The Ministry of Health and Welfare last week announced a new system of three work shifts with specific nurse-to-patient ratio targets. The ministry has earmarked a budget of NT$4 billion (US$128 million) to reduce the ratio of nurses to patients, which would help to improve the quality of care for inpatients and reduce the number of in-hospital deaths.
Given the nation’s shortfall of more than 7,000 nurses in all categories of hospitals, this advancement in the policy of three shifts with specified nurse-to-patient ratios is definitely welcome.
With regard to the new system’s nurse-to-patient ratio, official data show that, apart from district hospitals, relatively more of which can reach the target ratios, hospitals in the other two categories, namely medical centers and regional hospitals, currently face a shortfall of about 3,400 nurses.
In the case of regional hospitals, nationwide they are about 50 percent short of meeting the standard nurse-to-patient ratios for all three shifts. If they cannot recruit enough nurses to meet the target ratios, they might be forced to meet them by reducing the number of beds instead.
As for the ministry assigning night-shift bonuses, some critics question why district hospitals’ bonuses are the lowest although their nurse-to-patient ratios are the best.
To be specific, the ministry’s standard ratios for medical centers are one nurse to nine patients for the evening shift and one to 11 for the night shift; for regional hospitals, they are one to 11 for the evening shift and one to 13 for the night shift; and for district hospitals, they are one to 13 for the evening shift and one to 15 for the night shift.
Critics said that in all three cases nurses have to sacrifice their sleeping hours, so why should district hospital nurses be paid lower bonuses? Does this not go against the principle of equal pay for equal work?
The equal pay for equal work principle should also include different risks and stress factors. Nurses working night shifts at medical centers often have to deal with patients needing urgent intervention. The risks and stress levels for nurses working night shifts in different categories of hospitals are different, so paying them different bonuses complies with the principle of equal pay for equal work.
For a long-term solution, the National Health Insurance’s budget should be gradually increased. With regard to budget allocation, there should be a guaranteed point value of 0.95 or more. Hospitals’ management and operations should be strengthened. Nurses’ wages and conditions need to be improved to attract more people to join the profession and thoroughly resolve the existing shortage.
Yeh Yu-cheng is a secretary at the Pingtung Public Health Bureau.
Translated by Julian Clegg
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