New Reforms to Nurse and Midwife to Patient Ratios in Victoria

On 1 March 2019 the first suite of reforms to nurse and midwife to patient ratios came into effect. Here’s what Victorian hospitals need to know about the new and upcoming changes.

This alert applies to public hospitals and health services in Victoria and will likely amend the VIC – Safe Patient Care module.

Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Act 2019 (VIC)

Please be advised that the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Act 2019 (Vic) (the Amending Act) passed the Victorian Parliament on 21 February 2019 and was given the Royal Assent on 26 February 2019.

The Amending Act will amend the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 (Vic) (the Act) and is due to commence as follows:

  • Parts 1, 2 and 5 on 1 March 2019;
  • Part 3 on 1 March 2020;
  • Part 4 on 1 March 2021.

The matters dealt with under each Part are described below.

Background

The Amending Act is designed to update nurse (and midwife) to patient ratios regulation in Victorian public hospitals in response to new technologies, changing patient complexity, current best practice and community expectations. Below is a summary of some of the important changes. The legislation in question is highly prescriptive, meaning that a summary of it cannot cover all of the finer particulars relevant to each individual ward/hospital type. As such, we recommend that relevant subscribers review the legislation to the extent that it applies to their health services

The following provisions commenced on 1 March 2019:

Changes to rounding method

The Amending Act has repealed and replaced sections 12(1) and (2) of the Act. Section 12 accounts for circumstances where a ratio is applied under the Act that does not produce a whole number. The effect of the previous provisions is to exempt an operator from the requirement to roster an additional nurse if the ratio warrants the rostering of less than 50% of an additional nurse. The drafting of the replacement provisions refocuses the rule, to impose an obligation on an operator in relation to certain wards (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.

The obligation 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. The new provision operates in a highly particularised fashion, applying differently 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 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. For full details of the application of the new provisions, including their eventual application to wards such as antenatal wards and birthing suites (from 1 March 2021) please refer to section 12 of the Amending Act.

In relation to other wards, not mentioned in section 12(1), the operator is absolved from its obligation to allocate an additional nurse in such circumstances only if it would not compromise safe patient care and the application of the applicable ratio requires less than 50% of 1 additional nurse to be rostered to the ward.

Mixed ward ratios

The Amending Act has inserted section 12A, which deals with ratio determinations for mixed wards and applies to all hospitals under the Act. Wards that are mixed wards are to be determined by the operator and the operator must publish on the hospital website prescribed details of any mixed wards. The operator must take these steps if a ward/s at the hospital has been configured to provide a mixture of clinical services so that more than 1 ratio is applicable to the ward/s. 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.

The new provision compels an operator of a hospital to determine ratios for a mixed ward with reference to “portions”. A portion is defined as a category of patient found in a mixed ward to which a particular ratio applies (and a mixed ward will inevitably contain more than 1 category of patient). Therefore, 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 must 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 section 12A, 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 see section 12A of the Act for further details.

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, experience requirements have also been introduced for nurses or midwives allocated to special care nurseries, as well as for nurses allocated to postnatal wards. For the former, suitable employment set out under section 27(3) over 12 months and for the latter, appropriate placement experience, postgraduate study and further particulars to be prescribed by regulation.

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

The new provisions also insert changes to the ratio demands for these wards.

Transitional provisions

The Amending Act repeals sections 33-35 of the Act and therefore eliminates 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 also inserts section 50, 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 the above sections for the period specified under sections 33 or 34, or for the duration set out under section 35 (as the case may be).

Monash Children’s hospital

The Amending Act specifies Monash Children’s Hospital as a level 1 hospital for the purposes of the Act.

The following provisions are set to commence on 1 March 2020:

Ratios for acute stroke wards, oncology wards and haematology wards

Ratio requirements for the above wards are to be inserted by way of new sections 21A, 21B and 21C. The Act prescribes 1 nurse for every 3 patients and 1 nurse in charge for acute stroke and haematology wards and 1 nurse to every 4 patients and 1 nurse in charge for oncology wards. For oncology and haematology wards, ratio requirements for night shifts are more lenient.

Palliative care, special care nurseries and birthing suites

The amendments demand increased rostering for palliative care and prescribe a nurse in charge for special care nurseries if the ward holds more than 7 occupied cots (except for the night shift), among other changes. In relation to birthing suites, amendments to section 31(1) of the Act will require a nurse in charge to be allocated to a set of 6 or more nominated birthing suites.

The following provisions are set to commence on 1 March 2021:

Resuscitation beds in emergency departments

In phase 3 of the amendment level 1, level 2 and level 3 hospitals will be obliged to allocate 1 nurse for each resuscitation bed in an emergency department in addition to the nurses allocated in accordance with the applicable ratio under section 20 of the Act.


Please click here to access the full Amending Act.

Contact

For further information please contact the Law Compliance team:

Phone: 1300 862 667

Email: info@lawcompliance.com.au

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