New formula to calculate mixed ward ratio

5 August 2019

The staggered removal of the 50 per cent rule in public hospitals will impact the ratio formula for mixed wards.

A mixed ward is a nominated ward or unit where more than one ratio applies. A mixed ward may have for example, palliative care, aged care and geriatric evaluation patients who all require different ratios under the Safe Patient Care Act.

The application of ratios in a mixed ward is detailed in the Safe Patient Care Amendment Act 2019 and the Guide to implementation of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios Amendment Act 2019.

The ‘grace period’ for the first phase of ratio improvements ends on 31 August. The changes to the ’rounding method’ or ‘50 per cent rule’ in some clinical areas on some shifts will add an additional step to the formula to calculate the unique ratio for each shift on a mixed ward.

Members should be aware that hospitals must nominate their ‘mixed wards’ every February and August. Mixed wards must be declared on the health services’ websites.

The staggered amendments to the rounding method/50 per cent rule will occur each March until 2023.

The 50 per cent rule refers to the scenario when the number of beds is not divisible by the prescribed ratio. If the ratio required ‘half a nurse’, in the case of a 30-bed ward with a 1:4 ratio requiring 7.5 nurses, management was able to round down. When the rule is amended, management must always round up no matter what the fractional amount is.

Here is a quick guide to the dates when the new rounding method applies:

March 2019

all shifts in Level 1 and Level 2 hospital – medical and surgical wards; coronary care units; and high dependency units
on night shift in level 3 hospital— medical or surgical wards; coronary care units; high dependency units
on night shift in level 4 hospital— acute wards; coronary care units; high dependency units
on night shift in aged high care residential wards

March 2020

on morning shifts in level 3 hospital—medical or surgical wards; coronary care units; high dependency units
on morning shifts in level 4 hospital—acute wards; coronary care units; high dependency units
on night shift in—palliative care inpatient units; geriatric evaluation management beds

March 2021

on morning shift in all hospitals— palliative care inpatient units; geriatric evaluation management beds; rehabilitation beds
on afternoon shift in level 3 hospital— general medical or surgical wards; coronary care units; high dependency units
on afternoon shift in level 4 hospitals—acute wards; coronary care units; high dependency units
on night shift in all hospitals— special care nurseries; neonatal intensive care units; antenatal wards; postnatal wards; birthing suites

March 2022

on morning shift in all hospital— special care nurseries; neonatal intensive care units; antenatal wards; postnatal wards; birthing suites
on afternoon shift in all hospital—palliative care inpatient units; geriatric evaluation management beds; rehabilitation beds