Ratio improvements in the Safe Patient Care Act – What does this mean for you?

[AMENDED Wednesday 9 July 2025. This newsflash replaces ‘Ratio improvements in the Safe Patient Care Act – What does this mean for you?’ dated
Friday 27 June 2025. This version includes additional formula information and some formula corrections.]

As reported in the April OTR, the Allan Labor Government has passed new amending legislation to improve and introduce new nurse/midwife ratios as sought by ANMF (Vic Branch).

The amending legislation is now in effect – with a staged introduction to the improvements to ensure workforce capacity.

The amendments will provide for the following improvements:

1. postnatal and antenatal night shift ratios will move to 1:4 (currently 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 will move to 1:1 on the morning shift (currently 1:3)
3. 1:1 ICU ratio for all shifts in schedule 1, level 1 and level 2 ICUs (formalising current 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 in standalone high dependency units and coronary care units.

Please note: that where the number of beds in a unit does not evenly match the ratio the section 12 rounding method applies with the unit rounding up to meet the ratio. For example, in an 13-bed Maternity Capability Level 4 antenatal ward 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.

What does staged implementation mean?

To ensure health services can adequately staff these changes, the amendments will be rolled out in a staged process of three tranches. This includes:

• Tranche one: 25 per cent of amendments, now in effect
• Tranche two: 75 per cent from 1 December 2025
• Tranche three: 100 per cent from 1 July 2026 and ongoing.

When determining how to staff the ward with the additional hours to meet the new ratio requirements, health services are expected to consult with staff and ANMF (Vic Branch) to ensure that additional shifts are best allocated to support service delivery and address service demand during tranche one and tranche two of implementation.

ANMF will 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.

Health services will have a short grace period after each operational date to enable the additional staffing required at each tranche to be implemented appropriately.

The information below provides the calculations to determine the EFT for the initial 25 per cent implementation.

We acknowledge the detailed maths may appear complicated; we have included it for transparency.

What will staged implementation look like?

In order to calculate the required improvement in each tranche, the applicable proportion of the improvement (for example, 25 per cent initially) will generally be calculated back to a monthly hours amount in order to determine the number of shifts which must attract the additional staffing.

The number of additional staffing hours required to meet the staged improvement will be dependent on the number of “occupied beds” (or equivalent), so 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).

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 will apply.

How to calculate the ratio

• 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)

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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.

How to calculate the ratio

• 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. 25%) = ((A x 28) x 8) x 0.25
• Convert to number of shifts = (((A x 28) x 8) x 0.25)/8

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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. 25%) to find hours = ((A x 84) x 8.7) x 0.25 (B)
• Convert to number of shifts (as factors of 8 (AM/PM) and/or 10 (ND))

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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. 25%) to find number of shifts = (C x 0.25) + (D x 0.25) = 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)

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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%)
• Stage 2 – 5 night shifts with plus in charge (75%)
• Stage 3 – 7 night shifts with plus in charge (100%).

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More information

• These amendments follow earlier improvements to nurse/midwife ratios made in 2019 and 2020 by the Victorian Labor Government after it had fulfilled its commitment to Victorian nurses and midwives in 2015 to enshrine our critical nurse/midwife staffing minimums into Victorian law. Victoria was the second jurisdiction in the world to achieve ratios (California was the first) and the first to implement them. More information anmfvic.asn.au/ratiotimeline
• ANMF 2025 amendments to the Safe Patient Care Act 2015 frequently asked questions
• Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015
• Safer Care Victoria Maternity Capability Framework