Nurses union, hospitals divided over nurse-ratio law delay

Taipei, May 11 (CNA) The Taiwan Nursing and Medical Industries Union and hospital associations voiced opposing views Monday over a proposal by Taiwan's top health official to delay mandatory nurse-to-patient ratios in Taiwan's hospitals by two years.

The dispute follows passage of amendments to the Medical Care Act Friday that codified into law three-shift nurse-to-patient ratios introduced by the Ministry of Health and Welfare (MOHW) in 2024, with violators facing fines or even a suspension of operations.

The amendments, however, did not specify when the new laws would be enforced, leading Health Minister Shih Chung-liang (石崇良) to announce Friday that the new regulations would take effect on May 1, 2028.

Union criticizes delay

The nursing union on Monday echoed criticisms of the proposal raised Saturday by unions at six hospitals, saying the delay showed the ministry was protecting hospital management interests, and it accused Shih of dereliction of duty.

Union consultant, Chen Yu-feng (陳玉鳳), filed an appeal with the Control Yuan, the government body responsible for investigating and censuring public servant or public agency wrongdoing, to determine if Shih was guilty of misconduct or dereliction of duty.

Chen said the issue of nurse-to-patient ratios has been discussed in the Legislative Yuan since 2018, but no meaningful improvements have been made despite repeated MOHW pledges to address the issue.

Chen said the union also plans to file a complaint with prosecutors.

In their statement Saturday, the unions from the six hospitals said the plan be accelerated rather than delayed, given that the central government has already spent tens of billions of Taiwan dollars in taxpayer funds to subsidize hospital labor costs.

They further criticized the lack of auditing mechanisms for data submitted by hospitals and accused the MOHW of repeatedly dismissing concerns raised by nurses on the hospitals' front lines.

Hospitals back the MOHW

Taiwan's hospitals disagreed with the union position.

Seven hospital associations issued a joint statement Monday expressing concern over calls by "some groups" for immediate implementation of the requirements, saying the two-year grace period was essential to ensuring a smooth transition.

The statement was signed by the Taiwan Hospital Association, Taiwan Nongovernmental Hospitals and Clinics Association, Taiwan College of Healthcare Executives, Taiwan Medical Center Association, Taiwan Regional Hospital Association, Taiwan Community Hospital Association and Taiwan Medical Juristic Persons Association.

The groups said more than 30 percent of medical institutions in Taiwan are still unable to meet the required nurse-to-patient ratios, and warned that immediate enforcement could result in heavy fines or even suspension of operations for repeated violations.

They argued in the statement that hospitals might actually resort to reducing their number of hospital beds to avoid penalties at a time when medical centers and regional hospitals are already facing shortages of available emergency room beds.

The associations also said newly hired nursing staff require at least three to six months of clinical training, and the grace period would help ensure that nurses entering clinical settings would have the capabilities needed to do the job.

The grace period would not be simply an idle transition period, the groups said, but rather an opportunity to accelerate recruitment and retention efforts, strengthen training programs, and promote smart healthcare.

Health minister responds

Also on Monday, Shih echoed concerns that immediate enforcement could lead hospitals to remove beds in order to meet staffing requirements.

He said incentives encouraging hospitals to meet the ratios have been in place since 2024, with compliance rates rising from around 30 percent initially to about 70 percent by the second half of 2025.

Some smaller local and regional hospitals, however, have had to remove beds to meet the standards, he said.

Shih added that during the two-year grace period, the ministry would continue implementing measures aimed at retaining nursing staff, including providing night-shift allowances.

On concerns over inflated staffing data reported by hospitals, Shih said the ministry has established auditing mechanisms through national health insurance reporting systems to verify compliance and ensure incentive measures are properly implemented.

Under the MOHW's 2024 standards, three-shift nurse-to-patient target ratios at medical centers are set at 1:6 for day shifts, 1:9 for evening shifts and 1:11 for night shifts.

Regional hospitals are required to maintain ratios of 1:7, 1:11 and 1:13 respectively, while district hospitals must meet ratios of 1:10, 1:13 and 1:15.

Before the amendments were passed, hospitals meeting the standards were eligible for incentive payments, but there was no legal basis to impose penalties on institutions that failed to comply.