Ratios Save Lives and Money: Frequently Asked Questions

What's the QNMU's Ratios Save Lives and Money 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?

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. 

Ratios have also now been implemented in acute adult mental health units and state-run nursing homes. Midwifery ratios are expected to be implemented in a phased approach up to 2026.

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.

Aged care ratios

Thanks to years of campaigning by the QNMU and the Australian Nursing and Midwifery Federation, the Albanese Federal Government has introduced new reforms to address safe staffing levels and quality of care in aged care.

The Federal Government’s ‘Implementing Care Bill’ is now law, and legislates for:

  • Registered Nurses 24/7 from 1 July 2023
  • Mandated 200 minimum care minutes from 1 October 2023
  • Financial transparency and accountability on public funding.

Minimum nurse-to-resident nursing hours have also been legislated for Queensland’s 16 state-run nursing homes. Under this legislation (which was passed in 2019):

  • State-run nursing homes are 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.


Midwifery ratios 

After years of campaigning to have babies counted, the Queensland Government has passed legislation stipulating that a newborn baby is to be counted as a patient when they are staying on a maternity ward with their birthing parent. Under the new law, Queensland will become the only state or territory in Australia to count both mothers and babies in midwifery ratios!

This is an important step to achieving the promised 1:6 midwife to mother and baby ratio across all Queensland Health maternity services. The QNMU expects the Hospital and Health Boards Regulation will be updated in the coming months to reflect the new midwifery ratios, which the Queensland Government has committed to implementing in a phased approach up to 2026. Once legislated and fully implemented, midwifery ratios will apply in public sector postnatal maternity wards at Queensland’s major hospitals, with a minimum ratio of one midwife to every six patients, including babies (1:6).

The QNMU's 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.