The long struggle for nurse-patient ratios
On July 17 this year, at a mass meeting in Melbourne's Dallas Brooks Hall, nurses from across Victoria voted to work to nurse-patient ratios as part of orders handed down by the Australian Industrial Relations Commission. Nurse-patient ratios enable nurses to manage workloads and provide safe, high quality care. Prior to its introduction nurses were leaving the public health sector in their thousands because of unbearable workloads. The Secretary of the Victorian branch of the Australian Nursing Federation (ANF), Belinda Morieson, told the meeting: "The move is indefinite. The minimum mandated numbers as ordered by the Commission is the only way the Victorian public can be confident that nurses will be able to provide their legal duty of care to patients." "Nursing care is severely compromised in an understaffed ward. If additional patient admissions to a ward will result in a breach of the nurse-patient ratio, then the new admissions must be refused." Last year, in order to halt the exodus from nursing, the ANF included nurse-patient ratios in its enterprise bargaining claims. In its decision on August 31, 2000, the Commission awarded nurses nurse-patient ratios. In November, the ANF surveyed hospitals and established that prior to August 31 there were approximately 1300 funded nursing vacancies in the system. The ANF passed this information on to the Commission and the Victorian Hospitals' Industrial Association, representing hospital boards - - and the Department of Human Services, representing the government. The figure was accepted by all parties. In December, the Department of Human Services committed millions of dollars to a recruitment campaign which included the funding of refresher and re- entry programs for nurses who had left the profession, or were no longer working in the acute care area. These programs were very successful with close to 1500 nurses returning to nursing or transferring to acute areas. Then, in March this year the Department of Human Services advised that it wanted to cap the number of new positions so that it could project budget requirements. The ANF was sympathetic to this and following discussions the Commission issued a decision based on the following: * Fill the funded vacancies that existed prior to August 31, 2000 (1,300 equivalent full time); * Recruit 1300 new equivalent full time nursing positions which will be funded by the Department of Human Services; * Recruit an additional 400 equivalent full- time nurses for growth, including for new services. By June this year around 2300 additional nurses had been recruited. The main reason nurses returned to the public sector was that nurse-patient ratios enabled nurses to have some control over workloads, thus enabling them to provide proper patient care. The Department of Human Services then allocated funding for only 1300 new equivalent full-time positions (but not the 1300 funded vacancies) across the State. Meanwhile, in almost every hospital more nurses had been recruited to fill ratios than the allocated number, but the Department made no requirement for hospitals to fill vacancies first. The Commission determined that the 1300 plus the 400 would provide for the nurse-patient ratio and the ANF agreed to the "cap" on numbers as long as it was reasonable. Soon the reason the funded vacancies were passed over was revealed: the Department and the Victorian Hospitals' Industrial Association had earmarked the money for other areas of hospital funding i.e. management and the Department wanted the "flexibility" to use money from nursing budgets for other purposes. In July, the Commission ordered the ANF to accept this allocation of only 1300 equivalent full-time position as meeting the ratios. When the ANF pointed out that it was unable to do so because its membership had voted against accepting the allocation, the Commission withdrew the nurse-patient ratios and ordered the parties to make one last attempt to negotiate an agreement. The dispute was then referred to the full bench of the Commission. Members instructed the ANF to write a letter to Premier Steve Bracks to intervene, but no response was forthcoming. The ANF brought its planned stopwork meeting forward, from August 14 to August 9, the union observing, "As the Government has not been willing to meet the ANF and attempt to negotiate a mutually beneficial outcome, we can only conclude that the Government seems determined to have a major industrial dispute with Victorian nurses."