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Fears wording of new bill could result in fewer nurses in ICU
By Broede Carmody and Kieran Rooney
There could be fewer nurses in Victorian ICUs as an unintended consequence of how the government has phrased its incoming reforms, doctors and critical care specialists warn.
Three peak bodies say that the draft laws, already waved through the lower house, would not stop hospitals from cutting up to three senior nurses per day in the state’s largest ICUs compared to current industry standards. For a typical suburban ICU, the fear is that there could be one less nurse.
Victoria is planning to legislate nurse-to-patient ratios in intensive care wards for the first time. Credit: Justin McManus
The government is strengthening nurse-to-patient ratio laws by requiring, for the first time, ICUs to provide one nurse for every occupied bed. However, hospitals already do this, and many provide more senior support roles than what would be mandated.
The Australian College of Critical Care Nurses (ACCCN) and others say the problem is caused by the wording of the draft law, which could suggest that senior support nurses and team leaders are the same role.
Melbourne’s biggest hospitals typically have multiple senior support nurses in one ICU ward, including a team leader and what’s known as an “ACCESS” nurse. An ACCESS nurse supports less experienced colleagues and provides hands-on care as directed by the team leader, but this role is not named in the new bill.
ACCCN Victoria president Josh Allen said his members feared hospital management could argue that teams were overstaffed if the legislation did not specifically mention ACCESS nurses.
“We felt we couldn’t ignore those concerns and felt it was important to act now before the legislation made it through parliament to make sure that the Act does what it says,” Allen told The Age. “That is, provide for safer patient care.”
The draft law stipulates one team leader for every 10 occupied beds in large metropolitan hospitals. Allen wants this changed to “one team leader and one ACCESS nurse” for morning, afternoon and night shifts.
The ACCCN this week wrote to Labor MPs urging them to tweak the bill before it becomes law. The letter was co-signed by the College of Intensive Care Medicine of Australia and New Zealand as well as the Australian and New Zealand Intensive Care Society.
“Many nurse unit managers of intensive care units in Victoria have been in contact with us to express their confusion over the intent and language used in the proposed legislation,” the joint letter to MPs, seen by The Age, says.
“Their concerns [are about] the potential detrimental impact on staffing resources and, ultimately, safe patient care. Of note, many have highlighted the discrepancy between the ratios in the proposed legislation and the industry standards.”
An Allan government spokesperson said the bill was the result of extensive consultation, including with the Australian Nursing and Midwifery Federation, and was designed to give health services some flexibility if they had different service delivery models or ICU job titles.
“The bill does not stop health services from exceeding these minimums if this is their current practice,” the spokesperson said.
“There are currently no minimum prescribed staffing standards for stand-alone ICUs. Our bill will change this.
An Allan government spokesperson said the bill was the result of extensive consultation.Credit: Penny Stephens
“The only political party that is a threat to ratios and safer patient care is the Liberal Party, who tried to get rid of them the last time they were in government.”
The college of critical care nurses said neither the government nor the Health Department had directly consulted its organisation on the contents of the bill.
Hospitals were last year told to shore up their budgets for the first time since the COVID pandemic. Labor MPs are bracing for a difficult budget to be handed down this year.
Victoria’s net debt is forecast to reach $187.3 billion by 2028.
Opposition health spokeswoman Georgie Crozier said the draft law had created confusion for hardworking ICU nurses.
“The Allan Labor government is overseeing chaos and mismanagement in every area of government and health is no different,” Crozier said.
“Labor can’t manage money, can’t manage health and it’s Victorians who are paying the price.”
The bill was introduced to parliament late last month and could come before the upper house as soon as next week.
While hospitals already provide 1:1 ratios for ICUs, it will be the first time these ratios are mandated by law. Victoria has already mandated ratios of one nurse for every four beds during morning and afternoon shifts at the state’s largest general and surgical wards, and ratios of 1:8 for night shifts.
The latest changes would also increase the number of midwives working night shift and ensure an in-charge nurse on night duty in high dependency and coronary care units. The reforms would start coming into effect from July 1.
Labor committed to bolstering nurse-to-patient ratios in the leadup to the 2022 state election.
Earlier this month, the government was forced to fix an error in its own bill after the wrong figure was included on a new charge for the property industry.
The building industry legislation incorrectly said developers would be charged 3 per cent of an apartment building’s value to pay for a bond scheme use to fund defects, but the correct figure was 2 per cent.
The government was forced to move an amendment to fix the bill because it had already been read into parliament.
A Labor source, speaking on the condition of anonymity because they were not authorised to speak publicly, said there had been some “stupid” mistakes recently with the drafting of bills.
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