Thursday, November 25, 2010


Jenny Haines, former General Secretary,NSW Nurses Association 1982 to 1987.

NSW nurses need ratios. Nurses Australia-wide need ratios. Victoria has had ratios for the assessment of their nursing numbers per shift now for 10 years, and they successfully attracted 2650 nurses back to the nursing workforce in the first year of the ratios 2000/1.

The Californian Nurses Association, after a long running, and sometimes vindictive dispute with the Governator of Calfornia, Arne Scwharznegger, has ratios, and they in conjunction with nursing organizations in the other American states are taking their campaign for ratios nationwide. The Governator or Gropinator as the California Nurses call him, for his predeliction for close contact with women, tried at one point to close down the nurses registering body. Mind you, the California Nurses did try to sell Arne on eBay, and when it was pointed out to them that they couldn’t sell the Governator, they responded that he had already been bought and sold!!

Ratios in NSW will mean that medical surgical wards will be staffed according to the following ratios:

Morning shift: One nurse per four patients + RN in charge
Afternoon shift: One nurse per four patients + RN in charge
Night shift: One nurse per seven patients

The skill mix for each ward or unit will include a minimum of 85 per cent Registered Nurses for each shift. In terms of clinical support, the ratio specified above does not include the following positions or classifications: Nursing Unit Manager, Clinical Nurse Educator, Clinical Nurse Consultant, Nurse Practitioner, administrative support staff and wardspersons.

The current Secretary of the NSW Nurses Association Brett Holmes put it this way when launching the campaign for ratios in March 2010

"The extension of ratios into NSW is also a major initiative in terms of national healthcare reform. No real discussion about reform can occur without acknowledging the need to provide sufficient staff and funding for those required staffing levels. The issue goes to the heart of how any so-called national ‘efficient price' for a hospital service or procedure is set."

"Therefore, any work currently being done on costing public hospital services must develop scenarios that take this nurse-to-patient ratio claim into account. “

And patients need ratios. Patients need the reassurance that there is some science to the method of staffing wards and units and that it is not just based on whatever meager budget is left over for nurse staffing.

Those bureaucrats and politicians who go white at the mention of the cost of ratios for nurses - $400 million a year for the next 4 years - should consider this:

“Victoria’s public hospitals have recorded a combined financial surplus for the sixth successive year, Health Minister Daniel Andrews said today. “The hospital
annual reports, tabled in Parliament, confirm the Brumby Labor Government has positioned Victoria’s hospitals to continue delivering high quality services
to the community,” Mr Andrews said. “The hospitals are operating in surplus in the face of record demand.” (Statement by Victorian Health Minister, Daniel Andrews, 16 September 2010.)

Health system bureaucrats and politicians should also take into account the following factors:

1. The amount that has been saved by the downskilling of the nursing workforce over the last 10 -20 years.
2. The amount that has been saved through not providing adequate educational support to that downskilled workforce.
3. The amount that has been saved through the flattening of nursing management structures.
4. The amount that has been saved through the closure of too many beds in NSW.
5. The amount that has been saved through increased productivity and efficiency due to those bed closures and the need to expedite patient care within recommended guidelines.
6. The amount that has been saved through nurses working excessive overtime and never getting a chance to take time in lieu, which is supposed to be available under the award.
7. The amount that has been saved through the contracting out of ancillary services and the need for nurses to supervise the unskilled workers employed by the contractors.
8. The introduction of user pays for all services on hospital campuses and the costs to nurses for those services

The ratios are part of a wages and conditions package currently being negotiated by the NSW Nurses Association with the NSW government. There are to be as yet unspecified offsets in that package. I doubt that any of the above listed factors will be taken into consideration by NSW Health or the NSW Government, but they should stop and take notice of the enormous sacrifices being made by NSW nurses to keep the NSW health system running. It is just as well nurses are the nice people that they are. Wharfies and miners of old would have walked off the job years ago.