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Autumn 2003

Historic Agreement Reached on Hours per Patient Day Ratio

After months of negotiations and disputes in the Commission, Tasmanian nursing unions have reached an historic agreement with the State Government on the workloads benchmarks for nurses working in the public sector.

The number of nurse hours per patient day is to be determined according to a detailed schedule of patient diversity, complexity and nursing tasks required.

However, in general terms, the agreement states workload standards must be consistent with the Australian Nursing Council Code of Professional Conduct requirement and not adversely affect the rights, health or safety of the patient or client.

As well, the workload cannot be an unfair or unreasonable workload having regard to the skills, experience and classification of the employee.

The employer now has a duty to allocate and roster nurses in accordance with a process consistent with reasonable workload principles.

The agreed increase of 61 FTEs nurses is to be implemented as soon as practicable but no later than 12 months from the date of reaching this agreement.

The parties to the agreement have agreed as a principle to a staffing skill mix of 75% Registered Nurses to 25% Enrolled Nurses, where clinically appropriate.

This is a major win for HACSU members considering the State Government initially wanted the 61 FTE to all be ENs.

It has also been agreed that a 75/25 mix is not appropriate in some areas, for example in ICU, DEM and Neuro.

For the purpose of obtaining a settlement in these negotiations, it was agreed the percentage of enrolled nurses to registered nurses would not exceed 25% in any ward.

The skill mix of Enrolled Nurse to Registered Nurse on any given ward will be considered based on clinical appropriateness.

A range of wards and units have already been benchmarked, with the remaining areas to be completed soon. Discussions are continuing regarding benchmarking in areas such as palliative care, rural hospitals, and mental health.

The number of nurses required per patient day will be in accordance with the following key principles: clinical assessment of patient needs, the demands of the environment such as ward layout, statutory obligations including workplace safety and health legislation, the requirements of nurse regulatory legislation and professional standards and reasonable workloads.

The implementation of the NHPPD model by the employer is to be undertaken in a way that allows for ongoing consultation with HACSU members. An NHPPD Consultative Committee is to be established to oversee the implementation, monitoring and ongoing refinement of the NHPPD model at an Agency level.

A Workload Monitoring Committee (WMC) will be established at the Royal Hobart Hospital, the Launceston General Hospital and the North West Regional Hospital. The WMC will consist of equal union and employer representation and will look at nursing workloads generally (including outpatient clinics attached to inpatient wards), admissions, discharges and patient movements generally, including transfers and bed usage.

Significantly, as part of the agreement, the implementation of the NHPPD model, and any other mechanisms that may be in place to manage the workloads of nurses, must be made clearly visible to and readily understood by nurses at the ward or unit level.

A specific grievance procedure has been set out to resolve issues relating to nursing workloads. During the process of negotiating this agreement a number of anciliary matters have arisen.

Agreement has been reached on these matters, as follows.

To facilitate and maximise the Departments opportunities to recruit nurses, a new position of Nurse Recruitment Officer has been created within the Human Resource Services Branch.

Enrolled Nurses employed by the Agency or participating in a Department sponsored re-entry program who seek to undertake the Medication Package will have the cost of the package met by the Department.

The Department will undertake a survey of nurses on issues related to work and family life balance. This is aimed at identifying the barriers to nurses returning to the workforce or participating in it to a greater degree.

The Department will pursue the introduction of EN training in an accelerated training program. This training program is yet to be negotiated with OVET/TAFE and is subject to those negotiations.

EN trainee clinical placement hours and EN and RN re-entry clinical placement hours are not to be included in NHPPD model hours.

Refresher hours will initially be considered supernumerary and competence will be assessed individually by the Nurse Educator in consultation with the CNM as to whether clinical hours are included within the NHPPD hours.

The Agency is actively considering the possible role of Nurse Practitioners. The Agency Executive Committee of the Department has approved the establishment of a project management framework to examine nurse practitioners.

Re-entry training for ENs will be introduced, with intakes, placements and other organisational matters now agreed.

"HACSU's clear aim in these negotiations was to halt the spiralling increase in nursing workloads and responsibilities and the establishment of clear, understood and accepted standards. This is the most important step forward we have taken in this direction for decades." Chris Brown.