Ratios Save Lives and Money: Frequently Asked Questions

 
The QNMU’s Ratios Save Lives campaign has been ongoing since 2015, and will continue into the foreseeable future. Below is a summary of everything you need to know about the campaign so far.   Find out more about our campaign here, or download our full claims document here

What’s the QNMU’s Ratios Save Lives and Money campaign all about?

 
Queensland’s nurses and midwives told us loud and clear that the number one issue preventing them from delivering high quality patient and resident care was unmanageable workloads. The QNMU set out to fix this – we gathered the national and international evidence, and in 2015 we launched our long-term campaign for nurse/midwife-to-patient ratios across all sectors.   
 

Where are we up to?

 
PUBLIC SECTOR:
 
Legislated nurse-to-patient ratios took effect from 1 July 2016 in prescribed acute, medical and surgical wards across 27 Queensland public hospitals. An international evaluation has shown the large-scale benefits these ratios are having on patient safety, nurse workloads, and the health budget. See below for further details.    
 
In November 2019, legislated ratios commenced in designated Queensland Health acute adult mental health units. Consultation continues on a handbook to guide implementation and the principles for the team leader role, but all of those units are required to comply with the 1:4, 1:4, 1:7 ratios. Reporting on compliance began in December 2019.
 
AGED CARE:
 

In November 2019, the Queensland government passed legislation to establish minimum nurse-to-resident nursing hours for Queensland’s 16 State Aged Care Facilities (SACF). Under this legislation:

  • SACFs will be required to provide a minimum average of 3.65 daily resident care hours
  • Ratios will ensure at least 50% of care is provided by RNs and ENs, and at least 30% of overall care is provided by RNs. 
  • The government has committed to no job losses. 

 
These ratios will be rolled out over two years, with an evaluation study to commence mid-2020. 
 

What is Phase 3 of the Ratios campaign all about? 

 
In March 2020, the QNMU launched Ratios Save Live and Money Phase 3: Strengthening and Expanding the Care Guarantee. Essentially, this phase of the campaign calls for mandated minimum safe staffing requirements to be rolled out across all nursing and midwifery services in Queensland – whether they are public, private or aged care. 
 
The QNMU is seeking that ratios be rolled out in a phased approach (over five years). 
 
Details of these phases, including how current ratios should be further refined, can be found in the Phase 3 Claims document here.  
 
PHASE 3 KEY ASKS INCLUDE:

  • further refine and expand legislated minimum ratios in the public sector
  • further improve application and compliance with the Business Planning Framework (BPF) in the public sector 
  • mandate minimum ratios in the private hospital and private aged care sectors
  • refine and expand legislated public reporting of safety and quality performance to include indicators specific to nursing and midwifery in public, private and aged care sectors
  • mandate minimum positive practice environment standards in public, private and aged care sectors.

 

What are the Positive Practice Environment Standards?

 
An important aspect of Phase 3 is promoting the QNMU’s Positive Practice Environment Standards for Nursing and Midwifery (the Standards).
 
The Standards can be read in full here.  
 
We know studies have shown a dependent relationship between a nurse and midwifes’ work environment and consumer outcomes. We also know that current legislated ratios in Queensland Health facilities have worked best in areas where a positive practice environment exists.
 
Therefore, the QNMU is seeking to mandate the following Standards across all nursing and midwifery services in the public, private and aged care sectors:

  1. Nurses and midwives must have safe workloads
  2. Nurses and midwives must practice in a physically, psychologically and culturally safe environment
  3. Nurses and midwives must work in an environment that promotes autonomous and collaborative practice
  4. Nurses and midwives must be actively included in organisational governance and decision-making
  5. Nurses and midwives must lead and/or participate in research and innovation
  6. Nursing and midwifery leadership must be recognised at all levels.

 
What are the minimum ratios?

 
The legislated ratio that currently applies to 27 Queensland Health prescribed wards is 1:4 (morning and afternoon shifts) and 1:7 (night shift).
 

Can the ratio be changed to suit different acuities?

 
Yes. For Queensland Health, the legislated ratio is a safety net that guarantees the minimum number of nurses required on any given shift. However, these ratios can be improved by calculating the correct supply and demand using Queensland Health’s industrially mandated tool called the Business Planning Framework. This improved ratio is called the notional ratio, and applies across all Queensland Health wards and facilities regardless of whether the legislated ratio is in place.
 

Are ratios actually making a difference?

 
Yes! A world-class evaluation of Queensland’s ratios has now been completed by a team of independent researchers. Significantly, the evaluation concluded that since July 2016, there have been:
 

 
Thanks to legislated ratios, the average medical/surgical nurse has seen a workload reduction of:
 

 
Reductions of one patient per nurse were associated with:
 

 

Have a workload issue?

 
For Queensland Health nurses and midwives, all wards and facilities (regardless of whether legislated ratios apply or not) must comply with the Business Planning Framework – the industrially mandated tool that calculates the required staff numbers and skill mix in your workplace. If you have a workload issue, you should complete an electronic workload reporting form at https://qheps.health.qld.gov.au/nmoq 
 
If you work in the private or aged care sectors, members are encouraged to download and submit workload reporting forms from www.qnmu.org.au/workloads
 
If there is no resolution, contact your QNMU Representative or local Organiser on 3840 1444.