New research published in The Lancet shows the Queensland public health system has benefited greatly – clinically and economically – from nurse-to-patient ratios.

The research found significantly better patient outcomes in Queensland hospitals that had implemented ratios, with a reduction in re-admissions, shortened hospital stays and reduced costs.

The study also looked at the cost implications of implementing ratios and found that the money saved from fewer re-admissions and shorter length of stay was more than twice the cost of the additional nurse staffing – while also yielding lower mortality.

Queensland passed a law in 2016 establishing minimum nurse-to-patient ratios in medical–surgical wards in 27 public hospitals, which care for 83 per cent of patients hospitalised across the state. It was just the fourth jurisdiction in the world to implement ratios.

The legislation requires that average nurse-to-patient ratios on morning and afternoon shifts be no lower than 1:4 and on night shifts no lower than 1:7.

It was a massive win for the Queensland Nurses and Midwives’ Union, after a long and tenacious campaign.

Queensland is noteworthy because an independent evaluation was included as part of the legislation. The research published in The Lancet is the result of that analysis.

The evaluation consisted of a real-time assessment of the scheme by experts from the University of Pennsylvania in collaboration with researchers from Queensland University of Technology’s (QUT) School of Nursing.

The study ran from the ratios’ introduction in 2016 to 2018, with the researchers collecting extensive data from about 17,000 nurses and more than 400,000 patients.

The data was compared with a similar number of hospitals that did not implement ratios.

The researchers estimated that in each hospital with ratios, there were 145 fewer deaths, 255 fewer re-admissions, and 29,222 fewer hospital days than if they had not implemented the policy.

QUT Faculty of Health executive dean Professor Patsy Yates told the Sydney Morning Herald that in addition to improved patient outcomes, the measures also had direct cost benefits to the state’s public health system of about $70 million dollars over the study period.

“In fact, we saved twice as much as it cost for the extra staff, so this shows a clear economic benefit for early intervention and good nursing care.”

The researchers said their results were consistent with previous studies on the impact of better nurse staffing, in particular a landmark study published in The Lancet in 2014, which surveyed nearly half a million patients in nine European countries. They say the Queensland evaluation goes even further.

“Our study takes the additional step of informing whether direct state intervention yields better staffing, and whether those staffing improvements result in better patient outcomes. The answer to both questions was yes,” they said.

“Queensland’s policy implementation is a viable model, offering lessons for other countries.”

Lead author Professor Matthew McHugh, from the University of Pennsylvania, said the study findings were even more important in light of the pandemic and its effect on frontline health staff.

“These results are all the more relevant in the context of COVID-19, which has pushed an already strained and burnt-out hospital nurse workforce to the brink,” he said.

“Minimum safeguards to ensure that there are enough nurses to provide high-quality care to every patient is a simple but effective public safety measure.”

NSWNMA General Secretary, Brett Holmes, called on the NSW government to act on the findings.

“This research is further proof of why we desperately need shift-by-shift ratios in NSW. Enough is enough. The NSW government must stop relying on nurses’ goodwill to stay at the bedside. They deserve to be valued with shift-by-shift ratios and fair pay.”

Key findings

> Significant improvements in staffing at hospitals where nurse-to patient ratios were implemented.

> Significant improvements in mortality, length of stay and re-admissions.

> Significant cost savings

Read the report

‘Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, re-admissions, and length of stay: a prospective study in a panel of hospitals’