Lai brings forward nurse-to-patient ratio law to 2027

Taipei, May 12 (CNA) President Lai Ching-te (賴清德) said Tuesday that the law mandating nurse-to-patient ratios will take effect on May 20, 2027, not May 21, 2028, as announced on Friday by Health Minister Shih Chung-liang (石崇良).

Lai made the announcement at an International Nurses Day event on Tuesday, saying the policy will be "implemented in phases" in the hope of accelerating improvements in nurses' working conditions and the quality of patient care.

Lai's speech was met with applause from nursing personnel attending the event.

He did not elaborate on what phased implementation would entail.

Health minister's response

Speaking to reporters after the event, Shih said the nurse shortage is a longstanding issue that cannot be resolved immediately, particularly in small hospitals and those in remote areas, and that these two factors need to be taken into account.

Taking acute-care beds as an example, Shih said the shortage was estimated at 3,000 to 5,000 across all levels of hospitals needed to meet the mandatory nurse-to-patient ratios.

With an additional 4,900 nurses entering practice in March compared with the same period last year, about half of whom work with acute-care beds, Shih said the shortfall of 3,000 could be addressed next year.

Bringing forward the implementation of the nurse-to-patient ratio law by one year would require complementary measures to recruit and retain nurses to comply with the ratios, particularly in small and remote hospitals, Shih added.

Target nurse-to-patient ratios

Taiwan has long faced concerns of nurses being overworked due to the sheer number of patients.

In 2024, the Ministry of Health and Welfare (MOHW) issued an administrative order setting three-shift nurse-to-patient ratios to address the problem, but the policy did not contain any enforcement penalties for noncompliance.

Under the MOHW's 2024 standards, three-shift nurse-to-patient target ratios at medical centers were 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.

About 70 percent of hospitals met the ratios in the second half of 2025, up from 50 percent in the first half of the year, according to the ministry.

Unions' voices

On Friday, the Legislature passed amendments to the Medical Care Act, making nurse-to-patient ratios a legal requirement. The initial standards will mirror those set by the MOHW in 2024, and the ministry will review them every three years.

Under the amendments, hospitals that fail to make improvements after three penalties could face fines or suspension of operations for up to one year.

After the amendments passed, Shih said the new rules would not take effect until May 1, 2028, following discussions with representatives from nursing groups, the medical community and other stakeholders that lasted 3.5 hours.

Nursing groups had hoped the policy would take effect on Dec. 31, 2027, and, together with medical unions, issued a statement on Monday protesting the ministry, arguing that the May 1, 2028 timeline favored hospital management interests.

Defending the 2028 timeline on Monday, Shih said that immediate enforcement of the staffing ratios could prompt hospitals to reduce bed capacity in order to comply with the requirements, adding that increases in nursing manpower cannot be achieved overnight.

Policy discussion

On Monday, Kuomintang (KMT) Legislator Wang Yu-min (王育敏) said Lai had promised in 2023 to legislate nurse-to-patient ratios within two years, and that a May 1, 2028 implementation would amount to a broken pledge before the January 2028 presidential election.

Asked by reporters on Monday to comment on the 2028 timeline, Taipei Veterans General Hospital Superintendent Chen Wei-ming (陳威明) said the government should be given sufficient time to implement the policy.

Given the nurse shortage, Chen said that if strict penalties were imposed immediately, hospitals might become reluctant to admit patients -- especially during an epidemic -- potentially leading to patients being bounced between facilities.

On Tuesday, Premier Cho Jung-tai (卓榮泰) said the government and medical and nursing groups will study supporting measures following the enactment of the nurse-to-patient ratios into law, to ensure healthcare system sustainability and better protect public health.