Industrial action for ratios.
The NSW nurses association (NSWNA) is currently escalating its industrial actions in an attempt to secure safer nurse staffing ratios and to bring it into alignment with similar existing ratios in place in Victorian hospitals.
At this time the industrial actions have resulted in over 300 beds being closed across Sydney’s Royal Prince Alfred and Westmead Hospitals, St George Hospital and hospitals in Wollongong, Manly, Long Jetty, Taree. These numbers are expected to quickly escalate over the next few days.
The NSW health minister Carmel Tebbutt is refusing any negotiations with the union whilst industrial action is occurring, stating that the ratio of one nurse to four patients is not appropriate (ABC radio).
Currently, a General Workload Calculation Tool, that was developed in 2004, is used by NSW hospitals to calculate the nursing hours per patient day required on any particular ward or unit.
However, this tool has failed to meet the combination of escalating workloads and skill mix1 challenges that NSW hospitals currently face.
After examining the Victorian model and engaging nurse workforce and industrial relation academics, the NSWNA has found empiric evidence for the introduction of nurse to patient ratios.
â€œA nurse-to-patient ratio would mean all absences from the clinical roster must be replaced or backfilled by an employee of the same Award classification to ensure the quality and safety of patient care. Necessary budgets would be allocated to ensure this.â€
â€œThis claim also provides a consultation process regarding the introduction of Assistants in Nursing to the roster for any ward or unit. It includes provision to ensure Nursing Unit Managers have the delegated authority to make the final decision about whether patient care can be maintained with an AiN role as part of the unitâ€™s skill mix. This means if the NUM believes AiNs can enhance the nursing care for that unit then they can employ one as per the package but there cannot be more than one AiN per shift. No AiNs are to be rostered in emergency, palliative care or inpatient mental health units or wards.â€
:: NSWNA ::
Claims for staffing and skill mix for individual speciality areas can be found in this document. Of course, my interest lay in the emergency department model, so lets have a look at that.
Emergency Department Claim.
The NSWNA claim for staffing of emergency departments (Levels 6, 5, and 4) applies to all beds, treatment spaces, triage rooms, procedure rooms and any chairs where these spaces are regularly used to deliver care. This staffing ratio does not apply to the staffing of EMU, MAU or PECC units.
- Morning Shift: 1:3 + RN in charge + triage
- Afternoon Shift: 1:3 + RN in charge + 2 triage
- Night Shift: 1:3 + RN in charge + triage
- Resus beds will be staffed 1 nurse: 1 patient.
The following provisions will apply:
- The skill mix for each ward or unit will include a minimum of 90% Registered Nurses on each shift
- Due to the nature of the service, AiNs will not form part of the skill mix
- Where the proportion of Registered Nurses on each shift in any ward as at the date of this Agreement is higher than 90%, that proportion shall not be reduced.
The ratio specified above does not include the following positions or classifications: Nursing Unit Manager; Clinical Nurse Educator, Clinical Nurse Consultant, Clinical Initiative Nurse, Nurse Practitioner, administrative support staff and wardspersons.
Further, there shall be 1.4 FTE Clinical Nurse Educators employed for every 30 nursing staff, and a proportion thereof where there are fewer than 30 such staff in a unit/service. CNEs should be rostered to provide coverage on seven days of the week over each roster period.
Nurses speak up:
What say you?
What is your own feeling on this?
Do you work in a hospital that is currently affected by the NSWNA industrial actions?
What is the current nurse to patient ratio on the ward/area that you work? Do you feel this is safe? Can you give some examples?
Perhaps you are working in Victoria or other places where similarÂ ratios are in already in place…what is your experience of this?
Over to youâ€¦â€¦
- Skill Mix: the balance of relevant knowledge, skills and responsibilities required to provide safe, quality care in any particular speciality [↩]