Hospital and Health Boards (Safe Nurse-to-Patient and Midwife-to-Patient Ratios) Amendment Bill 2015

As Health Minister, introduced and championed the bill, citing extensive international research demonstrating that higher nurse-to-patient ratios reduce patient mortality and improve outcomes, and argued the minimum ratios would work in conjunction with the business planning framework.

“Through this legislation, patients can be assured that they will receive a transparent and reliable level of service from the state's public health system and nurses can be assured of more manageable and safer workloads and increased job satisfaction.”— 2016-05-12View Hansard

As shadow health minister, opposed the bill's mandatory fixed minimum ratios as a one-size-fits-all approach lacking sufficient research evidence, arguing the existing business planning framework should instead be elevated from an industrial to a legislative instrument.

“We on this side of the House cannot support a bill that will mandate a prescriptive statewide ratio that will result in a one-size-fits-all approach.”— 2016-05-12View Hansard

As committee chair, strongly supported the bill based on 20 years of international research and testimony from nurses at public hearings in Brisbane, Cairns, Townsville and Gladstone about the human cost of inadequate staffing.

“Each additional patient added to a nurse's workload is associated with a seven per cent increase in the likelihood of death within 30 days of admission.”— 2016-05-12View Hansard

As a former executive director of medical services and committee member, opposed mandatory minimum ratios as a blunt stick approach that ignores patient acuity, ward layout, staff experience and individual clinical needs, arguing the Queensland approach lacked the flexibility of even the Victorian model.

“Mandatory minimum ratios are a blunt stick approach to staffing which do not recognise allocation of staffing based on patient acuity, the individual patient's acute condition and comorbidities, and the patient's continuum of care needs.”— 2016-05-12View Hansard

As a registered nurse of nearly three decades, passionately supported the bill, providing a detailed account of a typical nursing shift and arguing that research unequivocally demonstrates ratios save lives by reducing nurse-sensitive adverse outcomes.

“If a nurse has to look after 10 patients your chances of falling over, becoming constipated, developing a pressure sore, becoming delirious or developing pneumonia all increase—not because the nurses are bad at their job: just because there are not enough of them.”— 2016-05-12View Hansard

As a registered nurse and committee member, opposed the bill due to insufficient evidence, incomplete data modelling, potentially unknown implementation costs, and a lack of consultation transparency, arguing the existing business planning framework had not been proven ineffective.

“Unfortunately, there can be no certainty that a legislative requirement to fix nurse-to-patient and midwife-to-patient ratios is necessary to achieve what we set out to do—that is, deliver better outcomes for nurses and better health outcomes for patients.”— 2016-05-12View Hansard

As a former paramedic and committee member, supported the bill based on extensive international research and testimony from nurses across regional Queensland who described fatigue, stress and being unable to provide the quality of care patients deserve.

“In Townsville, the nurses' clear compassion and caring nature was tangible when a nurse broke down for not being able to be with a mother and her newborn owing to the many others in the ward.”— 2016-05-12View Hansard

As a former committee member, acknowledged the importance of adequate staffing but opposed legislated ratios as unnecessary given the existing business planning framework, arguing the government had not provided data to prove the effectiveness of the specific ratios and that the bill was driven by union demands rather than clinical evidence.

“Although I acknowledge the critical role of nurses and midwives in ensuring positive health outcomes for Queenslanders and although I acknowledge the importance of adequate nurse staffing levels, I cannot support this bill in its current form.”— 2016-05-12View Hansard

Supported the bill drawing on her experience as the daughter of a nurse, as a former representative of health workers in negotiations, and as a patient, arguing that good faith and goodwill without mandated ratios were insufficient.

“As long as you do not have a commitment to legislated mandated ratios and workload provisions, good faith, goodwill and good governance frankly do not amount to much during a nurse's or midwife's shift.”— 2016-05-12View Hansard

As former shadow health minister, opposed the bill arguing the government had failed to substantiate the specific ratio with clinical evidence, noting the data modelling was based on occupancy rather than patient acuity and that only California had mandated minimum ratios in the US.

“If we do not know the basis from which we are beginning, how do we calculate the ratio that the government is asking us to agree to?”— 2016-05-12View Hansard

Supported the bill as delivering three important things for nurses: minimum ratios, nurse navigators, and nursing graduate positions, arguing that the evidence base for improved patient safety was clear.

“To those nurses everywhere who were sacked, or whose friends were sacked, or who have had to work in the most difficult circumstances, or who suffered an indignity as a result of the Campbell Newman government, I say that this bill is for you.”— 2016-05-12View Hansard

Proudly supported the bill, sharing personal stories about his mother's nursing career and his daughter's work as an RN, and commending the Queensland Nurses' Union for their years of advocacy.

“What is a nurse? By definition, a nurse is a person who is trained to give care to people who are sick and injured. Nurses are our No. 1 most trusted profession.”— 2016-05-12View Hansard

As Deputy Premier, supported the bill as a rock-solid example of the Labor Party, the trade union movement and front-line workers coming together to deliver significant health policy reform.

“This is a rock-solid example of where the Australian Labor Party together with a trade union and front-line workers have come together to guarantee a significant reform in terms of health policy in this state.”— 2016-05-12View Hansard

Supported the bill as part of Labor's longstanding commitment to better health services, citing the California experience where Governor Schwarzenegger's attempt to block nurse ratios was defeated.

“This bill should be seen as part of Labor's longstanding commitment over the last decade to deliver better health services to Queensland.”— 2016-05-12View Hansard

As Minister for Employment and a former Queensland Nurses' Union employee, strongly supported the bill as an historic moment, arguing there was irrefutable evidence that staffing numbers directly affect patient safety.

“There is irrefutable evidence that staffing numbers, skill mix and the work environment directly affect the safety and quality performance of health services. There is no available evidence to suggest ratios do not improve patient safety.”— 2016-05-12View Hansard

Supported the bill, sharing her experience from the 2014 Redcliffe by-election meeting nurses who had lost their jobs under the previous government.

“It is not that complicated: if you reduce the ratio of patients to nurses then you are going to get greater care. It is that simple, and that is what this bill seeks to do.”— 2016-05-12View Hansard

As Premier, spoke passionately about the bill as a major election commitment delivered on International Nurses Day, sharing stories of nurses she met across the state who were devastated by job losses under the previous government.

“Queensland becomes only the fourth jurisdiction to implement nurse-to-patient ratios in the world. Many people in this House will remember this moment for many years to come.”— 2016-05-12View Hansard