Sat, Jun 06, 2026 page8

• The nurses are starting to flee

  • By Lu Chun-wei 盧俊瑋
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  The bringing forward of new mandates for nurse-to-patient ratios to be enacted in May next year should represent a turning point for the chronically overstretched profession.

  However, not long after the legislation’s fast-tracking was announced, a number of leading medical centers began floating the idea of “same-day surgeries,” which would see some patients being sent home instead of being kept for an overnight stay in the hospital. This should be a reminder for us to keep interrogating why we continue to insist on treating the symptoms, not the cause, of the healthcare system’s most fundamental problems?

  Undeniably, there is a place for same-day surgeries, especially given improvements in anesthesia safety, minimally invasive procedures and post-operative care. However, patients have traditionally been kept for observation to manage pain, monitor bleeding or infection risks and track vital signs. If these patients are instead sent home, there must be clear and transparent screening standards, ER return and hospital readmission data, side-effect monitoring mechanisms and post-discharge care. Otherwise, the initiative would simply shift pressure from hospital wards to ERs, clinics, families and patients themselves.

  It is a prime example of what I have called “chessboard governance.” Government policy mandates safer nurse-to-patient ratios, and hospitals respond by introducing same-day surgeries, replacing in-ward observation with ER-administered antibiotics, clinic follow-ups and home-based care. On the surface, occupied beds fall and nurse-to-patient ratios improve. In reality, care needs remain.

  Healthcare policy is no stranger to this governing logic. Government designated Urgent Care Centers for weekends and public holidays are another example. Policymakers assumed that setting up a few service points and staffing schedules could ease ER overcrowding, but failed to address the deeper structural issues of bed shortages, nursing staff losses and disconnect between the long-term care and social welfare systems. It was essentially adding another chess piece to the board, but without formulating a strategy for addressing the root causes of ER congestion.

  What nurse-to-patient ratio legislation should really address is why nurses are leaving hospital wards, why they are unwilling to stay on night shifts, and why pay, risk and responsibility have remained out of proportion for so long.

  If healthcare authorities only require hospitals to meet targets without investing sufficient resources to improve working conditions, increase staffing and reduce unnecessary administrative burdens, hospitals would naturally develop their own coping strategies. The likely outcome might be shorter hospital stays, faster discharges, more patients returning to emergency departments and greater caregiving anxiety shifted onto families.

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  Lu Chun-wei is a dermatologist and assistant professor at Chang Gung Memorial Hospital.

  Translated by Gilda Knox Streader
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