The rollout of ratios is complex and at every step we will need to be vigilant, but phase one delivers significant improvements while giving us a strong platform to campaign robustly for further progress across the entire system.

Members have just finished voting on a plan that constitutes phase one of the roll out of ratios throughout the public health system.

That plan is the culmination of more than eight months of negotiations between the Ministry of Health and the NSWNMA.

We were cautious about moving to that first phase because we wanted to make sure the implementation of ratios is successful. The details of the roll out were expected to be published in October, but we continued to push for improvements that we thought were necessary.

When we reached the point that the Ministry would no longer negotiate, we felt that it was the appropriate time for public sector members to collectively express their will on whether to accept or reject the plan.

This first phase was endorsed by your 23-member NSWNMA Council in December because they believed the ratios proposal from the Safe Staffing Levels Taskforce would bring about “a shift-by-shift staffing system that is transparent, accountable, and enforceable for the first time in NSW, and will create a strong foundation as we campaign to have other specialties included”.

In phase one, our emergency departments will get the significant increase in staffing they desperately need, with some set to benefit from upwards of 20 to 50 additional FTE under the reform.

A, B, and C peer group hospitals will see their NHPPD wards and units convert to shift-by-shift ratios, ensuring that the complex averaging of staff numbers is gone and the correct numbers of staff are provided on each and every shift. Many wards will also see critical improvements to the number of supernumerary in charge roles.

All patients requiring critical care in ICUs and HDUs will be nursed by an RN, except in Level 4 ICUs where ENs currently employed will continue to be counted in the 1:1 or 1:2 ratio and additional access nurses will see many ICUs able to receive the vital support they were seeking.

A STRONGER COMPLIANCE PROCESS

On balance we think this initial plan provides significant staffing improvements in these areas.

It is instructive to compare these proposed ratios with other states.

In Queensland, specialty areas including ED, ICU and maternity do not yet have ratios.

In Victoria, resus staffing in ED on a morning shift is 1:3 (compared to 1:1 in NSW) and there are no legislated ICU ratios.

It took Victoria 20 years to achieve their level of ratios. We are attempting to overhaul our entire staffing system and achieve comparable ratios to Victoria in a space of less than four years. We should recognise that this is a remarkable and challenging reform to achieve.

An important component of the first phase is a compliance process that is much stronger than what we have been working with till now.

The onus will now be on management, up to and including the ministry, to address any ratio shortfalls in a ward or unit within a 24-hour to 48-hour period, under an agreed escalation process.

MECHANISMS TO PROTECT SKILLS MIX

We know the complexity of the NHPPD system gave management too many opportunities to rort the system. We wanted to see that system overhauled.

Changes to the Public Health System Nurses’ and Midwives’ (state) Award will give additional protections to staffing numbers and skill mix.

These changes ensure that any current staffing profile number and/or skill mix in a ward/unit which is better than what the Safe Staffing Levels Taskforce recommendations call for will be maintained.

Under this clause on any ward or unit where Safe Staffing Levels are implemented:

• staffing numbers can’t be reduced
• AiNs can’t be introduced into a staffing profile where they don’t currently exist, and
• the percentage of RNs can’t be

The existing safeguards such as Reasonable Workload Committees remain, giving us additional capacity to run local campaigns around staffing issues.

The issue of AiNs counted within ratios was a sticking point in our talks with the ministry and has been the source of many concerns voiced to us by members.

While we haven’t got everything we want, the proposed plan does, for the first time, give us a strong mechanism to regulate the number of AiNs on any one shift.

There are about 1800 AiNs currently working in the public health system. If they were all to be counted as supernumerary now, nearly three- quarters of the 2023 budget allocated by the state government for additional FTE nurses would go to replacing these AiNs.

That would greatly reduce the impact of the first phase of the roll out.

It’s clear that we need to continue our campaign for ratios to spread further, and for our entire claim to be funded, we remain committed to that campaign, and we know members are as well..

The SSLT will now focus on phase two, addressing our claim for MPS, Maternity and Level 2 EDs.