NSW campaigns for nurse-patient ratios

By Janaki Chellam

If the NSW Nurses’ Association achieves its goal, NSW will become the third place in the world to introduce nurse-to-patient ratios.

The result, the union claims, would be higher standards of patient care and a better working environment for nurses.

With the Memorandum of Understanding between the NSW Nurses’ Association and the NSW Government expiring this year, the union is in a unique position to address not just a new pay agreement but the pressing issue of improving patient care.

“Having a transparent, enforceable mechanism such as nurse-to-patient ratios is important to give a baseline assurance to nurses about the workloads they can expect in any particular category of patients,” explains Brett Holmes, General Secretary of NSW Nurses’ Association.

Nurse-to-patient ratios are already in place in Victoria and California.

Staffing Crisis

A report by a joint State-Federal National Health Workforce Taskforce forecasts Australia will be short of 11,822 nurses by next year. That means significantly higher workloads for nurses and an increased risk that many nurses will leave the sector.

The taskforce report, obtained by a Sydney newspaper under freedom of information laws last year, indicates that Australia needs to train 7,000 more nurses every year for the next 15 years.

Professor Christine Duffield from the Faculty of Nursing, Midwifery and Health at University of Technology Sydney carried out an extensive study of NSW hospitals looking at nurses, their work environment and patient safety.

She found that the skill mix and nurse workloads were getting worse and that the hours of care received by patients were decreasing.

Speaking at a nursing forum Professor Duffield told the audience: “In my opinion, nurse ratios are the best solution. There is no other solution.”

Patient Care Ratios in Victoria

Hospitals in Victoria faced their most trying time in 1992 when a newly elected State Government cut 2,000 nursing positions.

Victorian nurses were stretched to the limit and by the late 1990s had tried a range of measures to cope with their overwhelming workload. Measures included working unpaid overtime, working through rest and meal breaks and foregoing equipment and professional training in order to stay on the ward and preserve patient care levels.

Rather than hiring more permanent staff, the Victorian Government of the day employed expensive agency nurses to fill shortages.

In 2000, during their pay and conditions bargaining campaign, Victorian nurses put nurse-to-patient ratios on the table as the centrepiece of their negotiations.

They argued that introducing nurse-to-patient ratios would not only help to retain nurses but that ratios made financial sense as well by reducing the State’s dependence on expensive agency nurses. Dramatic and compelling testimony from nurses about workloads convinced employers to address the impact workloads were having on nurse professionalism and patient safety.

On August 31, 2000 the Australian Industrial Relations Commission ruled that nurse-to-patient ratios were necessary to address the workload and staffing crisis facing the Victorian health sector.

California’s Patient Care Campaign

This author was privileged enough to be on the spot when nurse-to-patient ratio laws were passed in California.

As a fresh young college graduate eager to make a difference in the world, one of my first jobs was working with the California Nurses Association to lobby for patient-to-nurse ratios.

I have vivid memories of talking to nurses in hospitals where the patient load was intolerable for many and burnout and exhaustion were regular occurrences. Patient care was increasingly compromised as patient loads of eight and nine patients per nurse were common practice. The current law stipulates one nurse to five patients – what a difference.

Like Victoria, the road to victory was long and hard fought. Ironically, once nurse-to-patient ratios in California were established, employers used the ratios to drive recruitment campaigns to attract more nurses.

Brett Holmes of the NSW Nurses’ Association agrees that nurse-to-patient ratios make a big difference to nurses staying in the healthcare sector.

“This has been proven in Victoria and California to be a powerful tool in convincing many nurses to come back to the nursing sector,” he says.

“To have that assurance that there will be some limits on their workloads and the expectations placed upon them is vital.”

He says nurse-to-patient ratios will result in higher standards of patient care and enable nurses to offer the levels of professionalism continuously they strive for.

CareerOne.com.au, May 17, 2010.