There is clear evidence to indicate that the number of nurses on a shift plays an important role in patient safety and quality of care.
The legislation of minimum nurse-to-patient ratios and minimum nurse workforce requirements further supports the industrially mandated Queensland Health Business Planning Framework: a tool for nursing and midwifery workload management (BPF). Along with professional college standards and professional judgement, the BPF will continue to apply in conjunction with legislation to support patient safety and quality of care, improve workforce sustainability and ensure safer workloads for frontline nursing staff.
Nurse-to-patient ratios in adult acute medical, surgical and mental health wards, as well as minimum nurse workforce requirements, are mandated under the Hospital and Health Boards Act 2011 and Hospital and Health Boards Regulation 2012.
Ratios in adult acute medical and surgical wards
The Queensland Government first legislated minimum nurse-to-patient ratios in the state’s public sector adult acute medical and surgical wards in 2016 to support patient safety and quality of care through appropriate resourcing. A nurse-to-patient ratio is the number of nurses or midwives working on a particular ward, unit or department, in relation to the number of patients they care for. The legislated ratios set the minimum number, also known as baseline, of nursing staff that a Hospital and Health Service must provide on a prescribed ward during a morning, afternoon or night shift.
Ratios in adult acute mental health wards
In 2019, the Queensland Government expanded legislated minimum nurse-to-patient ratios first introduced in 2016, expanding legislation to all adult acute mental health wards in prescribed facilities. This followed the 2016 pilot of nurse-to-patient ratios in two prescribed facilities at Metro North Hospital and Health Service and Metro South Hospital and Health Service.
Mandated nurse-to-patient ratios in adult acute mental health wards commenced on 15 November 2019.
Minimum nurse workforce requirements in public Residential Aged Care Facilities
Commencing 21 February 2020, the Queensland Government mandated minimum nurse workforce requirements of minimum nurse and support worker skill mix ratios and minimum average Daily Resident Care Hours (DRCH) in prescribed Queensland Health Residential Aged Care Facilities (RACFs).
These minimum nurse workforce requirements apply across all Queensland Health RACFs, as prescribed in the Hospital and Health Boards Regulation 2012.
To assess the impacts of the first minimum nurse-to-patient ratios legislation introduced in 2016, Queensland Health secured the expertise of the world leader in research on nurse-to-patient ratios, the University of Pennsylvania.
The University of Pennsylvania has carried out similar studies in more than 30 countries. The research team, led by Dr Linda Aiken and Dr Matthew McHugh presented their key findings from the research in December 2019.
Data analysis showed lower mortality and readmission rate as well as lower length of stay while overall the research found that increased nurse staffing was associated with improvements in outcomes for both patients and nurses, such as:
- Improved time to complete necessary care and time to detect patient changes;
- Better job satisfaction and less burnout;
- Less likely to give hospital a failing safety or infection prevention grade; and
- More likely to recommend hospital to family and friends.