The necessity for ‘extended team models’ or ‘surge workforce models’ to help meet ratios during the 2022 COVID-19 surges temporarily delayed the implementation of the phase 2, stage 2 improvements to public sector hospital and aged care ratios, outlined in the Safe Patient Care Amendment Act 2020.
The scheduled improvements are the result of the Andrews Government’s amendments to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015, one of their 2018 election commitments. There are two amendments: one from 2019 and the second from 2020.
The Amendment Act 2019 includes what are called the phase one amendments: phased removal of the 50 per cent rule, improvements to existing ratios, the creation of new ratios in a range of clinical settings and the introduction of other operational enhancements in the Act.
The removal of the 50 per cent rule means that, if the ratio does not divide equally into the number of beds, and you have a fractional amount left over, you need to round up to another full staff member.
The Amendment Act 2020 incorporates what are called the phase two amendments: the new 50 per cent rounding up methodology to shifts and wards, expansion of in-charge and without-a-patient allocation arrangements in a range of settings, new after-hours coordinator requirements for level 4 hospitals and the reclassification of Warrnambool hospital to a level 2 hospital. This Act fulfils the Andrews Government’s 2018 election promise to further improve ratios and introduce new ratios.
Implementation of the phase one amendments has been taking effect in five stages each March since 2019. The phase two amendments began in March 2021.
With the health system winter response ending on 26 September 2022, the Branch expects the delayed Phase 2, stage 2 improvements should all now be being implemented.
Phase two: stage 2 (originally scheduled for 1 July 2022)
(Safe Patient Care Amendment Act 2020)
50% rule removal
- Afternoon shift in residential aged care wards
- Night shifts for rehabilitation beds
Improved ratio
- General surgical and medical wards (night shift) in level 2 hospitals + in charge
currently no plus in charge (Part 2 s.16 of the Act)
- Birthing suites (night shift) + a midwife in charge if 6 or more nominated suites
currently no in charge (Part 2 s.31 of the Act) - Special care nurseries (night shift) + a midwife in charge if 8 occupied cots or more
currently no in charge (Part 2 s.27 of the Act)
- Postnatal wards (night shift) + a midwife/ nurse in charge
currently no plus in charge (Part 2 s.31of the Act)
Improved definition for the purposes of calculating a mixed ward ratio
A short stay observation area is defined as ‘an area of a hospital which patients admitted to the emergency department are transferred for the provision of short-term treatment, observation, assessment or reassessment when they no longer require emergency care.’
The mixed ratio calculation does not apply to a short stay observation unit, resulting in an additional nurse in charge on night shift, if the SSO is:
- co-located with an emergency department, and
- the number of beds available to be occupied in the combined SSO and emergency department is 30 or more (Part 2 s.12 of the Act)
After hours coordinators in level 4 hospitals
Level 4 hospitals with one or two wards must staff one after hours coordinator in addition to ratios if that hospital operates:
- a nominated birthing suite, and/or
- an emergency department (however titled) with greater than 2500 presentations per year.
Hospital level reclassification
Warrnambool Base Hospital has been reclassified from a level 3 to a level 2 hospital.
2023 improvements coming
The next stage of improvements to public sector ratios is set to roll out in March 2023. This comprises the removal of the 50 per cent rule from afternoon shifts in special care nurseries, neo-natal intensive care units, antenatal and postnatal wards and birthing suites.
In July 2023, the 50 per cent rule will be removed from the morning shift in aged high-care residential wards. July will also see improved night and afternoon shift ratios for general surgical and medical wards in level 3 hospitals, birthing suites and geriatric evaluation management bed – among other changes. See below for details.
Phase one: stage 5 from 1 March 2023
(Safe Patient Care Amendment Act 2019)
50% rule removal
Afternoon shift in:
- special care nurseries
- neo-natal intensive care units
- antenatal and postnatal wards
- birthing suites
Phase two: stage 3 from 1 July 2023
(Safe Patient Care Amendment Act 2020)
50% rule removal
Morning shift in:
- aged high care residential wards
Improved ratios
- Level 3 hospital general surgical and medical wards (night shift) + in charge
currently no plus in charge (Part 2 s.17 of the Act) - Birthing suites (afternoon shift) + in charge if six or more nominated suites
currently no in charge (Part 2 s.31 of the Act) - Geriatric evaluation management beds (night shift) + in charge
currently no plus in charge (Part 2 s.24 of the Act)
