Common use of SAFE STAFFING LEVELS Clause in Contracts

SAFE STAFFING LEVELS. 3.1.1 Health unit sites are to staff to meet patient/client demand according to the relevant indicators in the remainder of this clause and appendices 1 – 5. 3.1.2 As a minimum, staffing levels must be in accordance with the provisions of this clause and read in conjunction with the provisions of Appendix ▇, ▇▇▇▇▇▇▇▇ ▇, ▇▇▇▇▇▇▇▇ 3, Appendix 4 and Appendix 5. These appendices set out the details of minimum staffing arrangements for each relevant patient care area. These appendices (excluding Appendix 5) will apply unless further agreement is reached to vary them using the processes established by the Business Rules (refer to Appendix 13). 3.1.3 Health unit sites other than those listed at Appendix 2 are agreed as being minimum staffed health units; that is sites for which staffing levels and mix are unchanging from day to day or by time of the day. In these sites, a minimum of 1 registered nurse/midwife and 1 other nurse/midwife must be on duty at all times. These staff are in addition to the DON/M and the N/NUM roles. 3.1.4 DHW and ANMF have developed Business Rules that support the operation and review of this clause in all relevant patient care areas. The Nursing/Midwifery Hours per Patient Day (N/MHPPD) agreed staff ratios and staff plans as provided in Appendices 2 and 3 will only be amended by agreement of the parties, provided that the business rules are consistent with the provisions of this Agreement. Business Rules review after the commencement of this agreement will only be conducted if a party bound by the agreement can establish a prima facie case for material change. Material change means that staffing levels and/or mix are no longer safe nor appropriate for the type of patient care area to the extent that significant adjustment, by the addition or removal of at least one whole shift, is necessary. 3.1.5 Where the patient care area changes in its clinical/functional/service purpose or location, the parties are required to discuss the need for a Business Rules review. Such reviews will, after 1 January 2023, only take place where either or both parties can establish a prima facie case for material change, as defined in 3.1.4, to staffing arrangements. A mere change in function or location alone will not of itself necessitate a review. Rather the change must require adjustment to staffing levels and/or mix to ensure that they are both safe and appropriate to the new purpose. Where agreement is not reached, over the need for Business Rules reviews or where the review fails to produce an agreed outcome, the parties will have access to the dispute settlement procedures to resolve any disputes. 3.1.6 In patient care areas for which a ratio has been nominated as the measure for minimum staffing, the patient care area must maintain staffing to ensure the ratios are achieved for the period for which staffing is to be determined, rostered and allocated. 3.1.7 For all metropolitan health unit sites and Mt Gambier, Pt Augusta, Pt Pirie and Whyalla Hospitals the period within which the hours must be balanced is 14 days. 3.1.7.1 From 1 November 2023, the period within which the hours must be balanced is 7 days. 3.1.8 For all other regional units sites the period within which the hours must be balanced is 28 days. 3.1.8.1 From 1 March 2023, the period within which the hours must be balanced is 14 days. 3.1.8.2 From 1 November 2023, the period within which the hours must be balanced is 7 days. 3.1.9 The parties may enter into a further agreement to move to a shorter period for the balancing of hours (to a daily or shift basis). 3.1.10 In balancing hours within the relevant period, the health unit site must ensure that, as a minimum, all of the hours available for direct patient care are rostered and worked within the period at an individual ▇▇▇▇/unit level. In producing rosters for the relevant period the health site will include all direct patient care, project and other indirect hours. 3.1.11 The N/MUM (or equivalent) will, in consultation with their staff, allocate the direct care nursing/midwifery hours available for staffing across the relevant period in which they are to be balanced with due regard to expected care needs of patients/clients and the workload pattern of their patient care area. 3.1.12 The N/MUM (or equivalent) will ensure that, at the commencement of every shift, the occupancy and staffing information is displayed for staff within the patient care area: (i) Occupancy (number of beds that are occupied); (ii) Number of nursing/midwifery staff required to meet patient/client needs; and (iii) Agreed N/MHPPD averaged occupancy and indicative staff plan balanced over 14 days or 28 days (refer 3.1.7 and 3.1.8). 3.1.13 When, on a shift, the N/MUM (or equivalent) considers that patient care needs cannot be sufficiently met from the nurses/midwives immediately available and that additional hours should be provided in order to meet patient/client demand, the N/MUM (or equivalent) will consider solutions consistent with the business rules but which include options for action such as: (i) deployment of nurses/midwives from/to other wards/units; (ii) additional hours for part time staff; (iii) engagement of casual/agency nursing/midwifery staff; (iv) overtime; (v) prioritisation of nursing/midwifery activities on the ▇▇▇▇/unit; (vi) reallocation of patients. 3.1.14 Where sufficient nursing/midwifery staff are not available, the N/MUM (or equivalent) may, with approval from the Director of Nursing and Midwifery (or delegate) limit admissions when discharges occur from the patient care area. Such approval will not unreasonably be withheld. 3.1.15 The Chief Executive, Department for Health and Wellbeing is committed to making all reasonable efforts to engage additional Regional Nurse Educators (up to 16 FTE) across regional Local Health Networks. The Chief Executive will consult with the ANMF to develop a plan and timeframe for the recruitment to these positions by 30 June 2023.

SAFE STAFFING LEVELS. 3.1.1 Health unit sites are to staff to meet patient/client demand according to the relevant indicators in the remainder of this clause and appendices 1 – 5. 3.1.2 As a minimum, staffing levels must be in accordance with the provisions of this clause and read in conjunction with the provisions of Appendix ▇1, ▇▇▇▇▇▇▇▇ ▇Appendix 2, ▇▇▇▇▇▇▇▇ Appendix 3, Appendix 4 and Appendix 5. These appendices set out the details of minimum staffing arrangements for each relevant patient care area. These appendices (excluding Appendix 5) will apply unless further agreement is reached to vary them using the processes established by the Business Rules (refer to Appendix 13). 3.1.3 Health unit sites other than those listed at Appendix 2 are agreed as being minimum staffed health units; that is sites for which staffing levels and mix are unchanging from day to day or by time of the day. In these sites, a minimum of 1 registered nurse/midwife and 1 other nurse/midwife must be on duty at all times. These staff are in addition to the DON/M and the N/NUM roles. 3.1.4 DHW DHA and ANMF have developed Business Rules that support the operation and review of this clause in all relevant patient care areas. The Nursing/Midwifery Hours per Patient Day (N/MHPPD) agreed staff ratios and staff plans as provided in Appendices 2 and 3 will only be amended by agreement of the parties, provided that the business rules are consistent with the provisions of this Agreement. Business Rules review after the commencement of this agreement will only be conducted if a party bound by the agreement can establish a prima facie case for material change. Material change means that staffing levels and/or mix are no longer safe nor appropriate for the type of patient care area to the extent that significant adjustment, by the addition or removal of at least one whole shift, is necessary. 3.1.5 Where In applying the patient care area changes in its clinicalN/functional/service purpose or locationMHPPD, agreed staff ratios and staff plans where that is the parties are required to discuss nominated measure for minimum staffing, health unit sites will be consistent with the need for a application of the Business Rules review. Such reviews will, after 1 January 2023, only take place where either or both parties can establish a prima facie case for material change, as defined in 3.1.4, (refer to staffing arrangements. A mere change in function or location alone will not of itself necessitate a review. Rather the change must require adjustment to staffing levels and/or mix to ensure that they are both safe and appropriate to the new purpose. Where agreement is not reached, over the need for Business Rules reviews or where the review fails to produce an agreed outcome, the parties will have access to the dispute settlement procedures to resolve any disputesAppendix 13). 3.1.6 In patient care areas for which a ratio has been nominated as the measure for minimum staffing, the patient care area must maintain staffing to ensure the ratios are achieved for the period for which staffing is to be determined, rostered and allocated. 3.1.7 For all metropolitan health unit sites and Mt Gambier, Pt Augusta, Pt Pirie and Whyalla Hospitals the period within which the hours must be balanced is 14 days. 3.1.7.1 From 1 November 2023, the period within which the hours must be balanced is 7 days. 3.1.8 For all other regional country health units sites the period within which the hours must be balanced is 28 days. 3.1.8.1 From 1 March 20233.1.9 DHA/DCSI and ANMF may agree during the life of this Agreement to alter the staffing levels set out in appendices 1, 2, 3, 4 and 5 where: (i) there is a significant change to the period within patient population of the patient care area; or (ii) there are significant changes in practice, equipment or to models of care that may impact on the requirement for nursing/midwifery staff; or (iii) there are significant changes to the distribution of work across times of the day and/or days of the week; or (iv) there are any significant changes to the environment in which work is performed 3.1.9.1 Consultation with the hours must ANMF will be balanced is 14 daysinitiated by the health unit site to determine whether there should be adjustment, by agreement of the parties, to the stipulated N/MHPPD. In considering such matters the parties will have regard to efficient practice in other similar patient care areas or from areas which provide care to similar groups of clients/patients. 3.1.8.2 From 1 November 20233.1.9.2 The process will involve N/MHPPD allocation based on characteristics such as patient complexity and acuity, intervention levels, resource consumption, existing prescribed N/MHPPD for similar units and current efficient practices in SA Public Hospitals. The process will include: (i) Consultation with staff in the period within which determination of appropriate N/MHPPD (ii) Consultation with Nurse/Midwifery Unit Manager (N/MUM) and staff in the distribution of nursing/midwifery hours must be balanced is 7 days. 3.1.9 The parties may enter into a further agreement to move to a shorter period for over the balancing of hours (to a daily or shift basis).relevant period 3.1.10 In balancing hours within the relevant period, the health unit site must ensure that, as a minimum, all of the hours available for direct patient care are rostered and worked within the period at an individual ▇▇▇▇/unit level. In producing rosters for the relevant period the health site will include all direct patient care, project and other indirect hours. 3.1.11 The N/MUM (or equivalent) will, in consultation with their staff, allocate the direct care nursing/midwifery hours available for staffing across the relevant period in which they are to be balanced with due regard to expected care needs of patients/clients and the workload pattern of their patient care area. 3.1.12 The N/MUM (or equivalent) will ensure that, at the commencement of every shift, the occupancy and staffing information is displayed for staff within the patient care area: (i) Occupancy (number of beds that are occupied); (ii) Number of nursing/midwifery staff required to meet patient/client needs; and (iii) Agreed N/MHPPD averaged occupancy and indicative staff plan balanced over 14 days or 28 days (refer 3.1.7 and 3.1.8). 3.1.13 When, on a shift, the N/MUM (or equivalent) considers that patient care needs cannot be sufficiently met from the nurses/midwives immediately available and that additional hours should be provided in order to meet patient/client demand, the N/MUM (or equivalent) will consider solutions consistent with the business rules but which include options for action such as: (i) deployment of nurses/midwives from/to other wards/units; (ii) additional hours for part time staff; (iii) engagement of casual/agency nursing/midwifery staff; (iv) overtime; (v) prioritisation of nursing/midwifery activities on the ▇▇▇▇/unit; (vi) reallocation of patients. 3.1.14 Where sufficient nursing/midwifery staff are not available, the N/MUM (or equivalent) may, with approval from the Director of Nursing and Midwifery (or delegate) limit admissions when discharges occur from the patient care area. Such approval will not unreasonably be withheld. 3.1.15 The Chief Executive, Department for Health DHA and Wellbeing is committed to making all reasonable efforts to engage additional Regional Nurse Educators (up to 16 FTE) across regional Local Health Networks. The Chief Executive will consult with the ANMF have agreed to develop trial a revised N/MHPPD staffing model that supports visibility, transparency and accountability in the allocation of staff. (i) During the first 12 months of this Agreement, DHA and the ANMF will undertake a trial in a nominated health unit to evaluate the application of the proposed enhanced SA N/MHPPD Staffing Model of rounding to the nearest 0.25 increment of an hour. (ii) Subject to satisfactory evaluation of the trial outcomes, DHA and ANMF may agree to an implementation plan and timeframe for the recruitment transition to these positions by 30 June 2023the revised N/MHPPD Staffing Model over the life of this Agreement.