About ratios
Why do we need legislated ratios?
Excellent care across the public health system is paramount. Legislated ratios set the minimum number of nursing staff that a public Hospital and Health Service must provide on a prescribed ward during each morning, afternoon and night shift.
The introduction of legislated nurse-to-patient ratios further supports the existing Business Planning Framework, which determines adequate staffing supply, together with professional standards and professional judgement. This ensures we continue to deliver quality patient care, improve workforce sustainability and ensure manageable nursing workloads for front-line nursing staff.
What are the legislated ratios in Queensland?
For the purposes of reporting compliance with the legislation, the legislated ratios are the minimum number of nurses in relation to the number of patients on a ward. The ratios are one nurse to four patients (1:4) for morning and afternoon shifts and one nurse to seven patients (1:7) for night shifts.
For example, on a ward of 28 patients, the ratio of 1:4 would require a minimum of 7 nurses on a morning and afternoon shift, and minimum of 4 nurses on a night shift. All prescribed wards and facilities must ensure they meet the minimum ratios.
Patients will be allocated to nurses based on patient acuity to ensure we continue to deliver appropriate and safe patient care.
When did the ratios legislation come into effect?
Legislated ratios came into effect on 1 July 2016.
Legislated ratios mainly apply to prescribed adult acute medical and acute surgical wards and some mental health units in Queensland’s public health sector.
A list of wards and facilities in scope for ratios are detailed in the Hospital and Health Boards Amendment Regulation (No.2) 2016 (PDF, 170KB).
Why have some facilities and wards been selected?
This is the first stage of implementation. It will set minimum standards in wards where the evidence for the impact of legislated ratios on patient safety and positive patient outcomes is clear and the implementation is more straightforward.
Why are some facilities or wards not a part of the prescribed list?
A number of public hospitals and wards are not included in this first stage for a number of reasons including, their lower risk and acuity levels, their use of alternative models of care, the multi-purpose nature of wards within certain facilities and the need for more time to carefully consider appropriate ratios for some wards or even the use of more nurses than those proposed under the ratios such as 1:2, rather than 1:4.
What does this mean for those facilities and wards where legislated ratios do not apply?
Providing safe, high quality health services is an expectation for all service providers across Queensland, irrespective of whether they operate within a prescribed facility.
Non-prescribed facilities will continue to be expected to implement appropriate and safe standards and processes through the ongoing application of the Business Planning Framework to ensure patient safety and safe workplaces for front line staff.
When will other facilities and wards be included?
The impact of legislated ratios on nursing, patient and organisational outcomes will be assessed through independent research and evaluation by the world leader in nurse-to-patient ratios research, the University of Pennsylvania, working in collaboration with the Queensland University of Technology.
The health services will also monitor the effects of ratios at the local level to leverage opportunities to apply what has been learned in order to guide and inform on-going implementation. Findings from the assessment of the initial stage of implementation will inform future stages.
Business Planning Framework
What is the Business Planning Framework?
The Business Planning Framework (PDF 1329 kB) (BPF) is a tool currently used by Queensland Health to determine the nursing and midwifery staffing and skill mix levels that are needed to provide appropriate and safe care in different types of clinical settings.
The BPF is underpinned by key principles:
- Development of service profiles
- Resource allocation
- Evaluation of performance
- Escalation of workload concerns
The standard will apply to those facilities prescribed under the legislation. These facilities will be required to comply with both the standard and with the minimum nurse-to-patient ratios.
Ratios in practice
Will ratios impact the current model/s of care?
No. The model of care used on the ward will remain unchanged.
How will ratios be applied?
The BPF (PDF 1329 kB) will continue to be the primary mechanism through which the required staffing and skill mix will be determined on all wards and units in Queensland public hospitals.
The introduction of the ratios does not change the role of BPF, but sets a minimum legislated staffing level of registered and enrolled nurses on prescribed wards.
Professional standards, professional judgement, critical thinking and teamwork will continue to underpin the delivery of safe and high quality patient care in all wards and units.
Who can be counted as part of the ratio?
Only registered nurses and enrolled nurses who are directly providing patient care to one or more patients may be counted as part of the ratio. For example, Nurse Unit Managers, Clinical Nurse Consultants, Nurse Educators and Team Leaders who are not directly involved in providing care may not be counted as part of the ratio.
What happens if the minimum ratio is not met?
There will be a requirement to report on instances where the minimum legislated ratio has not been met. There is also a requirement to report workload concerns, through the existing process.
Are there penalties for non-compliance
There are no direct consequences of non-compliance; however, compliance with the legislation will be monitored and repeated instances of non-compliance will prompt a review at the local level through the Nursing and Midwifery Consultative Forum (NMCF).
Ratios and business functions
How will ratios affect resource planning on prescribed wards?
To support resource planning, each prescribed ward will determine notional ratios using the Nursing and Midwifery Workload Management Standard, Hospital and Health Boards Act 2011 (PDF, 90KB), which directly reflects the BPF methodology.
How do we report on compliance with the legislation?
From 1 July 2016, there is a requirement to report on compliance with the legislated ratios. This will require data to be collected at the ward level and then compiled by the BPF (PDF 1329 kB) nurse monthly for submission to the Executive Director of Nursing and Midwifery Services.
In addition to the obligation to report on compliance with the legislated ratios, HHS will be required track and report monthly to the NMCF and through other existing processes, where workload concerns have been identified or raised.
What do I do if I still think there is a work load issue?
All nurses and midwives are required to report workload concerns. The existing mechanisms for reporting and managing workload concerns will continue to apply to all wards.
Can a HHS seek a temporary exemption from meeting ratio requirements?
Yes. A HHS may seek in writing, a temporary exemption from the Minister, from meeting ratio requirements. The application for exemption must specify the period for which the exemption is sought and the remedial actions being undertaken to move to compliance within the exemption period. The particulars are outlined in the legislation.
