New Nurse and Midwife to Patient Ratios in Victoria

Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Act 2019 No.1 (Vic)

On 1 March 2019 relevant parts of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Act 2019 No.1 (Vic) (the Amending Act), which amended the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 (Vic) (the Act) commenced.

As a result of those amendments, on 6 March 2019 the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Regulations 2019 No.15 (Vic) (the Amending Regulations) also amended the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015 (the Regulations).

Overview

By way of overview, the changes introduced by the Amending Act and the Amending Regulations update nurse and midwife to patient ratios regulation in Victorian public hospitals and health services in response to new technologies, changing patient complexity, current best practice and community expectations. It is important to note that the new changes apply to hospitals as defined in section 3 of the Act being, a level 1 hospital, a level 2 hospital, a level 3 hospital or a level 4 hospital (as defined in section 3 of the Act); or

  • Darlingford Upper Goulburn Nursing Home Inc.;
  • Indigo North Health Inc.;
  • Lyndoch Living Inc.;
  • Red Cliffs and Community Aged Care Services Inc.

A summary of the key changes affecting hospitals (as defined above), as introduced by the Amending Act and Amending Regulations are discussed below.

New changes to the rounding rule

Hospitals will be aware that prior to 1 March 2019, section 12 of the Act provided for circumstances where a ratio was applied under the Act that did not produce a whole number. The effect of that previous section 12 was to exempt an operator of a hospital from the requirement to roster an additional nurse if the ratio warranted the rostering of less than 50% of an additional nurse. Hospitals should be aware that the Amending Act has amended section 12 in the Act to now impose an obligation on an operator of a hospital in relation to certain wards (as briefly discussed below) to roster an additional nurse where the application of a ratio to a ward results in a number that is not a whole number.

More specifically, the newly amended section 12 of the Act limits itself to certain wards of high-demand and complexity, applying to general medical or surgical wards, coronary care units, operating theatres, post-anaesthetic recovery rooms and emergency departments. It is important to note that the newly amended section 12 operates in a highly particularised fashion, applying differentially depending on the type of shift (i.e. morning, afternoon or night) in some circumstances, as well as the type of hospital (i.e. level 1, level 2, etc.). For example, the new rounding rule will only apply to emergency departments at hospitals specified in Part 2 of Schedule 3 of the Act during the night shift, that is, until 1 March 2020 when it will then apply to morning shifts at those emergency departments in accordance with the staggered commencements. The specific details of the application of the newly amended section 12 is outlined in full in the VIC – Safe Patient Care module.

Ratio for mixed wards

The Amending Act has also introduced section 12A to the Act, which deals with ratio determinations for mixed wards. Wards that are mixed wards are to be determined by the operator of the hospital, and the operator is required to publish on the hospital website prescribed details of any mixed wards. Section 12A requires the operator of a hospital to take these steps if a ward at the hospital has been configured to provide a mixture of clinical services so that more than 1 ratio is applicable to the ward. Furthermore, the nomination must be made in February and August of each year and the published particulars must be relevant to the 6 month period following the nomination.

In addition, section 12A requires an operator of a hospital to determine ratios for a mixed ward with reference to portions. A portion in relation to a mixed ward, means the category of those patients or beds in the ward to which a particular ratio applies. As such, under section 12A the appropriate ratios must be separately applied to each portion in the ward and the nurses required for each portion calculated accordingly. The individual totals must then be combined and the mixed ward ratio can then be determined by dividing the total number of beds by the total number of staff calculated in accordance with the above instructions. Only 1 nurse in charge can be rostered to a mixed ward, regardless of whether provisions applicable to more than 1 portion making up the ward separately necessitate a nurse in charge.

Additional and highly relevant rules are contained under the new section 12A in the Act to, for example, account for the situation where application of the mixed ward ratio does not give a whole number or where a hospital fails to properly nominate a mixed ward. Please review section 12A in the VIC – Safe Patient Care module for further information.

Allocation of nurses and midwives to fulfil ratio requirements

In relation to special care nurseries, neonatal and postnatal wards, both midwives and nurses can now be allocated to fulfil ratio requirements. However, it is important to note that experience requirements have also been introduced for nurses or midwives allocated to special care nurseries, as well as for nurses allocated to postnatal wards.

The newly amended section 27 of the Act provides that a nurse or midwife with whom the operator of a hospital staffs a special care nursery for the purpose of complying with this section must have completed:

  • the equivalent of at least 64 hours’ employment per fortnight as a nurse or a midwife during a 12 month period; or
  • a total of 64 hours’ placement in a special care nursery.

In addition, section 27 provides that for the purpose of ensuring that appropriate care and treatment of infants in a special care nursery is provided, the operator of the hospital must take into account the prescribed criteria as set out in regulation 5A (being:

  • the conditions of the infants in the special care nursery;
  • the level of care required by the infants in the special care nursery;
  • the experience and skill mix of staff;
  • the number of students requiring supervision).

Further to this, in fulfilling the ratio requirements for postnatal wards (now dealt with separately to antenatal wards under section 31A of the Act) the operator must ensure that at least 1 person rostered is a midwife and not more than 1 is a nurse.

Transitional provisions

Finally, the Amending Act has repealed sections 33-35 of the Act and has in turn has eliminated any opportunity for an operator of a hospital (or a nurse or midwife under sections 33 and 34) to make proposals for redistribution, below ratios distribution or alternative staffing models respectively. However, it is important to note that the Amending Act has introduced section 50 to the Act, which acts as a transitional provision and deems hospitals to be in compliance with ratio requirements under the Act if they continue to implement any such arrangement that commenced prior to the repeal of sections 33-35 for the period specified under sections 33 or 34, or for the duration set out under section 35 (as the case may be).

Conclusion

Organisations that are hospitals under section 3 of the Act should ensure that they update their staffing policies and systems to address the new changes discussed above, and as outlined in full in the VIC – Safe Patient Care module.  

Contact

For further information please contact the Law Compliance team:

Phone: 1300 862 667

Email: info@lawcompliance.com.au

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