A care guarantee for the delivery
of safe, high quality nursing and
midwifery to all Queenslanders.
Queensland Nurses’ Union 2015
Contents
Executive Summary
1
Introduction2
Our claims
2
Minimum nurse/midwife-to-patient ratios and skill mix levels
3
What are minimum nurse/midwife-to-patient ratios and skill mix levels?
3
How do minimum nurse/midwife-to-patient ratios and skill mix levels work?
3
Why should minimum nurse/midwife-to-patient ratios and skill mix levels be
mandated in Queensland?
3
Patient benefits
4
Staff benefits
4
Health Service benefits
4
Why make these claims now?
5
How will the state election claims help guarantee care in Queensland?
5
Where are nurse/midwife-to-patient ratios being used?
5
Enforcement of nurse/midwife ratios and skill mix levels
6
Nurse/midwife staffing ratios and skill mix claims
7
Critical Care (adult and paediatric)
7
Neonatal Intensive Care
7
Emergency Department (adult and paediatric)
8
Perioperative Services
8
Medical and Surgical (adult)
9
Paediatrics
9
Maternity Services
9
Inpatient Mental Health
10
Multi-Purpose Services
10
Rehabilitation
10
Aged Care
11
Community Health and Community Mental Health Services Caseloads
11
Clinical Nurse/Midwifery Educators
11
Operational guidelines for nurse/midwife-to-patient ratios and skill mix levels
12
References13
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
Queensland Nurses’ Union 2015
Executive Summary
Nurses and midwives are calling on all political parties and candidates standing in the 2015 state election to commit to the
safety and quality of health services in Queensland by mandating nurse/midwife-to-patient1 ratios, skill mix levels and nursing/
midwifery specific data collections.
The 2015 state election claims seek to:
Claim 1
Mandate and enforce via legislation and regulation standards minimum nurse/midwife-to-patient ratios
and skill mix levels for Queensland Health facilities to act as a care guarantee in conjunction with the
proper application of the Business Planning Framework workload methodology.
Claim 2
Mandate and enforce via legislation and regulation standards minimum nurse/midwife-to-patient ratios
and skill mix levels for acute private health facilities to minimise unwarranted service variation across
Queensland.
Claim 3
andate and enforce via legislation and regulation standards the participation of public, private and
M
aged care sectors in minimum nursing/midwifery data sets that monitor and openly report nurse/
midwife ratios, skill mix levels and quality outcomes across Queensland.
Claim 4
rgently review the adequacy of nurse numbers, skill mix and quality indicators in residential aged care
U
facilities across Queensland to determine the parameters of safe staffing for the purposes of mandating
minimum nurse-to-resident ratios and skill mix levels.
Claim 5
Mandate and enforce via legislation that a Registered Nurse is present on shift in residential aged care
facilities at all times to improve the safety and quality of care delivery in parity with New South Wales’
Public Health Act 2010.
Minimum nurse/midwife-to-patient ratios and endorsed skill mix levels are an economically sound method to save lives and
improve patient outcomes. National and international studies have irrefutably proven the number, skill mix and practice
environment of nurses/midwives directly affects the safety and quality performance of health services. Health services with
a higher percentage of Registered Nurses and increased nursing hours per patient will have lower patient mortality, reduced
length of stay, improved quality of life and less adverse events such as failure to rescue, pressure injuries and infections.
• Every one patient added to a nurse’s workload is associated with a 7% increase in deaths after common surgery [1].
• Every 10% increase in bachelor-educated nurses is associated with a 7% lower mortality [1].
• Every one patient added to a nurse’s workload increased a medically admitted child’s odds of readmission within
15-30 days by 11% and a surgically admitted child’s likelihood of readmission by 48% [2].
Nurse/midwife-to-patient ratios will contribute to organisational productivity, hospital efficiency and continuity of patient
care by increasing staff satisfaction, decreasing attrition rates, reducing service variation and improving equality across the
healthcare sectors.
1 Where the term “patient” is used, it also refers to “aged care resident”.
Queensland Nurses’ Union 2015
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
1
Introduction
Every person in Australia has the right to access and receive safe, high quality health care. Safe, high quality care is known
to produce better experiences and health outcomes for patients while improving the productivity and sustainability of health
services. National and international studies have empirically proven the number of nurses, their skill mix and their practice
environment are directly linked to the level of safe, quality care provided by health services. Higher levels of Registered Nurses
and increased nursing hours per patient reduce mortality, length of stay and preventable adverse events such as failure to
rescue, pressure injuries and infections.
The Queensland Government has made a commitment to improve the delivery of safe, high quality patient focused care as part
of the Blueprint for Better Healthcare in Queensland and the Strengthening health services through optimising nursing strategy
and action plan (2013-2016). To fulfil this commitment, investment in the number, skill mix and practice environment of
nurses is required. Ratios are a safety net and will provide Queenslanders with a care guarantee that genuinely demonstrates
the commitment to placing patient safety first. Nurses and midwives are calling on all political parties and candidates standing
in the 2015 state election to act on the evidence available and mandate minimum nurse/midwife-to-patient ratios, skill mix
levels and nurse sensitive quality data collections within all health sectors across the State.
Patients and other people using the Australian health system
have the right to receive safe and high quality care.
(Australian Charter of Healthcare Rights) [3]
OUR CLAIMS
The following claims seek to improve the delivery of safe, high quality patient focused care within all health services
across Queensland.
2
Claim 1
Mandate and enforce via legislation and regulation standards minimum nurse/midwife-to-patient ratios
and skill mix levels for Queensland Health facilities to act as a care guarantee in conjunction with the
proper application of the Business Planning Framework workload methodology.
Claim 2
Mandate and enforce via legislation and regulation standards minimum nurse/midwife-to-patient ratios
and skill mix levels for acute private health facilities to minimise unwarranted service variation across
Queensland.
Claim 3
andate and enforce via legislation and regulation standards the participation of public, private and
M
aged care sectors in minimum nursing/midwifery data sets that monitor and openly report nurse/
midwife ratios, skill mix levels and quality outcomes across Queensland.
Claim 4
rgently review the adequacy of nurse numbers, skill mix and quality indicators in residential aged care
U
facilities across Queensland to determine the parameters of safe staffing for the purposes of mandating
minimum nurse-to-resident ratios and skill mix levels.
Claim 5
Mandate and enforce via legislation that a Registered Nurse is present on shift in residential aged care
facilities at all times to improve the safety and quality of care delivery in parity with New South Wales’
Public Health Act 2010.
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
Queensland Nurses’ Union 2015
Minimum nurse/midwife-to-patient
ratios and skill mix levels
What are minimum nurse/midwife-to-patient ratios and skill mix levels?
Ratios are a guarantee that adequate nursing and midwifery numbers and skill mix will be available to meet patient demand.
Skill mix levels refer to the availability of adequate proportions of different nursing/midwifery categories such as Registered
Nurse, Registered Midwife, Enrolled Nurse, and Assistant in Nursing to satisfactorily meet patient demand.
How do minimum nurse/midwife-to-patient ratios and skill mix levels work?
Ratios and skill mix levels provide a safety net for patients, staff and organisations by outlining the minimum staffing and skill
required to adequately manage patient demand.
Higher levels of staffing and/or changes in skill mix may be necessary depending on the changes in the internal and external
clinical environment. Established minimum safe staffing levels should be adhered to at all times for patient and staff safety.
Ratios can be applied across a range of health services in the public, private and aged care sectors and are determined based on
the type of facility, domain of nursing/midwifery and time of day.
The Public Hospital Peer Group Classification is a primary reference source for the proposed peer groupings used in the claims
for ratios in Queensland. This classification broadly groups similar hospitals together according to activity and location.
Ratios and skill mix levels are supported by operational guidelines that determine how they are applied in relation to actual
patient numbers. Refer to the operational guidelines section for more information on how to apply ratios and skill mix levels.
Why should minimum nurse/midwife-to-patient ratios and skill mix levels be
mandated in Queensland?
Queenslanders have a right to receive safe and high quality health and aged care based on the best evidence available.
Ratios and endorsed skill mix levels are an economically sound method to save lives and improve patient outcomes [4, 5, 6, 7, 8].
National and international studies have irrefutably proven the number, skill mix and practice environment of nurses/midwives
directly affects the safety and quality performance of health services [1, 2, 4, 5, 7, 9, 10].
Health services with a higher percentage of Registered Nurses and increased nursing hours per patient will have lower patient
mortality, reduced length of stay, and less adverse events such as failure to rescue, pressure injuries and infections [1, 8, 10, 11].
Additionally, ratios will contribute to organisational productivity, hospital efficiency and continuity of patient care by
increasing staff satisfaction, decreasing attrition rates, reducing service variation and improving healthcare equality across the
sectors [1, 6, 12, 13].
In relation to ratios in public health facilities, the Queensland Nurses’ Union’s 2015 Queensland state election claims are
seeking parity with the nurse/midwife ratios already mandated in Victoria and New South Wales [14, 15].
Higher numbers of Registered Nurses and more nursing
hours deliver better health outcomes for patients.
Queensland Nurses’ Union 2015
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
3
Minimum nurse/midwife-to-patient
ratios and skill mix levels
Patient benefits:
Increase nursing numbers, higher proportion of Registered Nurses and better practice environments improve patient
satisfaction, lower mortality, decrease readmission rates and reduce adverse events such as infections, pressure injuries and
postoperative complications [1, 2, 4, 5, 6, 7, 9, 10, 12, 16]. For Queenslanders, this means they are likely to spend less time in hospital and
receive more personal nursing/midwifery care than they would now.
• Every one patient added to a nurse’s workload is associated with a 7% increase in deaths after common surgery [1].
• Every 10% increase in bachelor-educated nurses is associated with a 7% lower mortality [1].
• Hospitals with higher nurse staffing had 25% lower odds of being penalised for excessive readmissions compared to
otherwise similar hospitals with lower staffing [5].
• Every one patient added to a nurse’s workload increased a medically admitted child’s odds of readmission within
15-30 days by 11% and a surgically admitted child’s likelihood of readmission by 48% [2].
Staff benefits:
Improving staffing numbers and skill mix through ratios results in increased staff satisfaction and decreased attrition rates.
Nursing turnover is costly and adversely influences organisational productivity and efficiency due to poor continuity of care
[16, 17]
. For nurses and midwives, this means a better working environment, improved rosters and less overtime.
• Every one patient added to a nurse’s workload is associated with a 23% increase in nurse burnout and a 15%
increase is job dissatisfaction [18].
• A Queensland study showed 50% of nurses in the aged-care sector, 32% of nurses in the public sector and 30% of
nurses in the private sector experience the inability to meet patient demand due to insufficient staffing. Many of
these nurses indicated they were planning to leave the nursing profession [19].
Health Service benefits:
Mandating ratios and skill mix levels in Queensland will reduce healthcare variation and deliver economic benefits through
reducing adverse patient outcomes and improving healthcare equality across the sectors. For health services, this means the
delivery of direct patient care based on sound staffing methodologies is more achievable and affordable.
• In Western Australia, increased nursing hours have resulted in 1088 life years gained based on prevention of ‘failure
to rescue’ adverse events. The cost per life year gained was $8907, which is well below the reasonable cost-effective
threshold in Australia of $30-60,000 per life year gained [6].
• A study of Victorian and Queensland public hospitals estimated hospital acquired complications such as pneumonia
and urinary tract infections added 17.1% cost to a hospital admission [20]. Improved nurse staffing and skill mix
levels will reduces these types of adverse events and minimise unnecessary costs [1, 4, 6].
• Increased nursing skill mix in aged care is associated with reductions in hospital admissions, readmission rates,
presentation to emergency departments and improvement in management of end of life care [21].
4
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
Queensland Nurses’ Union 2015
Minimum nurse/midwife-to-patient
ratios and skill mix levels
Why make these claims now?
The principles of what constitutes safe staffing in relation to nurse/midwife numbers, adequate skill mix levels and quality
performance indicators are not consistent in Queensland healthcare services.
Varying approaches to workload management have led to unsafe work environments, disparity in patient outcomes and high
levels of staff dissatisfaction.
Recent changes within the Industrial Relations (Fair Work Act Harmonisation No. 2) and Other Legislation Amendment Bill 2013
will see this situation worsen as workload management provisions are removed from the modernised award and enterprise
agreement covering nurses and midwives employed by Queensland Health.
The elimination of workload management methodologies provisions will increase unwarranted service variation, which
results in health services not achieving the level of performance they could if minimum staffing ratios and skill mix levels were
standardised.
How will the state election claims help guarantee care in Queensland?
The claims seek to provide a reliable and enforceable workload management methodology for nurses and midwives in public,
private and residential aged care facilities reinforced by the public reporting of ratios, skill mix levels and quality outcomes.
Improvement in the application of Queensland Health’s Business Planning Framework workload methodology is achievable by
incorporating minimum ratios into the existing methodology to minimise complexity and maximise compliance.
Mandating that a Registered Nurse is on duty at all times in residential aged care facilities demonstrates commitment to safety
and quality of care delivered to older persons within our community while seeking parity with legislative staffing requirements
of residential aged care facilities in New South Wales.
Commitment from state political parties will be necessary to support the review of workloads in the aged care services and to
pursue any nursing workload management recommendations with the Commonwealth Government who primarily fund these
services.
The claims also call for the compulsory participation of all health sectors in publicly available data collections specifically
related to nurse/midwife ratios, skill mix levels and quality outcomes achieved. Public data reporting provides competitive
incentives for healthcare providers to improve their accountability and clinical performance [22, 23].
Where are nurse/midwife-to-patient ratios being used?
Ratios have been implemented in many countries around the world including Japan, Canada, United States, United Kingdom and
Australia.
California, Victoria and New South Wales have mandated ratios to ensure the provision of safe, high quality care to patients.
Queensland Nurses’ Union 2015
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
5
Enforcement of nurse/midwife ratios
and skill mix levels
To implement ratios and skill mix levels successfully in Queensland, enforcement and monitoring mechanisms appropriate for
government and healthcare organisations will be required.
Government
Changes in legislation and regulation standards will be necessary to implement and enforce the various components of ratios
and skill mix levels within the patient safety and quality frameworks of public, private and aged care health services.
For example, the New South Wales Government has incorporated into state legislation a buffer for safe and quality aged care by
mandating that residential aged care facilities have a Registered Nurse on shift at all times.
Legislation and regulation standards will need to outline the monitoring and reporting mechanisms required to measure
organisational compliance of ratios and skill mix levels against quality of care indicators and governance frameworks.
Monitoring and reporting mechanisms will need to be consistent across all health sectors to measure effectively the quality of
care delivered by nurses and midwives in Queensland.
Mechanisms such as nurse/midwifery sensitive indicators and nursing/midwifery minimum data sets offer standardised
methods in which to collect essential data for the purposes of analysing and comparing care inputs and outcomes across
different healthcare settings [24].
Organisation
Healthcare organisations will need to develop policies, standards and guidelines based on legislation and regulations to enforce
and monitor the local implementation of ratios and skill mix levels.
Enforcement mechanisms at the organisational level are required and may involve reward and penalty functions such as
funding incentives or penalties, which are applied based on the level of compliance with ratios and skill mix.
Organisations will be responsible for providing education and training to individuals to improve understanding and increase
commitment to the implementation of ratios and skill mix levels.
Individual
Expectations of the individual in relation to compliance with ratios and skill mix levels are to be outlined in organisational
policies, standards and guidelines.
Nursing and midwifery staff are reminded to adhere to the policies, codes and guidelines of the Nursing and Midwifery Board
of Australia (NMBA).
The NMBA’s competency standards and decision-making frameworks instruct nurses and midwives to practise within the
requirements of legislation while fulfilling their duty of care.
The competency standards for the Registered Nurse also mandate that the Registered Nurse must “communicate skill mix
requirements to meet care needs of individual/groups to management”.
Compliance strategies suitable for application by an individual or a group of individuals will be necessary to ensure ratios and
skill mix levels are being implemented on a shift-by-shift basis.
Compliance strategies
Spot check: at any time a nurse/midwife may make a written request to the Nurse Unit Manager for a spot check to confirm
that the staffing ratio and appropriate skill mix levels are being provided.
Safety scrums: are initiated by frontline staff when a safety issue such as inadequate staffing has been identified that requires
inter-professional collaboration to find a solution. Any staff member can call a safety scrum at any time.
‘Like for like’ replacement guarantee: frontline staff are guaranteed that in times of short-term, unplanned absences within the
workplace, nurses will be replaced by nurses with ‘like’ qualifications, education and competencies.
Agreed workload management flowchart: is referred to by frontline staff when inadequate staffing numbers and/or skill mix
has been identified. The flowchart includes pre-agreed strategies such as priority activities list, alternate work patterns, skill
mix substitution and activity reduction methods suitable for individual wards/services.
6
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
Queensland Nurses’ Union 2015
Nurse/midwife staffing ratios and
skill mix claims
Critical Care (adult and paediatric)
Service type
AM
PM
Night
Intensive Care Unit
1:1
+ in charge
+ access
1:1
+ in charge
+ access
1:1
+ in charge
+ access
High Dependency Unit
1:2
+ in charge
1:2
+ in charge
1:2
+ in charge
Coronary Care Unit
1:2
+ in charge
1:2
+ in charge
1:2
+ in charge
Skill Mix Requirements
•• Staffing and skill mix requirements for critical care services will be in accordance with the latest Australian College of Critical Care
Nurses (ACCCN) Staffing Position Statement (e.g. access nurse ratios).
•• There will be ‘like for like’ replacement of nursing staff.
•• Due to complex patient care needs, Assistants in Nursing will not be included in the direct care hours.
Neonatal Intensive Care
Service type
AM
PM
Night
Intensive Care Unit
1:1
+ in charge
1:1
+ in charge
1:1
+ in charge
High Dependency Unit
1:2
+ in charge
1:2
+ in charge
1:2
+ in charge
Special Care Nurseries
1:3
+ in charge
1:3
+ in charge
1:3
+ in charge
Skill Mix Requirements
•• There will be minimum 90% Registered Nurses rostered on every shift.
•• There will be ‘like for like’ replacement of nursing staff.
•• Due to complex patient care needs, Assistants in Nursing will not be included in the direct care hours.
Queensland Nurses’ Union 2015
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
7
Nurse/midwife staffing ratios and
skill mix claims
Emergency Department (adult and paediatric)
Service type
AM
PM
Night
Resuscitation Beds
1:1
1:1
1:1
Emergency Departments: level 4-6
1:3
+ in charge
+ triage
1:3
+ in charge
+ triage
1:3
+ in charge
+ triage
Emergency Departments: level 3
1:3
+ in charge
+ triage
1:3
+ in charge
+ triage
1:3
+ in charge
+ triage
Emergency Department: Level 2
1:3
1:3
1:3
Emergency Medical Units or Equivalent
1:3
+ in charge
1:3
+ in charge
1:4
+ in charge
Medical Assessment Units or Equivalent
1:4
+ in charge
1:4
+ in charge
1:4
+ in charge
Skill Mix Requirements
•• There will be minimum 90% Registered Nurses rostered on every shift.
•• There will be ‘like for like’ replacement of nursing staff.
•• Due to complex patient care needs, Assistants in Nursing will not be included in the direct care hours.
Note: This staffing ratio applies to beds, treatment spaces, rooms and chairs where patients are receiving health services.
Perioperative Services
Service type
AM
PM
Night
Staffing requirements for perioperative services will be in accordance with the latest Australian College of Operating Room Nurses
Standards.
Skill Mix Requirements
•• Skill mix requirements for perioperative services will be in accordance with the Australian College of Operating Room Nurses
Standards.
•• There will be ‘like for like’ replacement of nursing staff.
8
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
Queensland Nurses’ Union 2015
Nurse/midwife staffing ratios and
skill mix claims
Medical and Surgical (adult)
Service/WARD
AM
PM
Night
Peer Group A:
Principal referral hospital
1:4
+ in charge
1:4
+ in charge
1:7
Peer Group B:
Large major metropolitan and non-metropolitan hospital
1:4
+ in charge
1:4
+ in charge
1:7
Peer Group C:
Medium acute hospitals in metropolitan and non-metropolitan hospital
1:4
+ in charge
1:4
+ in charge
1:7
Peer Group D:
Small regional, small non-acute and small remote hospitals
1:4
+ in charge
1:4
+ in charge
1:7
Skill Mix Requirements
••
••
••
••
There will be a minimum of 80% Registered Nurses rostered on every shift.
There will be ‘like for like’ replacement of nursing staff.
No more than one (headcount) Assistant in Nursing performing work on any shift.
Engagement of an Assistant in Nursing is at the discretion of the Nurse Unit Manager’s professional judgement.
Paediatrics
Service/WARD
General Inpatient Wards
AM
PM
Night
1:3
+ in charge
1:3
+ in charge
1:3
+ in charge
Skill Mix Requirements
•• Minimum of 80% Registered Nurses rostered on every shift.
•• There will be ‘like for like’ replacement of nursing staff.
•• Due to complex patient care needs, Assistants in Nursing will not be included in the direct care hours.
Maternity Services
Service/WARD
AM
PM
Night
Delivery suites (*midwife to delivery suite ratio)
*2:3
*2:3
*2:3
1:4 + in charge
1:4 + in charge
1:6
Ante/postnatal wards
Continuity of midwifery care models
The caseload per 1 FTE midwife will not exceed 40 women booked in per annum.
Caseloads may differ depending on a number of variables such as model of care, case
complexity and geographical location. Local agreements are to be used to outline
appropriate caseloads (FTE/year)2. Proportional caseloads to be allocated to part-time
midwives.
Skill Mix Requirements
•• Minimum of 90% Registered Midwives rostered on every shift.
•• There will be ‘like for like’ replacement of midwifery staff.
•• Due to complex patient care needs, Assistants in Nursing will not be included in the direct care hours.
2 Queensland Government, 2012, Delivering continuity of midwifery care to Queensland women, Queensland Government, Brisbane.
Queensland Nurses’ Union 2015
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
9
Nurse/midwife staffing ratios and
skill mix claims
Inpatient Mental Health
Service/WARD
AM
PM
Night
Acute Adult Mental Health in general hospitals that are not specialised
1:3
+ in charge
1:3
+ in charge
1:5
Adult in specialised mental health facilities
1:4
+ in charge
1:4
+ in charge
1:7
Acute Mental Health Rehabilitation
1:4
+ in charge
1:4
+ in charge
1:7
Child and Adolescent
1:2
+ in charge
1:2
+ in charge
1:4
Long Term Mental Health Rehabilitation
1:6
+ in charge
1:6
+ in charge
1:10
Older Adult Mental Health
1:3
+ in charge
1:3
+ in charge
1:5
Skill Mix Requirements
••
••
••
••
There will be a minimum of 80% Registered Nurses rostered on every shift.
There will be ‘like for like’ replacement of nursing staff.
Due to complex patient care needs, Assistants in Nursing will not be included in the direct care hours.
A 1:1 Registered Nurse special will be provided when an adolescent is admitted into an acute adult ward.
Multi-Purpose Services
Service/WARD
Peer Group E2:
Integrated acute health, nursing home, hostel, community health and aged
care under one organisational structure. Includes aged care beds funded by
the Commonwealth.
AM
PM
Night
1:6
+ in charge
1:6
+ in charge
1:7
Skill Mix Requirements
••
••
••
••
There will be a minimum of two (headcount) Registered Nurses rostered on every shift.
There will be ‘like for like’ replacement of nursing staff.
No more than one (headcount) Assistant in Nursing performing work on any shift.
Engagement of an Assistant in Nursing is at the discretion of the Nurse Unit Manager’s professional judgement.
Rehabilitation
Service/WARD
Peer Group E4:
Facilities with a primary role in providing services to persons with an impairment
disability or handicap where the primary goal is to improve functional status.
AM
1:4
+ in charge
PM
1:4
+ in charge
Night
1:7
Skill Mix Requirements
•• There will be a minimum of two (headcount) Registered Nurses rostered on every shift.
•• No more than one (headcount) Assistant in Nursing performing work on any shift.
•• Engagement of an Assistant in Nursing is at the discretion of the Nurse Unit Manager’s professional judgement.
10
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
Queensland Nurses’ Union 2015
Nurse/midwife staffing ratios and
skill mix claims
Aged Care
Service/WARD
AM
PM
Night
Residential Aged Care Facility
1:8
1:10
1:12
Skill Mix Requirements
••
••
••
••
There will be a minimum of one (headcount) Registered Nurse rostered on for every 20 residents.
There will be a minimum of one (headcount) Enrolled Nurse rostered on for every 2 Registered Nurses.
There will be ‘like for like’ replacement of nursing staff.
The senior nurse on duty will use their professional judgement to determine staffing numbers and skill mix requirements in
relation to resident complexity.
•• Assistants in Nursing are included in the direct care hours.
Community Health and Community Mental Health Services Caseloads
Service type
Caseload Hours
Community Health
No more than 4 hours of face-to-face client contact time per 8
hour shift.
Community Mental Health
No more than 4 hours of face-to-face client contact time per 8
hour shift.
Community Mental Health Acute Assessment Teams
No more than 3.5 hours of face- to-face client contact time per
8 hour shift.
Skill Mix Requirements
•• There will be a minimum of 80% Registered Nurses rostered on every shift.
•• There will be ‘like for like’ replacement of nursing staff.
Note: Ratios are not suitable for application in community health services. Face-to-face client contact time offers a simple methodology
for the basic management of caseloads within community settings. Set face-to-face contact time per shift minimises staffing
variation between community services and improves the delivery of safe, high quality care through better caseload management
practices. Face-to-face represents the provision of direct cares to client and does not include processes such as travel or
administrative tasks [25].
Clinical Nurse/Midwifery Educators
Service type
Educator to Staff Ratio
All service types regardless of sector
1.4:30
Skill Mix Requirements
•• There will be a minimum of 1.4 FTE of Clinical Nurse/Midwifery Educator for 30 headcount of staff.
•• For wards/units with fewer than 30 head count of staff a proportional arrangement will be made.
Queensland Nurses’ Union 2015
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
11
Operational guidelines for nurse/midwifeto-patient ratios and skill mix levels
There are a number of guidelines supporting the daily operational application of ratios.
Operational Guidelines
Example
The actual patient numbers admitted in the ward/service
determines the number of nurses/midwives required.
The ratio on a morning shift for an adult medical ward is 1:4.
The wards holds 28 beds but only 24 beds are funded for activity.
There are currently 24 patients admitted in the ward.
Minimum nurses required = 6.
Unused bed stock is only made available when additional
nurses/midwives with the appropriate skills can be
sourced.
The ratio for an adult medical ward is 1:4. The wards holds 28 beds
but only 24 beds are funded for activity. Due to patient demand, an
increase to 28 beds is approved. Minimum nurses required = 7.
Where the application of the ratio results in a number of
nurses/midwives, plus an additional requirement of 50% or
more, rounding up shall be required.
The ratio for an adult medical ward is 1:4. There are currently 27
patients admitted in the ward. Using the rounding up principle 7
nurses will be required.
Where the application of the ratio results in a number of
nurses, plus an additional requirement of less than 50%,
rounding down shall be required.
The ratio for an adult medical ward is 1:4. There are currently 25
patients admitted in the ward. Using the rounding down principle
minimum 6 nurses will be required.
Frontline staff are guaranteed that in times of short-term,
unplanned absences within the workplace, nurses are
replaced with nurses with ‘like’ qualifications, education
and competencies.
A Clinical Nurse with specialised skills in cardiac surgery is replaced
with a Clinical Nurse/senior Registered Nurse with specialised skills in
cardiac surgery.
Nurse Unit Managers, Midwifery Unit Managers, Clinical
Nurse Educators/Facilitators, Clinical Nurse Consultants and
Nurse Practitioners are not included in the direct care ratios.
A Nurse Unit Manager/Midwifery Unit Manager cannot be included in
the direct care ratios or as the ‘in charge’ nurse/midwife.
A Clinical Nurse Educator/Facilitator employed in a ward is not
included in the direct care ratio or as the ‘in charge’ nurse/midwife.
Summary
Improving the safety and quality of healthcare services is important to those who use, provide, plan, and fund these services.
Research has demonstrated that healthcare services with lower nurse/midwife-to-patient ratios and higher number of bacheloreducated nurses delivers safer, higher quality care to patients in a more cost efficient manner. Political parties and candidates
standing in the 2015 state election have the opportunity to make a significant contribution to the safety, quality, and value of
health services across the state by commiting to:
• mandating ratios and skill mix levels in Queensland Health facilities
• mandating ratios and skill mix levels in acute private health facilities
• mandating participation in compulsory nursing/midwifery data collections within all health sector
• reviewing the adequacy of nurse numbers, skill mix and quality indicators in residential aged care facilities across
Queensland and
• mandating a Registered Nurse is present on shift in residential aged care facilities at all times.
Ratios will provide Queenslanders with a care guarantee that genuinely demonstrates a true commitment to placing the safety
and quality of patient care first.
12
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
Queensland Nurses’ Union 2015
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Queensland Nurses’ Union 2015
A care guarantee for the delivery of safe, high quality nursing and midwifery to all Queenslanders
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ratiossavelives.com.au
January 2015