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Minimum staffing in Level 4 hospitals

ANMF (Vic Branch) undertook an audit of all Victorian public hospitals over 2018 and early 2019 to help inform our ongoing efforts to improve staffing levels under the Safe Patient Care Act 2015.

Nurse/midwife patient ratios are set out in the Act, and ANMF has secured amendments to the Act to be phased in over coming years. However, there are some areas where ANMF is concerned that existing staffing obligations may not be being met, particularly in Level 4 hospitals. A level 4 hospital, according to the Act, is a campus of any public health service that is not named as a level 1 hospital, level 2 hospital or level 3 hospital.

Some additional staffing obligations are outlined in the public sector general enterprise agreement.

In April 2019, ANMF wrote to the CEOs of the hospitals where staffing obligations under the Act or enterprise agreement may not be being met, inviting them to meet and discuss the issues raised.

The most common issues identified were:

  • Hospital campuses with no full-time director of nursing (DON)
    Clause 90.3 of the enterprise agreement requires each employer to employ a full-time director of nursing on each campus, excluding community health centres. A small number of hospitals do not appear to be compliant with this: either a DON shared across more than one campus, or the DON is not full-time.
  • Hospital campuses with no nurse unit managers
    Clause 90.1 of the agreement requires one equivalent full-time nurse unit manager to be appointed in each ward/unit of each hospital. ANMF identified several hospitals that appear to have no nurse unit managers.
    It would be difficult to imagine a hospital with no wards.
  • Hospital with three wards or more, but after-hours coordinator not supernumerary
    It is a requirement under the Act to have an after-hours coordinator when the director of nursing/midwifery is off-duty. Section 11 of the Act requires that the after-hours coordinator be in addition to ratios if the hospital has three wards or more.

Under the Act a ward means a ward, unit, department or component of a hospital managed by a nurse or midwife who is undertaking, whether temporarily or permanently, the role of a nurse/midwifery unit manager or equivalent.

The ANMF identified many hospitals where it is apparent that there are three or more wards, but the after-hours coordinator is not in addition to ratios.

‘Urgent care centres’

In recent years, many smaller hospitals have renamed their emergency department as an ‘urgent care centre’. However, this does not mean that the emergency department minimum staffing requirements do not apply.

The minimum staffing for smaller emergency departments is set out in section 20 (6), (7) and (8) of the Act. Minimum staffing requirements differ depending on the number of annual presentations to the department and the number of wards in the hospital.

Some hospitals’ ‘urgent care centres’ are now treating more than 7000 presentations annually, however the employer does not seem to have adjusted its staffing to reflect growth in presentations.

Section 20 (5) of the Act requires ‘urgent care centres’ that treat more than 7000 presentations to have one nurse for every three beds and one nurse in charge on all shifts. If there was a regularly rostered triage nurse on one or more shifts immediately before the commencement of the Act, the hospital is required to continue to staff one triage nurse for that shift or each of those shifts to meet the minimum ratio requirements under the Act. The Act commenced on 23 December 2015.

Section 20 (8) of the Act states that emergency departments with fewer than 5000 annual presentations, where the hospital has three or more wards, must staff the emergency department with an additional nurse who is supernumerary and available to assess and care for patients within the emergency department when required. This nurse need not be stationed in the emergency department when no patients are present, and can work on the wards, but must be additional to any ratio requirement.