Ratios Save Lives

The Public Sector Enterprise Agreement campaign has concluded. Thank you to all members who participated in the survey to guide the development of the key issues in the Log of Claims.

The survey revealed that workloads, overtime and inadequate staffing levels were the greatest concern. 60% do not understand NHPPD staff allocation methodology, 70% raised workload concerns with manager and 65% do not have adequate staffing. The application of the Nursing Hours Per Patient Day staffing model requires enormous resources and it is clearly not well understood. The model is sound, however the application is problematic. It has clearly not delivered safe staffing and nurses and midwives need a transparent, simple staffing tool.

Members were overwhelmingly supportive of a Nurse to Patient ratio model with 85% indicating it would be easier to understand. ANMF have developed a hybrid ratio model which encompasses components of the Victorian/Queensland and current Tasmanian staffing industrial/legal instruments.

Nurse : patient ratios ensure appropriate nurse and midwife numbers which allows the provision of safe and quality care to their patients.

The evidence is irrefutable both nationally and internationally that adequate nurse and midwife numbers, coupled with appropriate skill mix and work environment, directly affect the level of safety and quality in health care services.[1, 2, 3, 4, 5, 6, 7]

Ratios have been proven to be an economically sound staffing methodology. Evidence demonstrates an increase in organisational productivity, continuity of patient care and efficiency through improvement of staff satisfaction, while also reducing service variation and improving healthcare equality. [1, 8, 9, 10]

The time is right to implement nurse: patient ratios in Tasmania as the transition to the Tasmanian Health Service begins. The benefits for nurse : patient ratios are clear for the Tasmanian health system, the patients and importantly for the staff working in it.

Improving efficiency and delivering services in an economically sustainable way in the Tasmanian health system has become a key objective of the Tasmanian government. Patient ratios will contribute to improving efficiency within the Tasmanian Health Service and will be cost effective in doing so.

‘Improving nurse staffing and skill mix will reduce adverse events and minimise unnecessary costs associated with inpatient complications. [1, 3, 8]’

Patients will experience much safer care that is of higher quality in a Tasmanian Health Service that implements patient ratios. Increasing nurse and midwife numbers improves patient satisfaction, lowers mortality, decreases re-admissions and reduces adverse events such as postoperative complications and pressure injuries. [1, 2, 3, 4, 5, 6, 7, 9, 11]

‘Hospitals with a higher nurse staffing level have a 25% less rate of readmission compared to similar hospitals with lower levels of nursing staff.[4]’

Improving patient safety and efficiency within the Tasmanian Health System hinges upon a willing and able nursing and midwifery workforce. The nursing workforce not only has a direct impact on patient safety and the quality of care patients receive, but can impact negatively on productivity where turnover rates are high due to staff burnout and low morale. [11,12,13]

‘Adding one patient to a nurse or midwifes workload directly increases the rate of burnout by 23% and reduces job satisfaction by 15% [13],implementing ratios will increase staff satisfaction and decrease attrition rates.’

The evidence is clear that nurse patient ratios are beneficial for the health system, patients and staff alike and reduces health servic variation while ensuring equality.


[1] L. Aiken, D. Sloane, L. Bruyneel, K. Van den Heede, P. Griffiths, R. Busse, M. Diomidous, J. Kinnunen, M. Kozka, E. Lesaffre, M. McHugh, M. Moreno-Casbas, A. Rafferty, R. Schwendimann, P. Scott, C. Tishelman, T. Achterberg and W. Sermeus, “Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study,” The Lancet, vol. 383, no. 9931, pp. 1824-1830, 2014.
[2] H. Tubbs-Cooley, J. Cimiotti, J. Silber, D. Sloane and L. Aiken, “An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions,” BMJ Quality and Safety, vol. 0, pp. 1-8, 2013.
[3] A. Lankshear, R. Sheldon and A. Maynard, “Nurse staffing and healthcare outcomes: a systematic review of the internation research evidence,” Advances in Nursing Science, vol. 25, no. 2, pp. 163-174, 2005.
[4] M. McHugh, J. Berez and D. Small, “Hospitals with higher nurse staffing had lower odds of readmissions penalities than hospitals with lower staffing,” Health Affairs, vol. 32, no. 10, pp. 1740-1747, 2013.
[5] P. Thungjaroenkul, G. Cummings and A. Embleton, “The impact of nurse staffing on hospital costs and patient length of stay: a systematic review,” Nursing Economics, vol. 25, no. 5, pp. 255-265, 2007.
[6] D. Twigg, C. Duffield, A. Bremner, P. Rapley and J. Finn, “The impact of the nursing hours per patient day (NHPPD) staffing method on patient outcomes: a retrospective analysis of patient and staffing data,” International Journal of Nursing Studies, vol. 48, no. 5, pp. 540-548, 2011.
[7] L. You, L. Aiken, D. Sloane, K. Liu, G. He, Y. Hu, X. Jiang, X. Li, H. Liu, S. Shang, A. Kutney-Lee and W. Sermeus, “Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses and patients in hospitals in China and Europe,” Internationl Journal of Nursing Studies, vol. 50, pp. 154-161, 2013.
[8] D. Twigg, E. Geelhoed, A. Bremner and C. Duffield, “The economic benefits of increased levels of nursing care in the hospital setting,” Journal of Advanced Nursing, pp. 2253-5561, 2013.
[9] D. Twigg, C. Duffield and G. Evans, “The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards,” Australian Health Review, vol. 37, pp. 541-546, 2013.
[10] Australian Commission on Safety and Quality in Health Care and Australian Insitute of Health and Welfare, “Exploring healthcare variation in Australia: analysis resulting from an OECD Study,” Australian Commission on Safety and Quality in Health Care, Sydney, 2014.
[11] C. Duffield, M. Roche, N. Blay and H. Stasa, “Nursing Unit Managers, staff retention and work environment,” Journal of Clinical Nursing, vol. 20, pp. 23-33, 2010.
[12] L. Hayes, L. O’Brien-Pallas, C. Duffield, J. Shamian, J. Buchan, F. Hughes, H. Laschinger and N. North, “Nurse turnover: a literature review – an update,” International Journal of Nursing Studies, vol. 49, pp. 887-905, 2012.
[13] Australian Nursing Federation, “Ensuring quality, safety and positive patient outcomes,” Melbourne, 2009.