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.
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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.”
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The study by Otago, Auckland and Victoria university physician, nurse and health researchers, just published in the international journal Annals of Family Medicine, follows the interactions that 32 patients had with their GPs, nurses and other health professionals in the first six months after being diagnosed with type 2 diabetes.
Professor Tony Dowell of University of Otago, Wellington, and the lead author, said the study found that despite many health professionals having high communication and technical skill levels, there were still many opportunities to communicate and consult more effectively with their patients.
The researchers videoed the first post-diagnosis consultation and all the patients’ subsequent consultations with health professionals over the six months, which ranged from just one consultation to up to 12 consultations. The time spent with all health professionals over that six months ranged from just 27 minutes for one patient to seven hours and 12 minutes for another patient* (see details below).
The average GP consultation was 22 minutes (range = 6 minutes to 56 minutes), the average nurse consultation was 41 minutes (range = 8 minutes to 95 minutes) and the average dietitian consultation was 24 minutes (range = 17 to 52 minutes).
Dowell said that strengths found by the researchers included high levels of communication skills, enthusiasm to co-ordinate services, and good allocation of time to patients.
But researchers believed optimal care for newly diagnosed patients could be improved in a number of ways, including questioning and listening to patients more in initial consultations to gain insight into what they already knew about diabetes and their personal circumstances.
Researchers found that often initial consultations were driven by biomedical explanations that patients did not relate to. Clinicians also often assumed patients knew little about diabetes, when many already had some diabetes knowledge from other family members or had had pre-diabetes symptoms.
“Patients who have just been diagnosed with diabetes or other long-term conditions bring their own expertise and experience to the situation and healthcare professionals need to listen to this. We need to rethink our usage of technical biomedical language when talking to these patients,” said Professor Dowell.
“Despite the high levels of generic communication expertise by clinicians, many patients found the style and content of health promotion and lifestyle advice did not apply to their lives.”
The researchers found patients were also concerned about the overuse of checklists, and suggested a need for more effective methods of sharing patient information.
The time spent with patients over the first six months was also found to vary considerably – which researchers said was partly due to patients’ varying complexities of needs, but they also found much of the time variation was due to repeating educational information because of a lack of co-ordination between GPs, nurses and other health professionals. The researchers said this meant time that could have been spent on motivation interviewing was often undermined by a duplication of information and advice.
“These findings suggest that time spent in consultations should be reviewed for appropriateness, and health professionals should agree on who will cover various aspects of education so that repetition is avoided unless intended,” found the study.
Dowell said that although there had been a huge amount of research into diabetes, this was the first study to directly observe the patient journey and interactions with different health professionals from the onset of diabetes.
“Our results highlight the important role that communication plays in diabetes management, and the overall commitment of primary care teams to delivering patient care.”
The study authors recommend that clinicians employ a framework for communications with diabetes patients that acknowledges the importance of the patient’s own particular situation and social needs and that time could be allocated more effectively and efficiently when patients see multiple clinicians.
“Our main aim is to improve our patients’ health, and this research shows that appropriate communication with patients is a key component,” said Dowell.
“The research makes us appreciate the importance of listening more and possibly talking less in consultations. It helps with understanding and improving healthcare one sentence at a time.”
*The patient with seven hours and 12 minutes of consultation time had their first post-diagnosis consultation with a nurse and in total had three Care Plus GP/nurse consultations, two nurse consultations, one GP consultation, two podiatrist consultations and two dietitian consultations.
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