Removal of nurse/patient ratios would prompt nursing exodus.

IF THE nurse/patient ratios introduced in the Australian state of Victoria in 2001 were removed it would "precipitate a major withdrawal of nursing labour from the system", according to just-published research commissioned by the Australian Nursing Federation (ANF).

The research, conducted by the University of Sydney's workplace research centre, concludes that nurse/patient ratios have contributed to a major improvement in patient care and stabilised the Victorian public health system. But the full benefits of staff/patient ratios have been diluted by wider systemic problems, particularly continuing pressures to increase nurses' workloads and the related problem of the Australia-wide nursing shortage. The nurse/ patient ratios have been credited with drawing almost 4000 nurses back into the workforce.

Late last year the ANF commissioned the workplace research centre to undertake a study of the working conditions of its members in the Victorian public health system. The study, based on 1737 responses, a 43.4 percent response rate, examined the nature of nurses' hours of work, staffing levels and the operation of the nurse/patient ratios. It shows the public system is relying heavily on the skills and commitment of older women, who tend to be in the latter stages of their working lives. More than half the respondents were over 40, a quarter were over 50 and 93 percent were women.

The research study said the nurse/patient ratios had "stabilised a deteriorating situation". Their implementation and impact had been uneven. "This reflects the context of the Victorian public health system: one of chronic nursing shortages and continual change," the report said. But the ratios had been associated with important improvements for patients and nurses. Over 90 percent of respondents reported that ratios were essential for the effective management of workloads. Of the nurses who had worked in the system before and since the implementation of ratios, more than four in five reported they had improved patient care and nurses' working conditions. Their removal would undermine patient care and working conditions, and precipitate a major withdrawal of nursing labour from the system. More than half the respondents indicated they would resign, take early retirement or cut their working hours if nurse/patient ratios were removed. "Few nurses in the Victorian public health system, it seems, trust management to get the issues of shift staffing levels correct," the report stated. "In short, ANF members in Victorian public health clearly feel the ratios are essential for an effective long-run solution for the system's problems. Their removal would make the situation even worse by triggering a greater number of working nurses to leave the system."

NZNO chief executive Geoff Annals said the Victorian research confirmed the effectiveness of nurse/patient ratios in improving patient care and nurses' working conditions and provided further evidence for their introduction in New Zealand. "They are not a panacea for all the problems in the health system, but the research makes clear the system would be much worse off if they had not been introduced. There are important lessons here for our health system. Health managers need to heed what NZNO is saying: that nurse/patient ratios are an important tool in safely managing nursing workloads."

NZNO's nurse/patient ratios are based on the Victorian figures.

As well as the ratios data, the Victorian research also revealed the public health system there still depended on unpaid overtime. The amount of unpaid overtime work varied from two hours to more than ten hours per week. Over half the nurses indicated they felt an imperative to work overtime to maintain a basic standard of patient care.

The research also revealed mixed signals from employers about the profession. Across the industry, employers supported continuing education for nurses and there were multiple strategies to help nurses study. Nurses acknowledged this support but felt employers were seeking to reduce the nursing workforce by replacing nurses with non-nursing personnel. "Nurses overwhelmingly expressed a view that increased use of non-nursing staff to undertake duties traditionally undertaken by nurse professionals will undermine the overall quality of patient care delivered by the health system and increase their workloads," the report said.