Nurse-to-patient ratios to take effect March 1; groups skeptical

Taipei, Jan. 27 (CNA) New standards for nurse-to-patient ratios in local hospitals for different shifts, supported by a "12-point incentive program," will take effect on March 1, but a nurses' union and hospital association were skeptical that the initiative will work.

The incentive program, which was approved by the Cabinet in September 2023, was aimed at dealing with an acute shortage of nurses by providing higher salaries and a sound environment to give them more incentives to work.

Though the program was supposed to take effect earlier in January, and the incentives have been distributed since the beginning of the month, details on the plan's nurse-to-patient ratios were not confirmed publicly until Friday.

Speaking at a press conference held by the Ministry of Health and Welfare, Health Minister Hsueh Jui-yuan (薛瑞元) said the new regulation will stipulate different ratios for different medical institutions.

For the highest level medical centers, the standards for nurse-to-patient ratios will be 1:6 for the day shift, 1:9 for the evening shift and 1:11 for the midnight shift, Hsueh said.

The average ratio for medical centers before the plan was initiated was 1:9.

For regional hospitals, the ratios will be 1:7 for the day shift, 1:11 for the evening shift and 1:13 for the midnight shift, while for district hospitals the ratios will be 1:10, 1:13 and 1:15, Hsueh said.

The average ratios for regional and district hospitals before the plan was initiated were 1:12 and 1:15, respectively, indicating that they have more ground to cover to reach the new nurse-to-patient standards.

According to Health Ministry data, there are about 310,000 registered professional nurses in Taiwan, but as of the end of December last year, only 61.3 percent of them, or 190,024, were working.

National Health Insurance Administration (NHIA) Director-General Shih Chung-liang (石崇良) said nurses working night shifts will earn an extra NT$6,400 (US$205) to NT$21,000 per month, and the government is hoping the higher pay levels will draw some of the inactive nurses back to the workplace.

Hsueh said having the ratios not take effect until March was meant to encourage hospitals to meet the new standards before they take effect.

Starting March 1, however, institutions that fail to meet the new standard will be disciplined, Hsueh warned.

People in the sector had their doubts over the plan's timetable and potential success.

Hung Tzu-jen (洪子仁), head of the Taiwan College of Healthcare Executive and deputy superintended of Shin Kong Wu Ho-Su Memorial Hospital, agreed that lowering the number of patients per nurse would improve the quality of care, but he felt most hospitals would initially have a hard time meeting the standard.

Cheng Yu-feng (陳玉鳳), head of the Taiwan Union of Nurses Association, said that despite the new standards, workloads will still be too heavy for nurses, and a workforce gap of around 7,500 nurses could still be expected even after the program took effect.

If the health ministry only distributes a night shift bonus, it might improve one part of the problem, Chen said, but the program is not attractive enough for most nurses and might even lead them to quit their jobs because they feel they are not being treated properly.

According to the Health Ministry, the night-shift bonus scheme, which the government has already begun to implement, will cost about NT$4 billion this year.

Nurses will receive an extra NT$400-NT$600 per shift for evening shifts and NT$600-NT$1,000 per shift for midnight shifts, with the amounts determined by the type of hospital they work at.

Hsueh said the government will further discuss the incentives with medical rights groups so that the increases in pay can be distributed not only to nurses working night shifts but also to any nurses with heavy workloads in any type of hospital.

Chu Yi-hung (朱益宏), head of the Taiwan Community Hospital Association, questioned the night shift incentives, especially given that nurses in different types of hospitals would receive different amounts under the plan.

Chu said nurses in district hospitals will be given the lowest bonuses under the plan even though they usually have to deal with the most patients per nurse.

That could result in an even more acute nursing shortage at district hospitals, Chu said, because nurses will be drawn to hospitals that offer better incentives and where the nurse-to-patient ratios are more favorable.