the upcoming state election.

Erin Francis, NSWNMA councillor and an RN in mental health, said they are asking people to sign a pledge that they will vote for better ratios.

Erin says “most of the conversations [we’re having] are very positive. At the McIver Women’s Baths we found that the ladies are really happy to support our campaign. Dads pushing prams are also really keen to sign the pledge.”

Erin says that this election will be an important one for nurses. “The Labor Party has agreed to support one-to-four ratios in medical and surgical wards and one-to-three in emergency department and paediatrics. The Greens have agreed, but the Liberal Party haven’t agreed to any of our claims.

“The general public understand that nursing is a really hard profession, but they don’t understand how dire the situation is and are quite shocked to hear what we have to deal with on an everyday basis.”

Nurses from the four Randwick campus branches have also been surveying NSWNMA members, says Erin. “We’ve been making calls both at the Association offices and meeting up at our homes. We call it a ‘call party’, and people bring a plate of food.”

So far Erin and other members have made more than 1,000 calls.

“The call parties have been quite a positive experience for most people. Our branch is finding it really useful to find out how other members are feeling.

“I’d encourage everyone to get involved (in this campaign). It can’t be achieved by just a handful of people. It is not as scary as you might think: it is actually quite fun and enjoyable. At the end of the day we are all nurses and everyone has been quite receptive to it.”

Stalls at night markets

Strong support from the public

Katrina Bough, the president of the Wyong branch of the NSWNMA, recently set up a stall at the Niagara Park twilight markets to educate the public about the issue of safe ratios.

At the most recent stall she met a woman whose mother had been admitted to hospital after a stroke and was in an acute phase.

“The daughter said she could see the nurses were overworked, and another patient was screaming at the nurse who was trying to look after her mother.

“The daughter said the nurse was in tears, and explained they were so overloaded, but the nurse felt responsible for not being able to provide basic nursing.”

Katrina and other delegates from Wyong have been taking time outside of their work hours to have these sorts of conversations with the public and educate the community about their rights to ratios.

“The feedback from community members is pretty strong: they want clear ratios,” Katrina said. “They don’t understand nursing hours per patient day, which is the current formula.”

She says the nursing hours formula can be “manipulated by the interpretation”, and is dependent on the hospital category. “People are mortified when you explain to someone that how much nursing care you will get depends on where they live”.

Katrina is part of a group of about 25 Wyong members who have been out speaking to voters in the Entrance and Gosford electorates to raise awareness before the state election. The reception has been “very good”, Katrina says.

“People are interested to know what is going on and they are glad that we are out there supporting them and educating everybody about how things work in our world.”

Fronting a radio ad

Getting involved is empowering

Skye Romer, a mental health nurse, is the nurse’s voice in the Association’s radio ad, calling on the public to support ratios when they vote in this month’s state election.

“I’m super excited to be involved in this campaign. It’s been really empowering. Today I’ve been talking in a radio ad which I never thought in my wildest dreams I’d be doing as a nurse.

“It’s an amazing opportunity to be part of such a strong union and to make such an impact. Sometimes we think we are just a little fish in the sea but together we can make a huge difference.

“The Association has done a fabulous job going out to the community. It’s making people think about where they’ll put their vote in this election.”

Skye says it is a passion for ratios in our hospitals that drove her to get involved in our campaign.

“I work in an acute mental health unit and ratios are very important for the safety of nurses and patients,” she said.

Skye has also participated in “home call centre” activities – contacting other nurses to hear their concerns and to encourage them to help out in the campaign.

“A lot of nurses want to be heard. The stories they are telling are about high levels of stress, high levels of aggression, not having enough nurses to provide the care and all the issues that come with that.”

She says she has learned a lot from being part of the campaign.

“You feel more in charge, you feel more inspired. The campaign has been so much fun. You meet like-minded people who have the same values and the same goals in nursing and in life as you and I’ve met people who will be lifelong friends.

“I think nurses have the power to make a difference. We have the strongest union in Australia. We back each other up. And the community is willing to listen to what nurses have to say.”

Skye says there is no room for complacency in this election if we are to achieve our goal of shift-by-shift ratios across the whole public health system.

 “This election is so crucial. Our current Liberal government doesn’t even want to talk about ratios. We need to get a government that supports us. I believe the only way to do that is to vote the current government out.

“The alternative is to vote for a political party that supports nurse-to-patient ratios, that supports the backbone of our health system – which is our nurses – and that will ensure that our public health system runs strongly.”

Engaging with the public

We need to talk to the community…

Mary Ann Niones, an NSWNMA branch member, says she is not a ‘political person’. But the importance of the issue of hospital staffing has seen her spending her own time out of hours at Nepean Square and Penrith Train Station speaking to the community.  

“We want people to know there is no legislation that a nurse should only look after a certain amount of patients, because if you exceed that number it becomes a risk,” Mary Ann said.

“The majority of people tend to agree with us if they have been in the hospital themselves – they might have seen how it is short-staffed, even if they really don’t know why.”

Mary Ann and other local nurses have been asking people if they are willing to sign a pledge to vote for ratios.

Mary Ann has found that talking to people becomes easier over time.

“Initially when we started we would feel rejected because the majority of people didn’t want to speak to a random person. But in time you get over it, you keep going and eventually you will find people who are really interested and want to know what your aim is.”

…And the community is doing its bit

The hit TV series M*A*S*H featuring a wartime army field hospital was a comedy about deadly serious situations.

It inspired Chris Sadrinna to organise a three-day M*A*S*H-themed event at Avalon’s Dunbar Park on 15-17 February.

“I heard so many bad stories (about the relocation of local hospital services to the privatised Northern Beaches Hospital) I thought, are we going to have to put up a M*A*S*H tent on Dunbar Park and look after ourselves?” he said.

“Then I thought, why not erect an old army tent and invite people to come and share their stories about how they are coping with the new hospital setup.

“Instead of M*A*S*H we’ll call it S*H*A*M. If the government can’t take the community seriously, why should we be serious?”

People were invited to record their stories in a variety of ways including postcards pinned to a wall, on a Facebook page via supplied laptops, and on video. There was music and children’s games.

Resources to help you

The NSWNMA has numerous resources online to help you take our message about shift-by-shift ratios out to the public during this election campaign.

Visit our Ratios – it’s a matter of life or death website and facebook page

Here you will find our TV commercials on ratios: Watch them! Share them!

There are also other great videos that are informative, funny and insightful featuring nurses and midwives who share their experiences working in grossly understaffed environments.

Plus news, actions, ideas and resources.

NSWNMA Activists Facebook page

This is a closed group that you have to join. Sign up and find out what other nurses and midwives are doing: there are plenty of ideas here for you to get up and run with to make shift-by-shift ratios a prominent election issue.

Want to help win ratios?

Get in touch with us and let us know what you are prepared to do. Fill in our form and we’ll help put you in touch with like-minded people and away you go!

Download a sign

Download one of our Ratios signs, fill them out, snap a photo of yourself or with colleagues and send them to so we can post it on Facebook.

Want to get involved?

There are plenty of ways to make a contribution to our campaign for shift-by-shift ratios leading up to the NSW state election on 23 March.

If you would like to get involved email: