The proposed ratios aim to put an end to the current uncontrolled growth in the use of Assistants in Nursing (AiNs) in the public health system.

The staffing proposal put to NSWNMA members includes AiNs in ratio numbers in some wards, with a limit on how many AiNs can work on any one shift.

On medical/surgical wards, the skill mix for acute wards is 80 per cent Registered Nurse (RN) and 20 per cent Enrolled Nurse (EN) or AiN, with a limit of one AiN per shift.

In sub-acute wards such as rehab, the skill mix is 70 per cent RN and 30 per cent EN or AiN, with a maximum of two AiNs on any one shift.

In emergency departments (EDs), the skill mix for level 5 and 6 EDs is 85 per cent RN and 15 per cent EN. AiNs may work in some of these EDs, as is already the case, but they won’t be part of the ratio count.

Level 3 and 4 EDs would have 85 per cent RN and 15 per cent EN/AiN, with a limit of one AiN per shift.

Speaking to members via a webinar before the vote, NSWNMA Assistant General Secretary, Michael Whaites, said the union spent months arguing with the Ministry of Health (the Ministry) about whether AiNs should be included in the count.

“The example we kept giving them was the repeated horror of a junior registered nurse being in charge of a ward with multiple AiNs on shift.

“We said that must never be allowed to occur again, and the Ministry and the LHDs agreed, so we have a limit of one AiN per shift in the acute wards.

“For example, in a large level 4 ED such as Wyong, there would be a maximum of one AiN with a minimum of 28 nursing staff on every shift.”

AN OPPORTUNITY TO REGULATE AINS

Michael says that several factors inf luenced the NSWNMA’s agreement to include AiNs in the ratios count in some units.

The ALP government had given NSW Health a budget to recruit 2480 FTE additional nurses.

The Ministry had shown that about 1800 AiNs were already working in the public health system.

‘Many AiNs are NSWNMA members and provide a benefit to the healthcare system.’

 “To treat AiNs as supernumerary within our current ratio proposal would mean that we would have to spend close to 1800 of that 2480 FTE on replacing AiNs.

“That would mean the breadth and depth of what we would be able to achieve in this first phase would be much shallower. In fact, we would probably only be looking at ratios in level 5 and 6 EDs.

“If we want AiNs to be supernumerary, we will have to go out and fight for the budget for them to be supernumerary on top of the 2480 who we want to bring in with ratios.

“This reform will allow us the opportunity to regulate the number of AiNs for the very first time, rather than allowing the current approach, which is multiple AiNs on a shift.”

He added that many AiNs are NSWNMA members who are welcomed by nurses for their contribution to patient care. However, no-one should be in a position where they are forced to work outside their scope of practice. Having multiple AiNs on any one shift in an acute ward creates that risk.”

Also, AiN undergraduate nurses were getting valuable exposure to the workplace, which helped to bring more job-ready RNs into in the system.

“The Ministry of Health argued initially that AiNs should just be part of the count – that there should be no limit to the number of AiNs that can be on a shift. We’ve pushed them to this point but they will go no further.”

‘Transparent, accountable and enforceable’

NSWNMA Council said 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.”

“Our fight for ratios has been about creating a better working life for members, and a better healthcare system for our communities. This fight has delivered almost $1 billion additional recurrent funding for an additional 2480 registered nurses, enrolled nurses and midwives, and will see ratios firmly embedded into the Public Health System Nurses’ and Midwives’ (state) Award.”