Australian Prime Minister Scott Morrison released the Commission’s Terms of Reference on October 9 saying the country had to “brace itself for some difficult stories”, reported the Australian Associated Press. Morrison also said he saw the commission as the first step in “re-establishing the trust that loved ones will be treated with dignity and with respect”.

But the Australian Nursing and Midwifery Federation said a Royal Commission would do nothing to fix the crisis in aged care unless the Government introduced mandated staffing ratios in residential nursing homes as “a matter of urgency”.

The Federation launched a major campaign at the beginning of 2018 calling for mandated staffing including a petition that has received more than 230,000 signatures. The Federation says currently residents received around 2.86 hours of care per day from nurses and carers which was “nowhere near enough time to shower, toilet, medicate, dress, feed, roll over or move – let alone talk to – a resident”. It says residents should instead receive a minimum of 4.3 hours per day.

It argues that a Royal Commission will delay action to address “dangerous understaffing in nursing homes across the country” with “too often” only one registered nurse to manage the care for over 100 residents or “only one carer to feed, bathe, dress and mobilise 16 residents in less than an hour”.

The Government’s initial request for a Royal Commission was announced on September 16 the day before an ABC Four Corners investigation into the care of the elderly in Australian rest homes.

The two commissioners are due to release an interim report on 31 October 2019, with a final report due on 30 April 2020.

The inquiry is to be based in Adelaide where cases of rest home abuse at a state-run nursing home prompted a senate inquiry last year.

Nurse-to-patient and midwife-to-patient ratios were first introduced in Victoria in 2000 as part of the public sector nurses’ collective agreement but were not enshrined in state law until 2015.  The new amendment follows a taskforce acknowledging ratios needed to be updated to reflect “increasing patient complexity, changing models of care and the growing demand for health services”.

Current ratios for a general medical or surgical ward on a morning shift in a large Victorian public hospital is one nurse for every four patients and one nurse in charge. The ratio for general medical/surgical wards will not change under the bill but will require management to “round-up” nursing numbers for example rostering eight nurses for a 30 bed ward rather than seven.  But the bill does introduce new ratios for

acute stroke wards, haematology wards and acute inpatient oncology wards and increased ratios for palliative care, birthing suites and special care nurseries, and during peak times in emergency department resuscitation cubicles

‘These changes are part of the Andrews Government’s promise that nurses and midwives will rightly never again have to bargain for safe patient care,” said ANMF branch secretary Lisa Fitzpatrick.

‘Victoria is still one of the few places in the world to have mandated ratios ward-by-ward and shift-by-shift. These improvements will make us the envy of many nurses and midwives across the world trying to care for patients with unpredictable staffing levels,’ she said.

The New Zealand Nurses Organisation was set to follow Victoria in seeking nurse-to-patient ratios during the ‘fair pay’ negotiations of 2003-4 but opted to follow an alternative safe staffing path which lead to the development of the patient acuity-based Care Capacity Demand Management System.

The slow implementation of the CCDM system – which requires accurate patient acuity data to calculate what staffing a ward or unit requires based on patient need (not the number of beds in a ward) – was a major issue in the recent DHB NZNO negotiations that saw DHBs agreeing to step up the implementation of CCDM and the signing of a safe staffing Accord  and a government commitment to monitor implementation.

The new NZNO DHB collective agreement also includes funding for the immediate employment of the equivalent of 500 extra nurses to reduce workload pressures in the 20 DHBs’ most stretched wards and units.

The Victorian branch of the Australian Nursing and Midwifery Federation has welcomed a $705 million boost for mental health in Victoria’s May 1 Budget, including $32.5 million extra being invested in the mental health nursing workforce and free training for enrolled nurses from next year.

The Federation said the new mental health initiatives announced in the Budget state’s government, led by Labor’s Daniel Andrews, included extra regional rehabilitation facilities, new emergency department ‘crisis hubs’ for patients with urgent mental health, and drug and alcohol issues and education opportunities, as well as expanding the mental health nursing workforce.

It added that the major plank of the mental health initiatives was investing $100.5 million to create six emergency department ‘crisis hubs’ across the state, to be staffed with specialised nurses with the aim of providing a safer environment to deal with patients presenting with serious mental health or addiction issues. The ‘crisis hubs’ were also intended to help police know which hospitals to take affected people to for expert care.

Paul Gilbert, acting secretary for the Victoria branch, said it congratulated the Andrews Government for “listening to nurses’ concerns and responding with fundamental changes to the mental health model for the care of patients in the acute and recovery stages that will benefit the whole community”.

‘The new crisis hubs will mean the patient is safer and so are the other emergency department patients, the nurses, the doctors, the security guards and the police,’ he said.

The Budget also announced $32.5 million for 31 supernumerary clinical liaison nurses to support less experienced nurses and doctors caring for vulnerable patients, 110 additional postgraduate mental health nursing positions and funding for 40 registered nurses to undertake education in mental health nursing.

As part of reforming clinical mental health services the Government was also providing $28.6 million for more intensive clinical nursing services in the state’s existing Prevention and Recovery Care Units (PARC) that were designed to reduce pressure in acute services. PARCs provide short-term residential care for people with a mental illness.

A further $11.9 million was to be spent on building a new 20-bed residential facility for young people with a mental illness, focusing on early interventions and tailored support.

An extra $40.6 million was in the budget to fund construction of three new 30-bed addiction residential treatment facilities in the State.

The $2.1 billion state Budget for health included hospital upgrades and equipment, more elective surgery and increased workforce immunisation.

Also from 2019 the Diploma of Nursing – the enrolled nurse qualification has also been recognised as one of the state’s priority fee-free courses.

‘This will help young people in regional and metropolitan Victoria secure a qualification and a job in the growing health sector including private and public acute care and new public aged care facilities,” said Gilbert. “We would also hope the private aged care sector recognise the value of enrolled nurses and makes decisions to recruit ENs instead of the string of redundancies we have recently seen.”