Following two previous amendments to the Safe Patient Care Act (Nurse to Patient and Midwife to Patient Ratios) Act 2015 (the SPC Act) and a further Victorian Government election commitment to improve ratios across emergency departments, antenatal and postnatal units, HDU/CCU and to introduce ICU to the SPC Act, the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025 was introduced to Parliament on 18 February 2025 and received Royal Assent in April 2025.
The amending legislation provides for the following improvements:
- postnatal and antenatal night shift ratios will move to 1:4 (currently 1:6) in Level 4 (metro load sharing), 5 and 6 services under the Safer Care Victoria Maternity Capability Framework
- schedule 3, part 1 hospital emergency department resuscitation bays will move to 1:1 on the morning shift (currently 1:3)
- inclusion of intensive care units in the SPC Act which includes:
– 1:1 ICU ratio for all shifts in schedule 1, level 1 and level 2 ICUs (formalising current staffing arrangements)
– team leader (resource nurses) in addition to the prescribed ratios in level 1 and level 2 ICUs
– liaison nurse (outreach nurses) in addition to prescribed ratios in level 1 and level 2 ICUs - night duty plus in charge in standalone high dependency units and coronary care units.
The following FAQs provide information to answer questions ANMF members may have about the amendments and what they mean in your workplace. The Department of Health is developing an implementation guide and FAQ sheet on the Phase three amendments. If you or your colleagues have additional questions, or questions that are specific to your ward or unit, please complete an ANMF Member Assistance form and we will direct your inquiry to the appropriate ANMF (Vic Branch) staff member.
Changes to the ratios will be phased in by 25 per cent in Tranche 1 and 75 per cent in Tranche 2, reaching 100 per cent implementation by 1 July 2026. It is an expectation of the government that health services will consult with affected staff and the ANMF (Vic Branch) to inform where the additional shifts may be best allocated to support clinical need, workload and safe patient care.
The 27 June 2025 ANMF newsflash ‘Ratio improvements in the Safe Patient Care Act’ provides examples for the calculation and application of the amended ratios for each area. The required hours or shifts applicable to each tranche should be applied in line with the needs of individual units, in collaboration with the staff and the ANMF (Vic Branch).[1] We recommend that each unit’s staff and management collaborate to reach agreement on the most suitable approach based on ward/unit workload and skill-mix pressures. Working with your ANMF Organiser, Job Reps are encouraged to schedule an ANMF members’ meeting in order to:
- calculate the increase in shifts/staffing for the 25 per cent implementation (and for subsequent percentage increases)
- identify how and when (that is, which shifts) the application of the additional staffing would most effectively reduce workload pressures. For example, in an emergency department, review the unit’s data and assess which shifts would benefit most from the additional AM resuscitation bay staffing.
- Following agreement on the shifts that would be most suited, pass an ANMF member resolution to guide the implementation of the changes. Use the following example resolution as a template:
[Hospital name and ward name] ANMF members have met to review the workload requirements of [ward name] to assess the best allocation of resources in relation to the first tranche of the 2025 amendments to Safe Patient Care Act 2015. We resolve that:- Having calculated the 25 per cent staffing increase as it applies to our ward, we note that there will be [XX] number of shifts available for the position of [XX].
- Considering the current workload variations in [ward name] we propose that the position is applied to the following shifts: [add shifts].
- We request that the NUM/MUM meets with [ward name] staff and the ANMF to confirm and plan implementation of the additional shifts.
- We request implementation of additional shifts by [specify date].
1. How do I know if my postnatal and antenatal wards units are eligible for the additional ratios?
Postnatal and antenatal night shift ratios will move to 1:4 (currently 1:6) in Level 4 (metro load sharing), 5 and 6 services under the Safer Care Victoria Maternity Capability Framework. This includes 18 hospitals across metropolitan Melbourne and regional Victoria. For details visit the Maternity Capability Framework on the Department of Health website.
Level 4 load sharing hospitals are those Level 4 Maternity Capability services that are part of a larger multi-campus metropolitan health service and include the following maternity services:
- Eastern Health – Angliss Hospital
- Mercy Werribee Hospital
- Monash Health – Casey Hospital
- Monash Health – Dandenong Hospital
- Monash Health Women’s – Sandringham
2. How do I know if a high dependency unit (HDU) is eligible for the ratio changes in this amendment?
All level 1 hospitals listed in Schedule 1 of the SPCA Act with a standalone HDU will gain an in-charge nurse on night duty. For example: Peter MacCallum has a standalone HDU.
3. How do I know if the coronary care unit (CCU) I work in will gain an in-charge nurse on night duty?
All hospitals that have a CCU will be eligible for the in-charge nurse on night duty, details of which can be found in the SPC Act that is currently in force but include Western Health – Footscray Hospital, Western Health – Sunshine Hospital, St Vincent’s Hospital and Royal Melbourne Hospital.
4. How do I know if the emergency department I work in is a Part 1 emergency department?
The Safe Patient Care Act lists the emergency departments in Part 1 in Schedule 3 of the SPC Act. This includes 22 hospitals across metropolitan Melbourne and regional Victoria, details of which can be found in the SPC Act that is currently in force.
5. There are different requirements for level 1 and level 2 hospitals. How do I know if the intensive care unit (ICU) I work in is classified as a level 1 or level 2 hospital?
The Safe Patient Care Act lists level 1 and 2 hospitals in Schedule 1 of the SPC Act. This includes 23 hospitals across metropolitan Melbourne and regional Victoria, details of which can be found in the SPC Act that is currently in force.
NB: The introduction of an enforceable staffing minimum of 1:1 and plus in charge in ICU, while important, merely makes existing clinical practice a legal requirement. The phased in approach to the legal minimum does not displace current staffing, which reflects clinical need.
6. What happens if our ward or unit does not have an equally divisible number of beds as the stipulated minimum ratio – for instance if we have 13 beds and the ratio is 1 nurse to every 4 beds?
All ward/unit areas covered in the Safe Patient Care Act are subject to rounding up of ratios (Section 12), and this includes all new areas like ICU. Therefore, if a ward or unit has 13 patients and the ratio is 1:4 then four nurses or midwives are required for that ratio per applicable shift. If the ward or unit is a Level 1 ICU and has 18 occupied beds, then for the 1:15 ICU liaison nurse am/pm ratio they will require two senior critical care liaison nurses (however titled) to fulfill the role and on night duty (1:30) one critical care liaison nurse (however titled) should be rostered.
7. What does the amendment mean by ‘occupied’ beds?
In the SPC Act, ‘occupied bed’ is defined as ‘available to be occupied’, so that is any bed that is nominated for an admission. For example, a ward or unit with eight available beds has eight occupied beds: whether there is a patient in the bed or not, it is still considered available for a patient to be admitted. Application of the nurse-to-occupied-bed ratio will ensure that operational ICU beds are staffed with appropriately qualified nursing staff, enabling those beds to become occupied as and when they are required for admission – for example, when there is a MET call or code blue on another ward/unit in the hospital.
This approach is also consistent with current requirements for emergency departments and neonatal intensive care units.
8. Our unit currently staffs above the amendments to the SPC Act. Do we have to change this?
Ratios are a minimum requirement, and the Principal Act is not intended to prevent the operator of a hospital from staffing a ward with additional staff beyond the number required by the minimum ratio. Therefore, hospitals should not make changes to current staffing if the unit is staffed with additional numbers of nurses/midwives above those stipulated as a minimum in the SPC Act, or above ratios. It is not uncommon for a hospital to staff above the ratios because of workload or patient acuity.
The Victorian Government is providing additional funding for these amendments, and where a unit is already budgeted to provide these staff, the additional funding will support the current budget. Under no circumstances should the staffing that is already in place to meet the workload, patient acuity or skill mix requirements of the ward or unit be reduced.
The Act outlines minimum staffing, for example Part 1, 4 (1) says:
‘The objective of this Act is to provide for safe patient care in hospitals by establishing requirements for a minimum number of nurses or midwives per number of patients in specified wards or beds, recognising that nursing workloads impact on the quality of patient care.’[2]
The Act also says the ratio is a minimum requirement only and is not intended to prevent a hospital staffing a ward or unit with additional nurses and/or midwives over the minimum staffing numbers, that are required in the Act, considering workloads and patient care requirements.[3]
Section 47 of the SPC Act also preserves staffing arrangements (including above minimum ratios) in particular circumstances.
9. The amendments to the SPC Act include a requirement for one team leader; our unit uses a different title for the team leader and liaison nurse; do we need to change the title to the one referred to in the SPC Act?
The titles or names of similar positions in intensive care units across Victoria’s health services often vary in relation to the team leader and liaison nurse roles. For example, the role of liaison nurse may be referred to as an outreach nurse and the team leader as a resource nurse.
To assist health services, the following descriptions apply to the roles:
- Team leader is a suitably skilled and qualified registered nurse who is an additional resource to assist, support and supervise ICU bedside nurses, and may facilitate patient care coordination. This role, however titled, refers to a senior and experienced critical care RN, for example an ANUM or clinical nurse specialist, in addition to the bedside 1:1 ratio, the 1:15 liaison nurse and the nurse in charge. The team leader role does not take a patient load, however acts as an additional senior resource to assist ICU bedside nurses and/or assist with managing patient care coordination.
- ICU liaison nurse (ICU LN) (however titled) refers to a senior critical care RN who provides clinical support, leadership and consultancy, both within and outside of the ICU. Liaison nurses take referrals for assistance, which may include ICU discharges; respond to hospital emergency calls (i.e. MET and code blue calls); and consult with other hospital wards/units on the care of complex patients to prevent patient deterioration and reduce the need for patients to be admitted or readmitted to the ICU. ICU liaison nurses are classified as clinical consultants.
For further information and best practice ICU workforce information, members can also refer to the ACCCN Workforce Standards.
10. How is it determined that a patient is critically ill and therefore requires 1:1 nursing?
This is determined by the clinical judgement of those nursing staff in the ICU on the shift, usually the ANUM/nurse in-charge. [4] Further all available ICU beds must be staffed 1:1 with ICU nurses as is current clinical practice. The introduction of an enforceable staffing minimum of 1:1 and plus in charge in ICU, while important, merely makes existing clinical practice a legal requirement.
11. What is the maximum number of patients or occupied beds that a nurse can be allocated in an ICU?
SPC Act 20A (2) (a) and (b) and 20B (2) (a) and (b) stipulates the care of up to two patients, where those patients are not critically ill; or do not require the sustained support of vital organ functions.[5] Again, this should be determined by the ANUM/nurse in-charge of the shift.
12. My unit is a critical care unit and has ICU and CCU beds. What beds do the ratios apply to? How do I know that the staffing is correct?
As with all mixed wards, a critical care unit (CCU) may have intensive care and coronary care beds. The 1:1 ratio only relates to ICU beds allocated to that unit. This means that a 20-bed CCU that has eight ICU occupied beds in a level 1 hospital would have a minimum of eight nurses at 1:1, one nurse in charge, one team leader and one liaison nurse to cover each morning shift, afternoon shift and night duty. Then the staffing related to the CCU beds would be 1:3 minimum.
Further, as per the Act, a mixed ward/unit has reporting obligations they must meet as stipulated in Part 1 Section 12A Ratio for mixed wards.[6]
More information
These amendments follow earlier improvements to nurse/midwife ratios made in 2019 and 2020 by the Victorian Labor Government after it had fulfilled its commitment to Victorian nurses and midwives in 2015 to enshrine our critical nurse/midwife staffing minimums into Victorian law. Victoria was the second jurisdiction in the world to achieve ratios (California was the first) and the first to implement them. More information
ANMF newsflash Ratio improvements in the Safe Patient Care Act – what does this mean for you?
Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015
Safer Care Victoria Maternity Capability Framework
[1] Parliament of Victoria 2025 Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025
[2] Parliament of Victoria 2023 Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 No. 51 of 2015 p8
[3] Ibid p10
[4] Australian College of Critical Care Nurses (2016). Workforce Standards for Intensive Care Nursing. Melbourne, ACCCN Ltd ISBN 9 780646 960739 www.acccn.com.au/aboutus/position-statements-standards p. 12
[5] Parliament of Victoria 2025 Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025
[6] Parliament of Victoria 2023 Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 No. 51 of 2015 p18
