Nurse and midwife to patient ratios (NMTPR)

The Nurse and Midwife to Patient Ratios Act 2025 (the Act) applies to South Australian public hospitals and enshrines transparent minimum ratio protections for nurses and midwives on a shift-by-shift basis.

The legislation aims to strengthen patient care, safety, and staff wellbeing, while providing transparency and consistency in staffing, was developed following extensive consultation with the Australian Nursing and Midwifery Federation (ANMF) and modelled on comparative ratios in Victoria. The legislation does not apply to private hospitals or private aged care providers.

Under the legislation:

  • Adelaide’s four largest metropolitan hospitals (the Royal Adelaide Hospital, Flinders Medical Centre, Lyell McEwin Hospital, and Women’s and Children’s Hospital) must maintain one nurse for every four patients, along with a nurse in charge, in general medical and surgical wards during morning and afternoon shifts. For night shifts, the ratio is one nurse for every eight patients, with a nurse in charge.
  • Other hospitals across metropolitan Adelaide (including Modbury Hospital, Noarlunga Hospital and The Queen Elizabeth Hospital) must maintain the same ratios as above for morning and night shifts, and one nurse for every five patients, with a nurse in charge for afternoon shifts.
  • Larger regional general hospitals and Peri-Urban Health services, such as the Port Lincoln and Southern Fleurieu Health Services must maintain one nurse for every five patients with a nurse in charge for morning shifts and one nurse for every six patients with a nurse in charge for afternoon shifts. A night shift must maintain one nurse for every ten patients with a nurse in charge.
  • Small hospitals not categorised in the legislation must maintain at least one registered nurse and one other nurse or midwife on all shifts.
  • Certain patient care areas and specialist wards have their own specific minimum ratios. For example:
    • in a coronary care unit, the ratio is one nurse for every two patients and one for every three overnight, regardless which hospital they are in.
    • antenatal wards require one midwife for every four patients and one for every six patients overnight, across all public hospitals.
  • There is a process for determining staffing levels in mixed wards where more than one patient care area is present and more than one minimum ratio could apply.

Refer to the Quick facts (PDF 212KB) and Agreed Ratios for Local Health Networks (PDF 246KB) for more information on how the ratios apply across different hospital settings and shift times.

Next steps

There is a moratorium on non-compliance until 5 November 2027. During this period, no penalties for non-compliance apply.

The legislation requires Local Health Networks to act in good faith and take all reasonable measures to meet the legislated minimum ratios as soon as practicable.

Contact

The Act can be accessed and downloaded on the South Australian Legislation website.

Contact the Department for Health and Wellbeing at  health.nmtpratios@sa.gov.au.