Ratio improvements in the Safe Patient Care Act – third tranche 100 per cent implementation

The final tranche of the Allan Government’s 2025 improved nurse/midwife ratios are required to be implemented in full by employers from 1 July 2026. This includes the recruitment of additional staff to meet the required ratios and employers’ obligations under the Safe Patient Care Act amendments.

If members have concerns about your employer’s capacity to meet the staffing requirements by the 1 July deadline it is important to alert your ANMF (Vic Branch) organiser to ensure full implementation of the new ratios.

If you do not know who your ANMF (Vic Branch) organiser is, speak with your ANMF Job Rep and/or HSR – you can find their names in the Member Portal – or submit a Member Assistance enquiry.

What are the ratio improvements?

The implementation of the third and final tranche will provide:

1. postnatal and antenatal night shift ratios of 1:4 (previously 1:6) in level 4 (metro load sharing), 5 and 6 services under the Safer Care Victoria Maternity Capability Framework
2. schedule 3, part 1 hospital emergency department resuscitation bays of 1:1 on the morning shift (previously 1:3)
3. 1:1 ICU ratio for all shifts in schedule 1, level 1 and level 2 ICUs (formalising previous staffing arrangements)
4. team leader (resource nurses) in addition to the prescribed ratios in level 1 and level 2 ICUs
5. liaison nurse in addition to prescribed ratios in level 1 and level 2 ICUs
6. night duty plus in charge for standalone high dependency units and coronary care units.

As 1 July draws closer, we encourage ANMF Job Reps to contact your organiser so that we can make sure rostering meets the additional staffing/ratios.

It is important to note that where the number of beds in a ward/unit does not evenly match the ratio the section of the Act that outlines the rounding method (section 12) applies with the ward/unit rounding up the staffing requirement to meet the ratio. For example, in a 13-bed Maternity Capability Level 4 antenatal ward/unit with 1:4 ratio, on night duty shifts there will be a requirement for four staff. In a 28-bed ICU at Level 1 with a 15:1 liaison nurse ratio, there will be two liaison nurses on the AM/PM shifts and one overnight.

Mixed wards may also impact the implementation of the calculation of the ratio. A critical care unit, for example, may have dedicated ICU beds and coronary care beds. In the instance of an 18-bed critical care ward in a Level 1 hospital that has 11 ICU beds and seven coronary care beds, the ICU liaison nurse ratio would be one ICU liaison nurse (at a ratio of 1:15). If all the beds were ICU beds, however, then two ICU liaison nurses would be required on AM and PM shifts and one on ND.

Contact your organiser if you are not sure about how to calculate the mixed ward ratios.

Important note

It is also critically important that workplaces understand that if a bed is not staffed then it is effectively closed until such time as it can be fully staffed to the ratio. Workplaces cannot open and close beds as they like. Section 13 stipulates that beds may only be occupied* if nurses or midwives are available to comply with the ratio.

*occupied includes available to be occupied

What does staged implementation mean?

To ensure health services could adequately staff these changes, the amendments were rolled out in a staged process of three tranches. The final tranche involves reaching 100 per cent implementation of the associated legislative amendments.

When determining how to staff the ward/unit with the additional hours to meet the new ratio requirements, health services were expected to consult with staff and ANMF (Vic Branch) to ensure that additional shifts were best allocated to support service delivery and address service demand.

While employers should be at or close to 100 per cent staffing compliance, ANMF is aware that some workplaces have been planning the full implementation of ratio improvements but are some way off 100 per cent compliance. From 1 July 2026, all employers will be expected to roster to the full extent of the ratio improvements.

ANMF will continue to work with members in relation to this consultation to ensure that additional staffing is provided in accordance with the required percentage at each stage of implementation. It is important that there is certainty about the required staffing levels so if you are not sure about what is required in your workplace, please contact your organiser for additional advice.

What does 100 per cent implementation look like?

To calculate the additional nurses and midwives, the 100 per cent improvement will generally be calculated back to a monthly hours amount in order to determine the number of shifts that must attract the additional staffing.

The number of additional staffing hours required to meet the fully implemented ratio improvements are dependent on the number of ‘occupied beds’ (or equivalent), so it will vary dependant on the capacity of the ward/unit.

Plus-in-charge requirements in HDUs and CCUs overnight, minimum ICU team leader and minimum ICU liaison nurse numbers will operate as a proportion of shifts (rather than being calculated back to hours).

The information below provides the calculations that determined tranche 2 at 75 per cent, and also for 100 per cent implementation.

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Postnatal and antenatal night shift ratios (level 4 (metro load sharing), 5 and 6 services)

Where the postnatal and antenatal night shift ratio improves from 1:6 to 1:4 the calculation below applies.

• Calculate number of nurses/midwives required on the night shift to meet 1:6 ratio = (number of beds /6) = (A) rounded up
• Calculate number of nurses/midwives required on the night shift to meet 1:4 ratio = (number of beds /4) = (B) rounded up
• Calculate how many hours of nurse/midwife staffing are required in a four-week roster for (A) x 280 (28 x 10-hour night shifts) and then (B) x 280 (28 x 10-hour night shifts)
• Convert hours to shifts required over a four-week roster (rounded)(C) = (A x 280) /10 and then (D) = (B x 280) /10
• Find the difference between (D) – (C) = (E) and apply the relevant proportion required in relevant stage, e.g. stage 1 (E) x 0.25), stage 2 (E x 0.75) and stage 3 (E)

Emergency department resuscitation bays on morning shifts

Where the Schedule 3, Part 1 hospital ED resuscitation bay ratio improves from 1:3 to 1:1 on the morning shift, the following calculation will apply.

• Calculate number of nurses required on morning shift to meet 1:1 ratio = (number of resus bays) = (A)
• Number of nurses required on AM shifts in a 4-week period (28) x shift length (8 hours) = (A x 28) x 8
• Apply proportion required in relevant stage (e.g. 75%) = ((A x 28) x 8) x 0.75
• Convert to number of shifts = (((A x 28) x 8) x 0.75)/8

Intensive care units

The introduction of an enforceable staffing minimum of 1:1 and plus in charge in ICU, while important, merely makes existing clinical practice a legal requirement.

The phased in approach to the legal minimum does not displace current staffing which reflects clinical need.

Team leader in ICU (level 1 and 2 hospitals)

The new enforceable minimum staffing for team leaders, in addition to the 1:1 ratio for ICU, will be as follows:

• 1:10 in level 1 hospitals across all shifts and
• 1:12 in level 2 hospitals on the morning and afternoon shifts and plus 1 on night duty.

Level 1 hospitals: How to calculate the team leader staffing for 8:8:10 rosters

With the introduction of a minimum team leader staffing, the calculation below for level 1 hospitals determines how many shifts to which the new minimum must apply.

• Calculate number of nurses required on each shift to meet 1:10 ratio = (number of beds /10) (A) rounded up
• Number of nurses required on shifts in a 4-week period (84) x average shift length (8.7 hours) = (A x 84) x 8.7
• Apply proportion required in relevant stage (e.g. 75%) to find hours = ((A x 84) x 8.7) x 0.75 (B)
• Convert to number of shifts (as factors of 8 (AM/PM) and/or 10 (ND))

Liaison nurses in ICU (level 1 and 2 hospitals)

The new enforceable minimums for liaison nurses, in addition to the 1:1 ratio for ICU, will be as follows:

• Liaison nurses in ICU will be 1:15 on the morning and afternoon shifts and 1:30 on night shift in level 1 hospitals, and plus 1 in level 2 hospitals on the morning and afternoon shifts.

Level 1 hospitals: How to calculate liaison nurses in ICU for 8:8:10 rosters

With the introduction of a minimum liaison nurse requirements in the ICU (in addition to the 1:1 ratio), the calculation below will apply for level 1 hospitals.

• Calculate number of nurses required on AM/PM shift to meet 1:15 ratio = (number of beds /15) = (A) rounded up
• Calculate number of nurses required on night shift to meet 1:30 ratio = (number of beds /30) = (B) rounded up
• Number of nurses required on AM/PM shifts in a 4-week period (56) = A x 56 = C
• Number of nurses required on night shifts in a 4-week period (28) = B x 28 = D
• Apply proportion required in relevant stage (e.g. 75%) to find number of shifts = (C x 0.75) + (D x 0.75) = E
• Convert to number of hours by applying average shift length of 8.7 = E x 8.7
• Find the difference between (D) – (C) = (E) and apply the relevant proportion required in relevant stage, e.g. stage 1 (E) x 0.25), stage 2 (E x 0.75) and stage 3 (E)

High dependency units and coronary care units plus in charge on night duty

The introduction of a plus in charge on night duty across a week should be phased in accordingly:

• Stage 1 – 2 night shifts with plus in charge (25%) – from April 2025, implemented
• Stage 2 – 5 night shifts with plus in charge (75%) – from 1 December 2025, implemented
• Stage 3 – 7 night shifts with plus in charge (100%) – from 1 July 2026