Nurse-to-patient ratios
Questions and answers
October 2015
What is a nurse-to-patient ratio?
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 ratio is calculated on the basis of patient
acuity: the greater the level of acuity, the higher the number of nursing staff required to provide safe care.
For example, in an intensive care unit it may be one nurse to two patients (1:2), while in a general
healthcare ward, a ratio of one nurse to six patients (1:6) may be suitable. The ratio is responsive to the
changing needs of patients over a 24-hour period.
Why is the government legislating safe nurse-to-patient ratios?
Research has shown that a higher number of registered nurses relative to the number of patients has a
positive impact on patient outcomes, including decreased lengths of stay in hospital and reduced inpatient
mortality. Evidence also indicates that appropriate staffing numbers benefits the nursing workforce by
reducing work-related injuries, absenteeism and turnover, and by increasing job satisfaction.
Ratios are not currently mandated in Queensland. Instead, public health facilities use the Queensland
Health Business Planning Framework: Nursing Resources to calculate the staffing levels and skills mix
required to appropriately and safely manage service requirements.
Under the Nursing Guarantee policy, the Government has committed to legislate for mandated ratios and
workload provisions (which will comprise the Business Planning Framework methodology) in Queensland’s
public sector health facilities.
This commitment recognises the important role that nurse-to-patient ratios and an appropriate mix of
nursing skills for different wards and services play in supporting patient safety and quality of care.
What is the Business Planning Framework?
The Business Planning Framework is a tool currently used by Queensland Health to determine the nursing
and midwifery staffing levels that are needed to provide appropriate and safe care in different types of
clinical settings. The Business Planning Framework is underpinned by consistent adherence to professional
standards and expert clinical judgement regarding appropriate staffing levels.
It is intended that the Business Planning Framework methodology for determining appropriate nursing and
midwifery staffing levels will be incorporated into a Standard that will apply to facilities prescribed under the
minimum nurse-to-patient ratio legislation. Prescribed facilities will therefore be required to comply with the
Standard and with the minimum nurse-to-patient ratios.
Who will the proposed legislated nurse-to-patient ratios affect?
Once the legislation comes into effect, prescribed facilities within Queensland Hospital and Health Services
will be required to implement and comply with minimum ratios within specific acute wards, and adhere to
workload provisions in the Standard to ensure safe nursing and midwifery staffing levels.
To ensure patient safety and safe workplaces for frontline staff, non-prescribed facilities will continue to be
expected to implement appropriate and safe standards and processes through the application of the
Business Planning Framework. Providing safe, high quality health services is an expectation for all service
providers across Queensland irrespective of whether they operate within a prescribed facility.
How will the government legislate safe nurse-to-patient ratios?
Nurse-to-patient ratios will be mandated in Queensland public sector health facilities by amending the
Hospitals and Health Boards Act 2011 and Hospital and Health Boards Regulation 2012.
It is proposed to mandate minimum ratios of one nurse per four patients (1:4) for morning and afternoon
shifts, and one nurse per seven patients (1:7) for overnight shifts in acute wards.
The mandated ratios will initially apply only to specified Queensland public sector health facilities, which will
be prescribed in the Hospital and Health Boards Regulation 2012.
For the purposes of ratios, a nurse or midwife who is counted as part of this ratio will be a registered or an
enrolled nurse, or a registered midwife.
What are the benefits of legislating safe ratios?
Mandating ratios in legislation will benefit patients, nurses and Hospital and Health Services. The key
benefits of legislating for safe ratios are:
•
Improved patient safety and quality of care, which will provide greater patient satisfaction and
improved patient outcomes.
•
Improved recruitment, retention and satisfaction of nurses and greater workforce sustainability.
•
Safer nursing workloads.
Facilities that have a higher percentage of nurses to patients have been shown to have lower patient
mortality, reduced length of stay, improved quality of life and fewer adverse events. Ratios will assist with
providing patients with better health outcomes.
Ratios will also positively impact on the wellbeing of nurses and midwives, by giving them the ability to
deliver expert professional service in well-managed environments where the workload is safe.
When will nurse-to-patient ratios be implemented in Queensland?
The implementation of mandated nurse-to-patient ratios requires careful consideration and planning to
ensure patient safety is maintained at all times, that Hospital and Health Services are appropriately
prepared to meet any changes in resourcing requirements, and that any potential implications for the nongovernment sector are identified and carefully managed.
A robust and methodical process has commenced to support this legislative change. The implementation
process will involve consultation and close liaison with a range of government and non-government
stakeholders to ensure these changes can be implemented in the most effective manner.
The implementation of mandated nurse-to-patient ratios will commence in mid-2016, subject to these
outcomes and the finalisation of the legislative process.
More information
This initiative is led by the Department of Health’s Office of the Chief Nursing and Midwifery Officer. For more information please
visit http://www.health.qld.gov.au
Nurse-to-patient ratios
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