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Crunching the numbers on nursing

ECU’s research in nurse staffing levels is having real world impacts.

Establishing the right nurse-to-patient ratio is the difference between life and death.

This is the powerful finding of ECU research that continues to influence nursing policy and legislation across Australia, and on the other side of the world.

Research aligned with health systems

The ECU Centre for Nursing, Midwifery and Health Services Research works closely with nurses, hospitals, health administrators, and government to translate its findings into safer, higher quality healthcare.

One of the Centre’s major bodies of work has been to determine the relationship between nurse staffing (the number and skill mix of nurses), and direct patient outcomes.

This analysis demonstrates that as the patient load per nurse increases, so does in-hospital mortality.

The research also examined other factors including: the impact of adding nursing support workers, the costs and consequences of nursing turnover, and the factors impacting on nurses’ health.

Informing policy

Professor Christine Duffield and Professor Diane Twigg have led this research since 2009, and were invited to provide expert opinion at Fair Work Australia, which informed the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015.

ECU research was cited by the Queensland Nurses and Midwives’ Union in their successful “Ratios Save Lives” campaign.

As a result, in 2016 the Queensland Government introduced minimum nursing staffing levels in medical and surgical wards. In Victoria, NSW, and Western Australia, the findings have informed wage negotiations and industrial agreements.

Advised by the ECU evidence, the Irish Government has also implemented its own national nurse workload monitoring system.

“The evidence base Professors Twigg and Duffield have provided on nurse staffing and patient outcomes has been critical to our strategic goal of a richer registered nurse skill mix, which we have achieved,” said Sue Davis, Nurse Director at WA’s Sir Charles Gairdner Hospital.

Important acknowledgement

In recognition of their expertise, Professors Duffield and Twigg both hold multiple senior external appointments.

In 2016, Professor Duffield was elected President and Chair of the Australian College of Nursing Board. Professor Twigg has served on the National Nursing and Midwifery Expert Advisory Network, the National Health Performance Authority, and Health Workforce Australia.

These roles allow their research outcomes to be shared directly with health administrators and practitioners.

The findings have been published widely in top journals including Nursing Economics, International Journal of Nursing Studies, Australian Health Review, Journal of Advanced Nursing, and Applied Nursing Research.

In addition to improved patient outcomes, the research has shown that a higher nurse-to-patient ratio increases efficiency, and provides greater return on investment.

ECU nursing researchers regularly provide advice to Australian and state and territory governments and agencies on a range of related issues including: use of specialist nurse positions, models of care, and aspects of the work environment that are linked to improved patient outcomes.

For further information contact Professor Di Twigg.


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