July 3, 2022

queensland ratios

‘We’re losing staff in droves’

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“Nurses want to work in Queensland because they have real ratios: one to four on the ward and one to three in ED. We are one kilometre from the Queensland border: the John Flynn Private Hospital, Gold Coast University Hospital, and Robina Hospital are well within half an hour from the border.

We’re losing staff in droves.

Far too many of our staff are first and second year out, and our ED is full of them. They are exhausted and they are frightened. I think half of them are in shock. In 2019–2020, our ED had more presentations than St Vincent’s in Sydney, and only 1000 less than the huge Children’s Hospital at Westmead.

The hospital has always been really united, though. We’ve got a really good branch and everyone is really passionate.

We went out on 10 June. We had a secret ballot and it was 96 to two in favour of walking out. We had staff organised to take the resolution to management and we went out the front door. The feeling when everyone went out was thrilling. The young ones had all the posters they had spent a lot of time making. It was very uniting for them; they realised ‘We’re a group, there are a lot of us.”

– Kristin Ryan-Agnew, President, Tweed Hospital Branch

Listen to the science on ratios 

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An evaluation of Queensland’s ratios has swept away the last tenuous excuses for not implementing them in NSW.

The evaluation, conducted by researchers from the United States and from Queensland, was a requirement built into the law that established ratios in 2016.

It found that ratios pay for themselves. In fact, the savings in Queensland were twice the cost of additional nurse staffing. The study also found the system delivered a “flexible design”.

The research found that more staff were attracted to work at hospitals where nurse-to-patient ratios were implemented. There were significant improvements in patient mortality, length of stay and re-admissions. There were substantial cost savings.

To paraphrase our Prime Minister’s favourite saying: How good are ratios?

The study, published in the prestigious medical journal The Lancet, builds on decades of previous research.

But it goes further and demolishes the last remaining arguments used to block their implementation. It provides unequivocal evidence that government intervention will yield better staffing and those extra staff will lead to better patient outcomes.

We need to make the government act

The evidence is now well and truly in and our immediate challenge is to get the NSW government to listen to the science and act.

It needs to hear that the system is in crisis and that nurses are holding a precarious public health system together.

Worryingly, we are receiving reports that many nurses and midwives can’t take it anymore 
and are walking away from the public health system.

We simply cannot let this happen.

The Association wrote to the Premier asking her to work with us to implement shift-by-shift ratios and to meet with a group of nurses and midwives to hear the challenges they face at the frontline. To date, she hasn’t even paid the courtesy of replying.

This isn’t good enough. The government has benefitted  greatly from the hard work and sacrifices made by nurses and midwives during the pandemic.

NSWNMA members throughout the state have been taking our message to their communities throughout May. We intend escalating those actions.

We are buoyed by the knowledge that the community is on our side and appreciate the sterling efforts of nurses during the pandemic.

We will continue to reach out to the community to join us in putting pressure on the government to meet their responsibilities and adequately resource the public health system with safe staffing.

Bold leadership required

Scott Morrison promised us a “once in a generation” reform of aged care in the federal budget but after raising such expectations the outcome was a damp squib.

At a time when bold leadership has been needed the prime minister has been found wanting.

The Royal Commission into Aged Care had done much to shine a harsh light on the sector and to provide a framework for fixing its myriad problems.

The royal commission concluded that inadequate staffing levels, skills mix and training were the principal causes of substandard care.

While there are positives in the budget but there is a sense of tinkering around the edges when it is so clear that fundamental change is required.

The time-honoured reflex of throwing taxpayers’ money from a helicopter at aged care providers has never worked and will never work when there is no accountability for delivering that money to the direct care of residents and consumers of home care.

Aged care needs to be reformed not only considering the royal commission’s findings but also in the broader context of lessons to be learned from the pandemic. The royal commission did not deliver on all of our claims, but the least Scott Morrison could do is implement those recommendations in full.

Expecting our public health system and our aged care sector to be able to provide safety and protection to our communities and our elderly when they are inadequately funded and where providers put profit before care will no longer wash.

Aged care has been left to wither over a long period of time and by governments of different stripes.

While we welcome the positives in the budget, the problems have not been sufficiently addressed and we will continue to campaign until they are.

Queensland’s ratios save lives and money

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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’