Any failure to meet shift-by-shift ratios at a ward or unit level must be addressed within 24 to 48 hours, under an agreed escalation process.

The Public Health System Nurses’ and Midwives’ (state) Award 2023 will include a written obligation to comply with ratios, the Safe Staffing Levels Taskforce agreed.

Any non-compliance, once flagged, must be addressed within 24 to 48 hours via an agreed escalation process, said NSWNMA Assistant General Secretary, Michael Whaites.

He told a union webinar that if members could not reach a solution with their unit manager to make the following shift compliant, they could take the issue to the local Director of Nursing and Midwifery within 24 hours.

That step would involve the local NSWNMA branch and a union organiser.

If the facility still did not comply with ratios, then the Local Health District (LHD) and/or Ministry of Health would be required to intervene – possibly by altering patient flow, including reducing services and surge beds, or by agreement with the NSWNMA.

“Everything has to be addressed within 24 to 48 hours,” Michael said.

He said the escalation process would require the employer to demonstrate its efforts to meet ratios via measures such as recruitment, extra hours, overtime and use of agencies.

“Where there is a ward or unit or hospital where the situation is problematic, or the local management can’t fix it because they can’t recruit enough staff, or they are suddenly getting a big influx of patients over a period of time, then the issue can be escalated by the Association to the Ministry of Health.

“At that point they need to look at either reducing services or changing flows within the LHD to meet the ratios requirement.”

RWCs STILL AN OPTION

Reasonable Workload Committees would not be involved in the escalation process but the safe staffing principles of Award Clause 53 would remain.

“We will still be able to take cases of what we say are poor workloads to management and run a campaign or dispute around those clauses. That opportunity will remain everywhere, even where the ratios are being complied with.”

The compliance framework would include a provision borrowed from the Victorian ratio system that considers the impact of long standing difficulty in being able to recruit enough staff to meet ratios.

“In such cases, we may agree a temporary ratio until such point that the recruitment has caught up.

“That is the extreme and in Victoria it has never been used. But it prevents a hospital being closed simply because it is not meeting ratios as a by-product of significant recruitment deficits.”

NSWNMA General Secretary, Shaye Candish, said the “positive onus” on the Ministry to comply with Award ratios would assist nurse managers and local directors of nursing to resist budget decisions such as a recruitment freeze or ban on agency staff.

“They can push back and say no, that can’t be tolerated because we now have an Award provision that requires us to comply with staffing ratios,” she said.

Ratios proposal ‘positive and helpful’ for EDs

Sarah Morton, an RN at Wollongong Hospital emergency department, described the ratios proposal as “a pretty good offer that seems to have been fought hard for at the bargaining table”.

“A lot of EDs that are really badly off are going to improve under these new ratios,” said Sarah, who is a NSWNMA delegate for Wollongong Hospital.

“The feedback I’m hearing from other EDs is also quite positive and having those set ratios is going to be really helpful.”

The state’s EDs will see over 1,300FTE additional nurses as they grow to meet the ratios, with some growing by as many as 20 to 50FTE. ED ratios are calculated on the basis of regularly used treatment spaces.

Sarah said this means that providing nursing care in the ED waiting room during very busy periods will likely remain a problem after the rollout.

“As good as the ratios proposal is, we can’t predict or control how many people are going to be sitting in the waiting room or the acuity. Sometimes we have two nurses to 50 patients and people waiting over 12 hours for treatment.

“In these situations, we usually have a float nurse and one or two extra CIN nurses to get us through the busy periods.”

Sarah said the government would not have agreed to the ratios rollout without the campaign of industrial action waged by members.

“It gives us a platform to take the ratios campaign forward. “We haven’t used up all our bargaining power and the fight for better conditions and patient safety never ends.

“We know that things get randomly taken away all the time if we don’t fight.

“We need to take the wins (on ratios) while we can and work up the energy for the next big fight, which is going to be over pay and for free parking.”