Historic proposal is the fruit of a determined campaign by nurses and midwives for safe staffing in the public health system.

A plan to introduce shift- by-shift ratios in NSW public hospitals would significantly  increase nurse numbers and create a strong platform to promote safe staffing throughout the public system, NSWNMA leaders said.

NSWNMA General Secretary, Shaye Candish, and Assistant General Secretary, Michael Whaites, outlined the plan to members via email and webinars in January.

The plan constitutes phase 1 of the rollout of ratios throughout the public system – a focus of a long NSWNMA campaign that included four statewide strikes in 2022.

Phase 1 was finalised after about eight months of negotiations between NSWNMA officials, the Ministry of Health and Local Health District representatives in the government’s Safe Staffing Levels Taskforce, and the office of NSW Minister for Health Ryan Park.

Phase 1 was endorsed by the 23-member NSWNMA Council in December.

Phase 1 covers four clinical areas: EDs levels 3 to 6, medical/surgical NHPPD wards, mental health NHPPD wards, and ICU/critical care units.

The ratios will be written into the Public Health System Nurses’ and Midwives’ (State) Award and commence from March 2024, starting with level 5 and 6 EDs.

A transition period will allow services to recruit the additional staff needed to achieve the ratios.

Shaye Candish told a webinar for members that the ratios proposal was “a strong safe staffing foundation” that would allow the union to work for staffing improvements needed across the public system.

For more info on ratios click here.

EDS GET SIGNIFICANT STAFFING INCREASES

For level 3 to 6 EDs, for example, the proposal is for a ratio of 1:1 in Resus on all shifts and 1:3 for other treatment spaces on all shifts.

“The closest comparison would be Victoria, which has 1:1 in Resus but only for their major hospitals on evening and night shifts. Queensland does not have ratios in ED at all – nor does the ACT. WA has a pilot that’s just started,” she said.

She pointed out it had taken Victoria 20 years to achieve their current ratios after their initial introduction.

“We are attempting to overhaul our entire staffing system and achieve comparable ratios (to Victoria) in less than four years – a pretty remarkable and quite challenging thing to achieve.”

Regarding EDs, Shaye said the ratios proposal was designed to “engineer out of the system a situation where you constantly have chairs lined up in corridors with people receiving fluids or even cardiac monitoring with no allocated staffing.”

Michael Whaites said that under the proposal, “Our EDs are going to get a significant increase in staffing, and they desperately need it.”

For example, Blue Mountains Hospital’s level 3 ED would get an estimated minimum of seven staff on every shift, compared to current staffing of four in the morning, five in the afternoon and four at night.

“In EDs the ratio is based on treatment spaces that are regularly used. You will have 1:3 applied to those spaces, no matter how big or small your unit is,” he said.

MEDICAL/SURGICAL WARDS GET 1:4

Regarding medical/surgical wards, Michael said A, B and C peer- group hospitals would generally get a ratio of 1:4 patients plus an in-charge nurse in the mornings and afternoons, with 1:7 at night.

“For B and C, if there are less than 24 patients (the ward will get) only one in-charge per day. It’s up to the NUM and staff to work out whether they want the in-charge in the morning or afternoon.

“If you go to 25 patients you not only get an extra nurse, you will also get a second in-charge.”

LATE NEGOTIATIONS STRENGTHEN ICU SKILL MIX

Following feedback from members, the Ministry of Health and the Health Minister agreed to amend the Safe Staffing Levels Taskforce recommendation concerning skill mix provisions for ICUs.

The amendments also guarantee that no ward or unit will be worse off under the plan.

In a message to members, General Secretary Shaye Candish and Assistant General Secretary Michael Whaites said a clause would be inserted into the Public Health System Nurses’ and Midwives’ (State) Award, to ensure that any current staffing profile number and/or skill mix in  a ward/unit which is better than the Taskforce recommendation would be maintained.

They said the clause meant that on any ward or unit where SSL is implemented,

• staffing numbers cannot be reduced
• AINs cannot be introduced into a staffing profile where they do not currently exist, and
• the percentage of RNs cannot be reduced, unless there is a review undertaken which considers clinical need.

“If the NSWNMA doesn’t agree with the outcome of the review,  the matter can be taken to a dispute, including to the NSW Industrial Relations Commission if necessary,” they added.

“Safe staffing ratios are a minimum, wards and units which have higher staffing numbers and/or better skill mix should keep them.”

Shaye and Michael said the amended Taskforce recommendation included

a guarantee that all patients requiring ICU and HDU care would be nursed by an RN, except in Level 4 ICUs where ENs currently employed would continue to be counted in the 1:1 or 1:2 ratio.

“AiNs will not count toward the safe staffing levels for ICUs,” they said.

They added that all ICUs and HDUs would be covered by the general staffing and skill mix protections to ensure that any existing staffing which is better than the Taskforce recommendation would be maintained.

Members have voted “yes” to the first phase of the rollout of ratios in the public health system. – 79% voted to accept.