Bendigo Advertiser letters to the editor

VITALLY IMPORTANT: Letter-writer and registered nurse Michelle Goldsmith says nurses "are the backbone of any hospital".
VITALLY IMPORTANT: Letter-writer and registered nurse Michelle Goldsmith says nurses "are the backbone of any hospital".

Nurse to patient ratios

In 2015 the Victorian Parliament passed the “Victorian Safe Patient Care Act”, which enshrines in legislation nurse/patient ratios in our public acute care hospitals, legally mandating a minimum number of qualified nurses on each shift to ensure the safest quality of care for every patient in the public health system.

The 1:4 ratio is the minimum nurse to patient ratio on an acute medical or surgical ward in a public hospital on morning and afternoon shifts. On a 20-bed ward this means that a minimum of five nurses, plus the nurse in charge are rostered to work on both shifts.

A good example, therefore, for 20 acute-care patients is five registered nurses, including the charge nurse, and one enrolled nurse for a ratio of one nurse to every four patients, plus the in-charge RN.

Detailed empirical evidence tells us that the number of patients allocated to a nurse on a shift is directly related to patient safety and mortality, and the quality of care they receive. In short, ratios save lives in Victorian public hospitals. So, what happens in Victorian private hospitals?

Legislation for private hospital minimum nurse staffing was removed from the Health Services Act by the Kennett state government during the 1990s. The 1:4 nurse/patient legislation applies only to public hospitals in Victoria. 

This means that, as a patient on a private hospital general medical or surgical ward, you may not benefit from the public hospital best practice 1:4 ratio. You may, in fact, be one of up to 10 patients for whom only one registered nurse, with the assistance of an enrolled nurse or an assistant in nursing, is responsible. 

A registered nurse is, as a minimum, degree-qualified. An enrolled nurse is TAFE diploma qualified, and an assistant in nursing is a certificate qualified personal carer. Skill-mix refers to the combination of the different categories and levels of seniority and experience of workers employed to deliver patient care. A skill-mix with a higher number of experienced RNs sees a significant reduction in: gastrointestinal bleeds, sepsis, shock, physiological/metabolic derangement, pulmonary failure, failure to rescue, pressure injuries and falls.

When an RN in a private hospital is teamed with a less qualified caregiver to nurse up to 10 patients, she/he is ultimately legally responsible for the care of those 10 patients, and the oversight of the less qualified staff-member. 

As an RN with several decades of experience, I know that this kind of patient load would make it difficult for me to provide the level of continuous assessment I consider necessary to maximise patient safety and quality of care.

Hospitals with higher numbers of registered nurses are associated with: lower rates of mortality within 30 days of admissions, lower medication errors, lower rates of wound infection and lower rates of hospital acquired complications.

Many people pay a premium for private health insurance expecting to receive premium care within the private hospital system. Nurses are the backbone of any hospital, and the quality of care they can deliver is significantly dependent upon optimal staff-mix and best-practice nurse/patient ratios.

Michelle Goldsmith, Eaglehawk

Economic boost welcome

It is the best news to see that components for the new passenger trains for Victoria will be manufactured in Bendigo. This will create much needed jobs and boost the local economy. This is a timely announcement, coming after the closure of the dairy plant in Rochester. One hopes that many of the workers displaced by that closure may find employment in this project.

With the growth of population in the region, more manufacturing and industrial businesses are needed to balance the service industries we are becoming so reliant on.

This is very good news indeed.

Murray McPhie, Epsom