Nurses-to-patient ratios will ease health crisis

The legal mandating of nurse-to-patient ratios needs to be done immediately to help turn around a crisis that puts staff and patients at risk, New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO).

NZNO President Anne Daniels said feedback from across the health sector showed the Care Capacity Demand Management (CCDM) based system used by Te Whatu Ora was clearly not working for patients or staff as there aren’t enough nurses to make it work.

Ms Daniels said decades ago during weekends and holiday periods such as Christmas, hospitals would reduce staff to allow more people to take a break over the Christmas period, but that was no longer the case.

"We are as busy if not busier than ever. And the culture of reducing staff over this period has continued which puts more pressure on the nurses who remain at work because they've got even less staff than they should have and it's already unsafe."

Nurse-to-patient ratio legislation has markedly improved recruitment and retention in Australia, Ireland, Canada and parts of the United States, Ms Daniels said.

"It will keep nurses in the profession and will attract more students by showing they are valued for the work they do and the incredible pressures they face every day.

"Our patients have the right to safe care and our nurses/midwives have the legislated right to a safe working environment. Legislated nurse-to-patient ratios will deliver both."

The health sector has been plagued by chronic understaffing and that’s why NZNO is seeking to have nurse-to-patient ratios established not just within hospitals but across all sectors including primary care and aged residential care.

"We are actually regressing because some of our members say that 97 percent of shifts at Te Whatu Ora are understaffed. It was 83 percent in 2022 and lower before that.

"Getting legislation on nurse-to-patient ratios is a top priority for the organisation because safe and healthy work environments need to be reestablished."

A nurse-to-patient ratio is the number of nurses or midwives working on a particular ward, unit or department, in relation to the number of patients. CCDM is intended to be used to adjust the minimum number of nurses to meet patient acuity (how sick the patient is and how much nursing care they need).

"Full implementation of CCDM has never occurred or been funded appropriately. The system needs to be reviewed and made fit for purpose to support culturally safe care.

"Legislation is the forcing factor that will deliver the right number of nurses and midwives with the skills, knowledge and experience needed to deliver safe and timely care, where and when it is needed."

Ms Daniels said the major challenge for Te Whatu Ora and other health sector employers lay in their inability to retain staff and this was reflected in the turnover numbers.

"Nurse turnover has increased from 9.1 percent in 2013 to 15.3 percent in 2022 for registered nurses and more than doubled for nurse practitioners, emergency nurses and health care assistants.

"The costs of registered nurse turnover alone is about $1.5 billion a year and this reflects poor staff retention. The time has arrived to turn this around."

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