Ratios now law in Queensland

Queensland has become the fourth government in the world – and the second Australian state – to legislate for minimum nurse to patient ratios.

Queensland Health expects to recruit an additional 250 nurses to meet nurse and midwife to patient ratios being phased in throughout the state from July 1.

Queensland became the second state after Victoria to legislate for minimum ratios in public hospitals.

The state Labor government amended the Hospital and Health Boards Act by establishing a legislative framework which ensures safe nursing and midwifery staff numbers, according to the Queensland Nurses Union (QNU).

The QNU says ratios will increase staff satisfaction, decrease attrition rates, reduce service variation and improve equality across the health service.

These improvements will boost productivity, help make hospitals more efficient and provide greater continuity of patient care, the union predicts.

Under the legislation and regulations, prescribed medical, surgical and mental health wards are required to maintain a minimum of one nurse to four patients for morning and afternoon shifts, and one nurse to seven patients for night shifts.

Health Minister Cameron Dick said the government would review the Act next year to consider whether ratios should be extended to other wards and facilities, or different ratios should be developed.

He said the law was the product of a broad consultation process including with the QNU.

Ratios save lives

QNU State Secretary Beth Mohle said the introduction of minimum nurse to patient ratios would save lives.

“International evidence concludes patient mortality rates and outcomes are directly linked to nurse numbers and the level of care each patient receives,” she said.

“Health services with a higher percentage of registered nurses and increased nursing hours per patient will have lower patient mortality, reduced length of stay, improved quality of life and less adverse events such as failure to rescue, pressure injuries and infections.”

“According to international research, an increase in a nurse’s workload by one patient increases the likelihood of an inpatient dying by seven per cent.

“For every patient added to a nurse’s workload, readmission within 15-30 days increased 11 per cent for a child with a medical condition and 48 per cent for a child who had undergone surgery.

“Ratios will also result in significant cost savings through reduced health care costs, retaining staff and reducing patient complications and adverse events.”

Ms Mohle said the QNU would continue to work with Queensland Health to make the transition to ratios as smooth as possible.

Nurse ratio legislation was passed in the Victorian parliament in October 2015 and in Wales in February this year.

California became the first government in the world to introduce the laws in 2004 after a 13-year campaign by the California Nurses’ Association.

New York nurses are campaigning to have similar laws adopted in their state.

Only the LNP opposed ratios

Queensland’s move to improve patient safety by adopting ratios was supported by all parties and independent Members of Parliament except the Liberal National Party.

The former LNP government slashed 1800 nursing jobs across Queensland Health between 2012 and 2015 – including positions in operating theatres, intensive care units, emergency medicine, maternity services and mental health.

“They did this despite research that showed Queensland would need more nurses to cope with our growing and ageing population over the next decade, not less,” said QNU state secretary Beth Mohle.

“All research shows that employing more nurses saves lives and offers better health outcomes for patients.

“Overworked nurses skip meal breaks, work excessive overtime, work double shifts and rush through their work to fit it all in.

“This is when accidents happen, when things get overlooked, when care is simply not as good as it should be.

“Mandatory ratios can help fix this.”

Ratios win followed a crisis

The drive for ratios came from the crisis that arose after Premier Campbell Newman sacked thousands of nurses in 2012 says Queensland RN Moira Purcell.

“This led to a cull of all the experienced nurses with skill and knowledge. That was to the detriment of the patients and the stress for young nurses was unbearable. Most of them were unable to bear the strain. Many of them have left because they couldn’t handle the pressure,” she said.

“The wards were understaffed and over worked. Proper care was not possible. Proper monitoring and communication was not possible. Mistakes and dangerous outcomes became inevitable. It had become a very worrying and dangerous situation.

“Patients see the effects of how hard nurses are working and they withhold vital pieces of information. They don’t want to trouble nurses and be a burden and that can be a burden in itself.

“It reached a state of crisis – a breaking point where it couldn’t continue.”

Moira says the announced ratios are just a beginning and “a lot more pressure will be required to maintain this momentum”.

“It’s actually only happening in a certain number of the main tertiary hospitals in the medical and surgery wards to begin with. It still needs to go more widespread than that. It certainly needs to be addressed in aged care and community nursing. Also the midwifery model as well – how will ratios apply there? There’s a lot more work to be done.”