The Victorian Government will reclassify 26 public hospitals, including 17 regional hospitals, for the first time in the 25-year-history of Victoria’s nurse/midwife patient ratios.
The changes to the classification of these hospitals in the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 (the Act) will mean improved ratios in medical/surgical wards, ICU and emergency departments. This ratio uplift is a direct result of consistent ANMF member advocacy for a hospital classification review.
The Premier attended the 2026 ANMF (Vic Branch) Annual Delegates Conference in June to address Job Reps and HSRs and to give an update on the hospital classification review, announcing that the government would introduce legislation into Parliament in July. The Premier and Health Minister attended a media conference at ANMF with members on 28 June to publicly announce this significant ratio improvement.
The implementation of the changes will result in the affected hospitals receiving more than $100 million in additional funding to recruit extra nurses and midwives.
The Victorian Government, the Department of Health and ANMF have reached agreement for a transparent and evidence-based review methodology to determine the classification of hospital levels in Schedule 1 (medical/surgical wards and now ICU) and Schedule 3 (emergency departments). This methodology helps to ensure that ratios remain fit for purpose and responsive to the clinical and workforce needs of increasingly busy Victorian hospitals.
This legislative change reflects the Victorian Government’s commitment to nurse-to-patient and midwife-to-patient ratios.
ANMF will continue to update members on the progress of the review.
Members are encouraged to refer to the frequently asked questions below. If you have further questions, contact Member Assistance via https://anmfvic.asn.au/ma
HOSPITAL CLASSIFICATION REVIEW FAQS
1. What hospitals are changing levels in Schedule 1 under the classification review?
Hospitals moving to level 1. This classification requires:
- hospital bed days greater than 100,000; or
- hospital bed days greater than 50,000 and ED presentations greater than 70,000 and ICU average hours of care greater than 140 or your NICU/special care admissions are greater than 500 or your maternity capability level is five or six.
| Current level | Revised level | |
| Ballarat Base Hospital | 2 | 1 |
| Bendigo Hospital | 2 | 1 |
| Goulburn Valley Health | 2 | 1 |
| Latrobe Regional Hospital | 2 | 1 |
| Maroondah Hospital | 2 | 1 |
| Mercy Hospital for Women | 2 | 1 |
| Royal Women’s Hospital | 2 | 1 |
| Werribee Mercy Hospital | 2 | 1 |
Hospitals moving to level 2. This classification requires:
- hospital bed days greater than 25,000 and ED presentations between 20,000 and 69,999 OR the ICU average daily hours of care greater than 100 or your NICU/special care nursery admissions are greater than 350 or your maternity capability level is four or five.
| Current level | Revised level | |
| Angliss Hospital | 3 | 2 |
| Bairnsdale Regional Health Service | 3 | 2 |
| Echuca Regional Health | 3 | 2 |
| Rosebud Hospital | 3 | 2 |
| Sale Hospital | 3 | 2 |
| Sandringham Hospital | 3 | 2 |
| Royal Victorian Eye and Ear Hospital | 3 | 2 |
| Victorian Heart Hospital | Not listed | 2 |
| West Gippsland Healthcare group | 3 | 2 |
| Wimmera Hospital | 3 | 2 |
| Albury Wodonga Health, Wodonga Campus | 3 | 2 |
| Wonthaggi Hospital | 4 | 2 |
Hospitals moving to Level 3. This classification requires:
- hospital bed days greater than 15,000 AND the hospital has an urgent care centre.
| Current level | Revised level | |
| Ararat Hospital | 4 | 3 |
| Colac Area Health | 4 | 3 |
| Maryborough District Hospital | 4 | 3 |
2. Will any hospitals go down a level?
ANMF has secured a commitment from the government that no hospital will go down a level as a result of this review.
3. What hospital emergency departments are changing under Schedule 3?
Schedule 3 of the Act classifies hospitals into part 1, part 2 and part 3 emergency departments.
Emergency departments moving to Part 1 of Schedule 3. Following implementation of the review, the algorithm threshold for part 1 will be ED presentations of 35,000 or more.
| Current part | Revised part | |
| Echuca Regional Health | 3 | 1 |
| Northeast Health Wangaratta | 3 | 1 |
| Royal Victorian Eye and Ear Hospital | 3 | 1 |
Emergency departments moving to Part 2 of Schedule 3. The algorithm threshold for part 2 will be ED presentations between 20,000 and 34,999.
| Current Part | Revised Part | |
| Royal Women’s Hospital | 3 | 2 |
| Sale Hospital | 3 | 2 |
| Swan Hill District Health | 3 | 2 |
| West Gippsland Hospital | 3 | 2 |
| Wonthaggi Hospital | Not listed | 2 |
Emergency departments moving to Part 3 of Schedule 3. The algorithm threshold for part 3 will be ED presentations lower than 20,000.
| Current Part | Revised Part | |
| Hamilton Base Hospital | Not listed | 3 |
| Mercy Hospital for Women | Not listed | 3 |
| Victorian Heart Hospital | No listed | 3 |
4. Will any emergency department go down a level?
ANMF has secured a commitment from the government that no ED will go down a level as a result of this review.
5. How do the hospital levels in the Safe Patient Care Act work?
Public hospitals in Victoria are grouped into three schedules in the Safe Patient Care Act:
- Schedule 1: level 1, 2 and 3 hospitals (hospitals not listed in the schedule are considered level 4)
- Schedule 2: hospitals not restricted in use of enrolled nurses
- Schedule 3: categories of hospitals for emergency departments
A hospital’s classification in Schedule 1 determines the ratios required at that hospital. For example:
| Medical/surgical ratios | |||
| Hospital level | AM | PM | Night shift |
| Schedule 1, Level 1 hospital | 1:4, plus a nurse in charge | 1:4, plus a nurse in charge | 1:8 plus a nurse in charge |
| Schedule 1, Level 2 hospital | 1:4, plus a nurse in charge | 1:5, plus a nurse in charge | 1:8 plus a nurse in charge |
| Schedule 1, Level 3 hospital | 1:5, plus a nurse in charge | 1:6, plus a nurse in charge | 1:10, plus a nurse in charge |
| Level | 1:6, plus a nurse in charge | 1:7, plus a nurse in charge | 1:10 |
Under the classification review, Schedule 1 hospital levels now also determine a hospital’s ICU for Level 1 and level 2 hospitals.
| ICU ratios | |||
| Hospital level | AM | PM | Night shift |
| Schedule 1, Level 1 hospital | 1:1 nurse to occupied bed, plus 1:10 team leader, plus 1:15 liaison nurse, plus a nurse in charge
|
1:1 registered nurse to occupied bed
1:10 team leader 1:15 liaison nurse plus a nurse in charge
|
1:1 registered nurse to occupied bed, plus 1:10 team leader, plus 1:30 liaison nurse, plus a nurse in charge
|
| Schedule 1, Level 2 hospital | 1:1 registered nurse to occupied bed, plus 1:12 team leader, plus, a liaison nurse, plus a nurse in charge
|
1:1 registered nurse to occupied bed
1:12 team leader, plus a liaison nurse, plus a nurse in charge
|
1:1 registered nurse to occupied bed
1:12 team leader, plus a nurse in charge
|
A hospital’s classification in Schedule 3 determines the emergency department ratios required. Emergency ratios are:
| Emergency department ratios | |||
| ED category | AM | PM | Night shift |
| Schedule 3, Part 1 | 1 nurse for every 3 beds (not including any resuscitation bed)
1 nurse for every resuscitation bed 1 nurse in charge 1 triage nurse |
1 nurse for every 3 beds (not including any resuscitation bed)
1 nurse for every resuscitation bed plus a nurse in charge 2 triage nurses |
1 nurse for every 3 beds (not including any resuscitation bed)
1 nurse for every resuscitation bed plus a nurse in charge 1 triage nurse |
| Schedule 3, Part 2 | 1 nurse for every 3 beds
1 nurse in charge 1 triage nurse |
1 nurse for every 3 beds
1 nurse in charge 1 triage nurse |
1 nurse for every 3 beds
1 nurse in charge 1 triage nurse |
| Schedule 3, Part 3 | 1 nurse for every 3 beds
1 nurse in charge 1 triage nurse |
1 nurse for every 3 beds
1 nurse in charge 1 triage nurse |
1 nurse for every 3 beds
1 nurse in charge |
6. When will these changes be implemented?
The legislation to amend the Safe Patient Care Act will be introduced into Parliament in July 2026. Once the bill passes into legislation, ANMF will provide further updates on implementation.
7. Has a hospital changed classification before?
Only once. Warrnambool Hospital moved from a Schedule 1, Level 3 hospital to a Level 2 hospital in 2022.
8. Why did you do a classification review rather than improve other clinical ratios?
For a number of years ANMF members, particularly those in regional Victoria, have been calling for a review of hospital classifications because these classifications in schedule 1 and schedule 3 of the Act determined medical/surgical, emergency and now ICU ratios. Members reported that their workload was not supported by the nurse-patient ratios they were working under based on their hospital’s current classification.
9. How did you do the review?
ANMF and the Department of Health reached an in-principle agreement on the data and methodology that would be used to review hospital level and emergency department classifications. In the review ANMF sought:
- transparent, clear and easily applied data sets.
- to develop hospital nursing- and midwifery-to-patient ratios that are sensitive to the hospital service profile.
To ensure transparency, the data utilised was taken from the publicly available Victorian Agency for Health Information (VAHI) hospital performance data and includes:
- Schedule 1 hospital data: utilises the annual data of patient bed days, emergency department (ED) presentations, average daily ICU hours, NICU/SCN admissions. Schedule 1 hospital classification data also includes, where applicable, the Maternity Capability Framework. This data is weighted using the Modified Monash Model (MMM), which accounts for hospital remoteness (see below for ratings list).
- Schedule 3 hospital data: includes emergency department presentation data only (MMM weighted).
Further information about the review and the data used is available in the document titled ‘Department of Health’s Hospital classification review algorithms’ via https://anmfvic.asn.au/review
10. What about other ratios?
It is important to note that this review relates specifically to the classification of hospital levels in Schedule 1 and Schedule 3 and therefore is applied where those levels are referenced. For Schedule 1 this impacts medical and surgical wards and now ICUs, and for Schedule 3 the impact is to emergency departments. It is not related to ratios for other specified clinical areas e.g. Oncology or GEM.
The classification review was based on the data of every hospital and emergency service.
There have also been three tranches of improved and new ratios between 2019 and 2026. See question 17.
11. What about urgent care centres?
As part of the review, ANMF has sought a commitment for urgent care centre (UCC) data to be made publicly available with the VAHI dataset. Members will be updated on the progress of this request.
12. Why has it taken so long?
We know that members have been waiting a long time for this classification review. It’s not been a perfect process and getting here has required continued advocacy, negotiation, and attention to data. This will be the fourth tranche of ratio improvements under this government, and this change to the legislation is important because it ensures that the nursing- and midwifery-to-patient ratios are responsive, and based on transparent, clear and publicly available data.
13. How many additional nurses will be required to implement the improved ratios?
The improved ratios will require an additional 253 (EFT) nurses backed by an investment of $109.7 million.
14. Where will the extra nurses and midwives come from?
This is the same question that those opposed to mandated nurse/patient ratios have been asking since ratios were introduced in 2001. More than 6000 nurses and midwives, who had been unwilling to work in an understaffed health system, returned in the first few years of ratios.
Our experience over 25 years shows that when ratios and workloads are improved nurses and midwives increase their permanent hours, pick up additional shifts and return to the professions. Improved ratios are a workforce retention and recruitment tool.
We also know there are a significant number of graduate nurses and midwives and enrolled nurses entering the professions due to the Victorian Government’s programs to make the diploma of nursing free since 2019 and providing financial assistance for Victorians who started their nursing and midwifery undergraduate degrees in 2023 and 2024.
15. Didn’t all the grads miss out on graduate programs?
ANMF advocacy secured an additional 250 graduate position places in the Victorian Government’s 2026/27 budget and a commitment to improve graduate nurse pathways into aged care. ANMF continues to advocate for an increase to the number of graduate positions in public and private hospitals. Work is also underway to understand how many graduate nurses and midwives have secured a graduate position or employment as a nurse or midwife.
16. Are ratios in the EBA or legislation?
The short answer is ratios are in legislation – the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 (the Act).
Mandated minimum ratios were first achieved in the 2000 Victorian public sector nurses and midwives enterprise agreement.
After years of ANMF fighting both Labor and Liberal state governments to save and improve ratios during EBA campaigns, then Opposition Leader Daniel Andrews made an election commitment to ANMF members to enshrine the ratios in the EBA into legislation. Labor was elected in 2014 and the Safe Patient Care Act (Nurse to Patient and Midwife to Patient Ratios) Act 2015 was passed.
17. What happened before ratios?
Before ratios, individual managers received a budget and decided how many nurses and midwives to roster. This ended in a serious nursing and midwifery shortage crisis by the end of the 1990s.
18. What are the ratio improvements that have already occurred?
There have been three legislative amendments for improved and new ratios.
Two tranches of improvements were implemented concurrently between 2019 and 2022.
The number of improvements is too long to list here. They covered a broad range of clinical areas including medical/surgical, rehab, geriatric evaluation management beds, palliative care, emergency departments, birthing suites, antenatal and postnatal wards, special care nurseries, NICU, mixed wards, haematology, oncology, acute stroke and aged care. Importantly these improvements removed the 50 per cent rule which was used by employers to round down if the ward was not easily divisible by the ratio. Employers are now always required to round up.
Read the list of improvements during 2019 and 2022 via https://anmfvic.asn.au/ratiotimeline
A third tranche began in April 2025 and was fully implemented by 1 July 2026. These included improved postnatal ratios in level 4 (metro sharing), 5 and 6 services under the Safer Care Victora Maternity Capability Framework; improved ED resuscitation bay ratios in Schedule 3, part 1 hospitals; formalising ICU ratios in Schedule 1, level 1 and 2 ICUs plus an additional liaison nurse in these ICUs; and an additional night shift plus in charge for standalone high dependency and coronary care units.
Read the list of improvements implemented between 2025 and 2026
https://anmfvic.asn.au/thirdtranche
19. What about further ratio improvements?
Ratios are not set and forget. ANMF will continue to advocate for future improvements to ratios based on outcomes of members meetings, data collected by members and advocacy through Job Representatives and HSRs.
It is important for members seeking improvement to their ratios to meet with their Job Rep, HSR and ANMF Organiser. You may need to gather data about your workload to progress a claim to inform ANMF’s advocacy with the Department of Health and the Victorian Government.
There are countless hours of members’ work behind every hard-won improvement in Victoria’s ratios.
It is important to note that mandated ratios are a minimum, not a maximum. If there are clinical determinations and occupational health and safety reasons to roster above the ratios this can and should happen. If you are concerned about workloads in your ward or unit, contact your Job Rep, HSR and ANMF Organiser to discuss methods to improve staffing levels.
20. What about public sector mental health ratios?
ANMF has been consistent in our messaging and in discussions with the Victorian Government that we need nurse-consumer ratios in public mental health. ANMF has always stood for safe staffing mechanisms, and we know (from our experiences in general nursing since the early 2000s) that ratios work. Importantly, our experience in general nursing has taught us that achieving ratios needs to be progressive and carefully stepped out. In general nursing, we first achieved nurse-to-patient ratios in the enterprise agreement; this is what formed the basis for the Safe Patient Care Act legislation when general nursing and midwifery ratios became law in 2015.
ANMF is seeking the same staged process for mental health and we secured members’ claim for staffing profiles to be reflected in the 2024-28 Victorian Public Mental Health Services Agreement. We know this is the necessary foundation for nurse-to-consumer ratios to be added to the Safe Patient Care Act in the future.
21. What about private hospital ratios?
Victorian private hospitals are not covered by the Safe Patient Care Act.
ANMF strongly advocated for the inclusion of nurse/midwife ratios in Victoria’s private hospitals as part of the Victorian Government’s review of the regulations that cover private hospitals and day procedure centres.
The Victorian Government’s review of the Health Services (Health Service Establishments) Regulations 2013 took place between 2023 and 2024.
ANMF sought to establish minimum nurse-to-patient and midwife-to-patient ratios that were identical or aligned closely with the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015.
Many private sector members provided expertise and insights that informed our comprehensive submission during the stakeholder consultation.
Unfortunately, despite the ANMF’s advocacy and submission, none of the changes to the 2024 regulations related to workforce issues.
ANMF and its members continue to campaign for improved staffing levels in private sector enterprise agreements. Work begins with private sector Job Reps in September on the next round of bargaining. Invitations have been sent to Job Reps.
If you are passionate about ratios, improved staffing levels and safer workloads become a Job Rep via https://anmfvic.asn.au/jobrep.
