Public Health
It’s time to improve ratios
Government-employed nurses across NSW have voted to campaign for greater quality and equality in public health services.
One hundred and seventy seven NSWNMA branches overwhelmingly voted ‘yes’ to endorse the union’s 2017 ratios and pay claim.
The claim puts nurse-to- patient ratios at the forefront of our 2017 campaign.
NSWNMA General Secretary Brett Holmes said the vote reflected NSW nurses’ deep concerns for patient safety due to understaffing.
“Our claim seeks to extend nurse- to-patient ratios to health services that still don’t have them,” he said.
“A lot of regional and rural hospitals were not included when the union’s first ratios campaign won mandatory ratios for many units of metropolitan and rural hospitals in 2011.
“Also not included were specialty areas such as emergency departments, units for paediatrics, intensive care, high dependency and neonatal intensive care, community nursing and community mental health nursing.
“All are crying out for a safer clinical working environment for both nursing staff and patients.”
“We aim to bring staffing levels in non-tertiary hospitals up to the same level as tertiary referral city hospitals.
“This would ensure patients receive the same level of care regardless of where they live or are treated.”
No improvements in hospital staffing since 2011
Brett said the campaign also focuses on services that have ratios but are being undermined by measures such as replacing registered nurses with lesser-qualified nurses and failing to allocate additional nursing hours to patients who require specialised one-to-one care.
“Short-sighted attempts to cut budgets by employing lower skilled staff result in higher rates of hospital-acquired infections, adverse events and failure to rescue. Evidence-based academic research has proved this repeatedly.
“Likewise, the pressure to make do without additional nurses is unacceptable and unsafe.
“Patients clinically assessed as requiring a special should not have their care compromised.
“Too often ‘specials’ are not provided, or lower-skilled classifications are used.
“It is clinically inappropriate for specialised care to be within rostered nursing hours because it takes time away from other patients.”
He said the government had done nothing to improve hospital-staffing ratios since the union’s 2011 win resulted in the employment of more than 1800 FTE nurses.
“Year on year, we have lobbied the NSW Coalition government for improved and expanded ratios, but the government has stubbornly sat on its hands.
“With budget surpluses forecast over the next four years the Berejiklian government can afford to give residents of NSW safer ratios.
“The evidence is clear that better ratios save lives and there is no reason why the NSW government should be lagging behind Queensland and Victoria.”
Our ratio claims
Under the public health system award, Peer Group A medical and surgical wards are currently staffed at 6 nursing hours for each patient per day.
That is equivalent to ratios of 1:4 on morning shifts, 1:4 on afternoon, shift and 1:7 on night shifts, with some shifts including an ‘in charge’ nurse without a patient allocation.
This year we are calling on the state government to extend the same level of nursing care to patients at all Peer Group B, C and D hospitals, as well as the acute beds of Multi-Purpose Service facilities throughout NSW.
Ratios must also be extended to speciality units such as emergency departments, intensive care and high dependency units, paediatric and neonatal intensive care units. New staffing models must be introduced into community and community mental health nursing, drug and alcohol units and small birthing units.
Other states show the way
Victoria and Queensland have committed to minimum nurse-to-patient ratios in their public health awards.
They have also enshrined ratios in legislation.
Under the Queensland legislation and regulations, which take effect in July, medical, surgical and mental health wards must maintain a minimum of one nurse to four patients for morning and afternoon shifts, and one nurse to seven patients for night shifts.
Queensland Health expects to recruit an additional 250 nurses to staff these ratios and the government says it will consider whether ratios should be extended to other wards and facilities this year.
Ratios save lives
International research increasingly shows that lives are saved when hospitals employ more nurses.
Research, published in The Lancet, showed the greater the number of registered nurses, the lower the number of patient deaths.
When hospitals are understaffed, patients die, get infections, get injured, or get sent home too soon without adequate education about how to take care of their illness or injury.
The research shows:
– Every one patient added to a nurse’s workload is associated with a 7 per cent increase in deaths following common surgery.
– Every 10 per cent increase in university- educated nurses is associated with 7 per cent lower mortality.
– If all hospitals in nine European countries studied had at least 60 per cent university-educated nurses, with no more than six patients each, more than 3500 deaths a year might be prevented.
‘Special’ patients need special care
In 2017 we want the Berejiklian government to accept that staffing for patients clinically assessed as needing a ‘special’ must be separate and in excess of mandated ratios or rostered staffing.
The pressure to make do without additional qualified nurses is unacceptable and unsafe.
Protect our skill mix
Our public hospital system badly needs a better skills mix to take some pressure off our most experienced registered nurses and registered midwives to guarantee patient safety. And there is an alarming lack of support for beginning practitioners in many areas.
The government can and must do more to help by funding more clinical nurse/midwifery educators – and not just on day shift.
As part of our 2017 claim we seek the employment of an additional 275 clinical nurse/midwifery educators working across seven days and all shifts.
That would help to keep transitional registered nurses in the system and working safely. It would also aid the retention of experienced nurses and midwives in the medium term.
Evidence based academic research has repeatedly shown that short-sighted attempts to cut budgets by employing lower skilled staff result in higher rates of hospital-acquired infections, adverse events and failure to rescue.
Assistants in nursing/midwifery should be used only where clinically appropriate.
Our claim calls for AiNs to be introduced only in accordance with the ministry’s own ‘2010 Health Service Implementation Package for AiNs in Acute Care’.
The government’s refusal to adopt these measures would erode the improvements nurses won in the 2011 introduction of ratios.
Things you can do
Download Ratios signs from our website http://www.nswnma.asn.au/get-involved/ratios-put-patient-safety-first/, fill them out, snap a photo of yourself or with colleagues, and send them to photos@nswnma.asn.au so we can post it on Facebook.
Like our Ratios put patient safety first Facebook page: https://www.facebook.com/safepatientcare?ref=hl
Sign up to get regular information about our ratios campaign: http://action.nswnma.asn.au/page/s/ratios-put-patient-safety-first-newsletter
Contact your NSWNMA organiser/branch official if there’s a staffing or ratios- related workplace issue you want to get active around