Premier Daniel Andrews, Health Minister Jenny Mikakos, with nurses and midwives, announcing the ratio amendment bill would be introduced on the first day of the 59th Victorian Parliament. Photo Chris Hopkins
Update: the proposed amendments outlined below were passed by the Victorian Parliament’s upper house on 21 February 2019. The phases will be implemented each March until 2022.
What do the proposed changes mean for you?
The Andrews Government has tabled draft legislation to improve and introduce new nurse/midwife ratios. The changes will mean an additional 600 nurses and midwives over the next five years and is the first of the ratio election commitments promised by the Andrews Government during the 2018 election campaign.
The bill was introduced into the lower house on Wednesday 19 December 2018, on its first sitting day. It will be debated in the next session of the 59th Victorian Parliament in February 2019. ANMF is urging all parliamentarians to support the bill which will result in more nurses and midwives working in our public health system. If passed in time, the changes are to be introduced from March 2019. We will be working to ensure that the legislation is debated and passed by both houses of Parliament.
This is a significant win for members and demonstrates the government’s respect for nurses, midwives and their patients. The process stands out in stark contrast to campaigning for nine months, closing beds, walking out of hospitals and more than 30 community rallies to save nurse/midwife patient ratios during the 2011/2012 ‘Respect Our Work’ EBA campaign.
In addition phase two (total of 542 EFT) ratio amendment committed to by the Andrews Government during the 2018 election campaign will be introduced at a later date, but in time for 2021–2022 (month to be confirmed). Details were included in the Andrews Government election commitments reported in the November On the Record sent to members on 15 November 2018.
You can read the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 and the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2018
Each phase has two key changes:
When passed, and to ensure the nurses and midwives required to implement the improvements are available, the changes will be phased in over five years each March from 2019. Each phase has two key changes:
- changes to ratios – either improvements or the introduction of new ratios
- the removal of the ‘50% rule’. Where the number of beds is not divisible by the prescribed ratio, e.g. a 29-bed ward with a 1:4 ratio = 7.25 nurses, the number of nurses must always be rounded up, not down.
Phase 1 from 1 March 2019 (or royal assent) – proposed amendments
Ratio improvement
Removal of night shift emergency department formula (s.20(2) of the Safe Patient Care Act 2015)
50% rule removal
1. All shifts in the following wards of level 1 and level 2 hospitals
a. general medical or surgical wards
b. coronary care units
c. high dependency units
d. operating theatres
e. post-anaesthetic recovery rooms
f. all shifts in Level 1 emergency departments
2. Night shifts in the following wards of level 3 and level 4 hospitals
a. general medical or surgical wards
b. all aged high care residential wards
c. coronary care units
d. high dependency units
e. operating theatres
f. 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
1. Abolition of the provisions allowing for below ratio arrangements to be proposed by a hospital
2. Sunshine, Casey and Monash Children’s hospitals will be named as level 1 hospitals (Schedule 1 Part 1 of the Act)
3. 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)
4. Delivery suites become known as birthing suites
5. Direct entry midwives may be counted in meeting special care nursery ratios
6. Fairer, transparent and evidence-based provision for declaring nominated birthing suites to be used
7. Fairer, transparent and evidence-based provision for determining ratios in mixed wards
Phase 2 from 1 March 2020 – proposed amendments
Ratio improvements
1. 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)
2. Birthing suites (AM shifts) + in-charge if 6 suites or more (currently no in-charge Part 2 S.31 of the Act)
3. 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
1. Oncology wards 4:4:8 + in-charge on all shifts
2. Acute stroke units 1:3 + in-charge on all shifts (where they meet the definition under the Act)
3. Specialist haematology wards 3:3:5 + in-charge on all shifts (where they meet the definition under the Act)
50% rule removal
1. Night shifts in all palliative care inpatient units and geriatric evaluation management beds
2. Morning shifts in the following wards of level 3 and level 4 hospitals
a. general medical or surgical wards
b. coronary care units
c. high dependency units
d. operating theatres
e. post-anaesthetic recovery rooms
f. level 4 acute wards
3. Morning shifts in Level 2 emergency departments, and emergency departments with more than 7000 presentations per annum
Phase 3 from 1 March 2021 – proposed amendments
New ratio
New morning, afternoon and night shift ratios in level 1 emergency department resuscitation bays 1:1 (currently NO ratio)
50% rule removal
1. Afternoon shifts in the following wards of level 3 and level 4 hospitals
a. general medical or surgical wards
b. coronary care units
c. high dependency units
d. operating theatres
e. post-anaesthetic recovery rooms
2. Morning shifts in:
a. palliative care inpatient units
b. rehabilitation beds and
c. geriatric evaluation management beds
3. Afternoon shifts in Level 2 emergency departments, and emergency departments with 5000-7000 presentations per annum
4. Night shifts in:
a) special care nurseries
b) neo-natal intensive care units
c) antenatal and postnatal wards
d) birthing suites
Phase 4 from 1 March 2022 – proposed amendments
50% rule removal
1. Afternoon shifts in:
a) palliative care inpatient units
b) rehabilitation beds and
c) geriatric evaluation management beds
2. Morning shifts in:
a) special care nurseries
b) neo-natal intensive care units
c) antenatal and postnatal wards
d) birthing suites
Phase 5 from 1 March 2023 – proposed amendments
50% rule removal
1. Afternoon shifts in:
a) special care nurseries
b) neo-natal intensive care units
c) antenatal and postnatal wards
d) birthing suites
If you have questions, refer to our ratio improvements frequently asked questions.
This newsflash was sent to ANMF members on 20 December 2018.
Update: the proposed amendments above were passed on Thursday 21 February 2019. The phases will be implemented each March until 2022.
