Former health minister Jenny Mikakos, nurse Mel Carron and ANMF (Vic Branch) Secretary Lisa Fitzpatrick in June 2020 at the ratios amendment announcement.
Significant Victorian public health service ratio improvements will come into effect in March and July.
The changes are part of the Andrews Government’s election commitments and are contained in amendments to the Safe Patient Care Act in 2019 and more recently in late 2020.
ANMF (Vic Branch) Acting Secretary Paul Gilbert said ‘These important changes recognise mandated minimum ratios are not set in stone and must be reviewed to reflect patient care needs and how our health services are working.
‘Many of the changes originated in resolutions passed at our annual delegates conferences which guided ANMF’s advocacy.
‘Any time we improve our ratios we always remember the members who campaigned so hard to save safe mandated minimum staff levels from the politicians who wanted to scrap them to save money,’ he said.
Victoria was the second place in the world, after California in the US, to secure ratios and was the first to implement ratios.
Ratios were included in the public sector nurses and midwives enterprise agreement from 2000 until they were legislated by the Andrews Government in 2015.
Work continues on building workforce capacity through the Andrews Government $50 million nursing and midwifery workforce fund and the ANMF annual fee grant. ANMF provides grants totalling up to $750,000 per year to assist eligible members undertaking post-registration and postgraduate nursing and midwifery education. Applications for the 2020-21 fee grant close on 31 March.
MARCH 2021 RATIO IMPROVEMENTS
Emergency department resuscitation bays will have a ratio for the first time.
The 50 per cent rule will be removed (meaning nursing staff numbers must always be rounded up if the number of beds is not easily divisible) on:
- afternoon shifts in level 3 and 4 hospitals in general medical and surgical wards, coronary care units, high dependency units, operating theatres and post- anaesthetic recovery rooms.
- morning shifts in palliative care inpatient units, rehabilitation beds and geriatric evaluation management beds.
- afternoon shifts in level 2 emergency departments and those with 5000 to 7000 presentations per year.
- night shifts in special care nurseries, neo-natal intensive care units, ante-natal and postnatal wards and birthing suites.
- on all shifts on acute stroke, haematology and oncology wards.
JULY 2021 RATIO IMPROVEMENTS
All level one hospital general surgical and medical wards the nurse in change will now be in addition to ratios on night shifts.
TWO PHASES, FIVE STAGES
Implementation of the 2019 amendments, known as phase one, is taking effect in five stages each March and began in 2019.
The 2020 amendments, known as phase two, will be introduced each July, except for the removal of the 50 per cent rule on all shifts in acute stroke, haematology and oncology wards which comes into effect in March 2021.
All amendments will be implemented by July 2023 and will require more than 1000 nurses and midwives.
TIMELINE OF ALL OF THE RATIO CHANGES: 2019 – 2023
Phase one: stage 1 improvements from 1 March 2019
(Safe Patient Care Amendment Act 2019)
Ratio improvement
Removal of night shift emergency department formula (Part 2 s.20 of the Safe Patient Care Act 2015)
50% rule removal
1. All shifts in the following wards of level 1 and level 2 hospitals
- general medical or surgical wards
- coronary care units
- high dependency units
- operating theatres
- post-anaesthetic recovery rooms
- all shifts in level 1 emergency departments
2. Night shifts in the following wards of level 3 and level 4 hospitals:
- general medical or surgical wards
- all aged high care residential wards
- coronary care units
- high dependency units
- operating theatres
- post-anaesthetic recovery rooms
3. Night shifts in level 2 and level 3 emergency departments (and those with more than 7000 presentations per annum)
4. Night shifts in all aged high care residential ward in all hospitals
Other improvements
- Abolition of the provisions allowing for below ratio arrangements to be proposed by a hospital
- Sunshine, Casey and Monash Children’s hospitals will be named as level 1 hospitals
(Schedule 1 Part 1 of the Act) - Neo-natal intensive care unit ratios apply to all hospitals which have a NICU, rather than only the four named in the current Act (Part 2 s.28 of the Act)
- Delivery suites become known as birthing suites
- Direct entry midwives may be counted in meeting special care nursery ratios
- Fairer, transparent and evidence-based provision for declaring nominated birthing suites to be used
- Fairer, transparent and evidence-based provision for determining ratios in mixed wards
Phase one: stage 2 from 1 March 2020
(Safe Patient Care Amendment Act 2019)
Ratio improvements
- Palliative care units 4:4:6 + in-charge on each shift
currently 4:5:8 with no in-charge on ND (Part 2 s.23 of the Act) - Birthing suites (AM shifts) + in-charge if 6 suites or more
currently no in-charge (Part 2 s.31 of the Act) - Special care nurseries (AM and PM shifts) + in-charge if 8 cots or more
currently no in-charge (Part 2 s.27 of the Act)
New ratios
- Oncology wards 4:4:8 + in-charge on all shifts
- Acute stroke units 1:3 + in-charge on all shifts
(where they meet the definition under the Act) - Specialist haematology wards 3:3:5 + in-charge on all shifts
(where they meet the definition under the Act)
50% rule removal
- Night shift in all palliative care inpatient units and geriatric evaluation management beds
- Morning shift in the following wards of level 3 and level 4 hospitals
- general medical or surgical wards
- coronary care units
- high dependency units
- operating theatres
- post-anaesthetic recovery rooms
- level 4 acute wards
- Morning shift in level 2 emergency departments, and emergency departments with more than 7000 presentations per annum
Phase one: stage 3 from 1 March 2021
(Safe Patient Care Amendment Act 2019)
New ratio
New morning, afternoon and night shift ratios in level 1 emergency department resuscitation bays 1:1
(currently NO ratio)
50% rule removal
- Afternoon shift in the following wards of level 3 and level 4 hospitals:
- general medical or surgical wards
- coronary care units
- high dependency units
- operating theatres
- post-anaesthetic recovery rooms
2. Morning shift in:
- palliative care inpatient units
- rehabilitation beds and
- geriatric evaluation management beds
3. Afternoon shift in level 2 emergency departments, and emergency departments with 5000-7000 presentations per annum
4. Night shift in:
- special care nurseries
- neo-natal intensive care units
- antenatal and postnatal wards
- birthing suites
Phase two: stage 1 from 1 March 2021
(Safe Patient Care Amendment Act 2020)
New definition of a short stay observation area for the purposes of calculating a ratio for a mixed ward.
50% rule removal
1. All shifts on:
- acute stroke wards
- haematology wards
- oncology wards
Phase two: stage 1 (continued) from 1 July 2021
(Safe Patient Care Amendment Act 2020)
Improved ratio
- general surgical and medical wards in level 1 hospitals
4:4:8 (+ in-charge on all shifts)
currently no plus in charge on night shift (Part 2 s.15 of the Act)
Phase one: stage 4 from 1 March 2022
(Safe Patient Care Amendment Act 2019)
50% rule removal
- Afternoon shift in:
- palliative care inpatient units
- rehabilitation beds and
- geriatric evaluation management beds
2. Morning shift in:
- special care nurseries
- neo-natal intensive care units
- antenatal and postnatal wards
- birthing suites
Phase two: stage 4 from 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.31 of 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 occupied beds 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
Warnambool Base Hospital will be reclassified from a level 3 to a level 2 hospital.
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 5 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)
EBA #5 2011-12 ‘Respect our work’ – defending ratios again at a 10,000-strong rally in Melbourne CBD.
