Wednesday, December 01, 2010


Nurse ratio is double safe level: union

Louise Hall, SMH.

December 1, 2010

NURSES in public hospitals are caring for up to eight patients each, double the ratio the nurses' union says is needed for safe patient care.

A study of staffing in 332 hospital wards, commissioned by the NSW Nurses Association, found the ratio in general wards at most major hospitals averaged one nurse to 5.3 patients.

However the number of patients assigned to each nurse varied widely, with those on evening shifts often caring for seven patients each, and those on nights looking after more than eight.

Advertisement: Story continues below The study, by nursing workforce experts at two Sydney universities, comes as the state government agreed to consider mandated staffing ratios in return for a halt to industrial action planned for today.

The minimum ratio sought for general wards at most major hospitals is one nurse for four patients plus a registered nurse (RN) in charge of morning and evening shifts. At night, the ratio could rise to one to seven.

The general secretary of the association, Brett Holmes, said: ''Just one extra person on a shift can make the difference between a ward coping really well and a situation where there's lots of near-misses.''

The Minister for Health, Carmel Tebbutt, has said staffing ratios are a ''blunt'' and ''inflexible'' tool to manage workloads when patients' need for care in hospitals varied widely. The current nursing award had a workload calculation tool to determine staffing levels based on several factors, including patients needing acute care.

However, the report's co-author, Christine Duffield, said the tool had become largely redundant since its limited introduction to wards in 2004.

Professor Duffield, the director of the Centre for Health Services Management at the University of Technology, Sydney, said ratios were important but it was vital that hospitals had the right ''skill mix'', the proportion of hours worked by the different classifications of nurses.

She warned that mandated ratios, if filled with higher proportions of enrolled nurses or assistants-in-nursing, would create a less safe environment for patients. Studies show a ward in which at least 85 per cent of staff are registered nurses will have lower rates of medication errors, falls, complications and deaths.

However, the survey found a skill mix as low as 46 per cent in some community hospitals.

Professor Duffield said the average skill mix of 66 per cent - with enrolled nurses or assistants-in-nursing making up the balance - reported in medical and surgical wards in second-tier hospitals such as Bankstown was also a concern.