Ratios. How are they working in Victoria?

[pickledpepperRN]

Please excuse me if this has been discussed already.

The ratios of the State of Victoria are faous here. This is from the California state web site:

http://www.dhs.ca.gov/lnc/default.htm

From the California Department of Health Services:

"The positive impact of changes in workload on the nursing workforce was recently demonstrated in the state of Victoria, Australia. After intense lobbying and political pressure from the Australian Nurses Association, the Victorian Ministry for Health, which is responsible for the operation of acute care hospitals there, adopted the union-backed nurse-to-patient ratios effective December 1, 2000. For medical/surgical units, those ratios varied from 1:4 to 1:6, with more patients permitted on the night shift; for emergency departments the ratio was 1:3 at all times, and the triage and charge nurses were not counted in the ratios. The Victorian government also committed to--and funded--re-entry and refresher programs for nurses who wished to return to the workforce, as well as a vigorous advertising recruitment campaign. In addition, Victoria mandated a 12.5% pay increase over three years, paid study leave, and financial rewards based on education. The results were impressive. In 1999, Victoria's hospitals had approximately 20,000 full-time equivalent nursing positions, with 1300 of those positions vacant. By October, 2001, there were an additional 2650 full-time equivalent nurses employed in Victoria's hospitals--half filling the vacancies and the other half to staff up to meet the ratios (Exhibits J, K, and L). "

[ainz]

Any word about the impact on patient outcomes and quality indicators?

[gwenith, BSN, RN]

I can only talk of Queensland and it is not mandated here. We do use the computer system "Trendcare" which was developed by a Central Qld Nurse doing her Masters program (listen up all you would be nurse entrepreneurs). It is relatively simple taking only a couple of minutes a day to "click" though the acuity indicators for all the patients. On these indicators a certain number of nursing "hours" are allocated to each patient. i.e. for a patient in coronary care who is self caring, not having any special counseling, education or drugs then they will still be allocated 2 hours nursing time to cover observations, investigations and charting. If however they are getting "one involved medication" and there is a help list that includes what this is then the hours go up to 3.5 that is not because it takes 1.5 hours to do the work but because it indicates the patient is that much sicker.

We staff on trendcare if the program says we need 16 hours of nursing time then 2 nurses are allocated (2x8 hours). Of course there is leeway in the system and if it says you need 10 hours for that shift we are expected to cope. conversely there are times when the acuity is only 14 hours and they will still allocate 2 nurses but one might be expected to help in ICU for and hour or two. Or if we are lucky we use that "spare" time for policy writing, teaching new staff etc.

The system is a long way from perfect but I do not think we will ever get a good system

I hope this helps.

[ceridwyn]

Hi Gwenith,

It is all makes sense now! Trendcare comes from Queensland, can you thank the lady please.

I work in a public hospital in Victoria, that I notice sometimes nurses tend to have more than the patient ratios eg. 5 in am when it is suppose to be 4. And afo shift tends to be sometimes 3 sometimes 6 depending on the care needed for these patients.

I am still coming to terms with this, when I am in the middle of !V antis, someones in the shower, RPAO are due and a call comes from the desk "You have not done your trendcare yet!!!! or "You lhave not actualised yet"!!!!!!. I just hate the thing at the moment finding those 5 mins in the am shift is near impossible while everyone fights for the computer - there is only one on our ward, and when you have a few breathers for 1 min someone else is already on it. I think it is one stress that I do not need in the early part of my grad year. Anyway I suppose it will all be revealed why I am doing it if I ever get orientation to the hospital.

Other places I have worked as a Div 2 implement the ratios, but sometimes nurses will have the much heavier workload more than others with the 4 pts.

health.vic.gov.au might have more on the statics if these ratios are working quality wise or not.

[sehbear]

They are working really quite well.

We are currently gearing up for the next public sectore E.B.A. and there are a few hiccups that do need sorting out. The ratios have helped keep nurses nursing but maybe its is naive of the government to think that it is all fixed now!

In relation to patient outcomes there has been no formal study that I am aware of but one could only imagine that a nurse with 4 patients instead of 8 will give more complete and better care?

I will keep you up to date.

:)

[pickledpepperRN]

Thank you!

We have a different system, but admire what we know of yours.

Many hospitals are already staffing to the ratios that will be the law January 1st.