Nurse-to-patient ratios could be introduced across the health system as Health NZ confirms 380 extra frontline nursing and support roles after an annual staffing calculation.
The agency is developing a business case to assess how ratios, alongside other staffing models, could be applied. International evidence had shown ratios can improve patient safety, quality of care and staff wellbeing.
Speaking at Auckland's North Shore Hospital on Friday, Health NZ national chief nurse Nadine Gray said nurses had called for change.
"As part of our recent settlement with our nursing partners, we committed to explore this together and we're moving on that," she said.
No decision on ratios has been made. The business case is expected to be completed next year and will inform any future decisions on implementation.
Health Minister Simeon Brown welcomed the work.
"This is a key evidence-based step to making sure our patients get the quality care they need, and that our nurses feel supported to deliver it," he said in a statement to 1News.
"The way we currently calculate nursing staffing has been in place for 20 years, and it no longer reflects the needs of patients or the realities nurses face on the ward and in the community."
Winter pressure
Health NZ will add 380 full-time equivalent (FTE) nursing, midwifery and health care assistant roles this financial year. The South Island will get 149 FTE, the Northern region 120, the Central region 76 and the Midland region 32.
"Hospitals have experienced significant demand throughout winter, including sustained pressure on emergency departments and inpatient services," Gray said.
"Emergency departments have continued to experience high demand, which is why we're investing in 94 additional positions, largely nurses, to better support patients and the staff caring for them."
The extra roles came out of Health NZ's annual Care Capacity Demand Management (CCDM) staffing calculations, the system used to set nursing numbers for the past 20 years.
Current system under review
An independent review earlier this year identified problems with the consistency, quality and reliability of the data used in CCDM. It found the approach did not suit every care setting, and that district nursing, community mental health and outpatient services had no nationally agreed method for setting annual staffing levels.
Gray said CCDM had supported planning in many inpatient settings but could be "complex, resource-intensive, and difficult to apply across a large and diverse health system".
Health NZ has since agreed with the New Zealand Nurses Organisation (NZNO) and the Public Service Association (PSA) to evaluate the best way to calculate staffing across different clinical settings.
"We are looking at a range of approaches used internationally, it's clear there's no one-size-fits-all staffing model," Gray said.
"Different services have different needs, and what works well in an inpatient ward may not be the best approach for community mental health or perioperative services."
Brown said the work would "help make sure we have the right nurses, in the right places, to care for New Zealanders".
As well as ratios, which set a minimum number of nurses per patient, such as one nurse for every four patients, Health NZ will consider models based on nursing hours per patient each day and on measured patient acuity.
The business case will also examine workforce supply and how services are delivered. It is part of Health NZ's Nursing Workforce Safety and Sustainability Programme.
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