Nurse and midwife to patient ratios (NMTP ratios)

On 2 September 2025, the State Government introduced legislation to mandate nursing and midwifery staffing ratios across South Australian public hospitals.

The proposed new laws will be introduced to Parliament following extensive consultation with the Australian Nursing and Midwifery Federation (ANMF).

They ensure the nurse-and-midwife-to-patient ratio meets the requirements of differing patient care areas across nursing and midwifery shifts.

The new South Australian ratios have been modelled on ratios in Victoria and prioritise both patient care and safety, and staff wellbeing.

Example of how the ratios will work under the proposed new laws

For example, under the laws:

• Adelaide’s four largest metropolitan hospitals (the Royal Adelaide Hospital, Flinders Medical Centre, Lyell McEwin Hospital, and Women’s and Children’s Hospital) will be required to have 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, it will be 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) will be required to have 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.
• Large regional general hospitals and Peri-Urban Health services, such as the Port Lincoln and Southern Fleurieu Health Services will require 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 will require one nurse for every ten patients with a nurse in charge.
• Small hospitals which are not categorised in the legislation must be staffed with at least 1 registered nurse and 1 other nurse or midwife on all shifts.
  
• In a coronary care unit, the ratio will become one nurse for every two patients and one for every three overnight, regardless which hospital they are in.
• An antenatal ward will require one midwife for every four patients and one for every six patients overnight, across all public hospitals.
• The ratios legislation provides the minimum number of nurses or midwives required for any given shift.
  

Next steps

It’s hoped the bill will pass through the Parliament and be enacted as legislation before the end of 2025, with commencement early in 2026.

The legislation will cover specified patient care areas in the public health system. It will not apply to private hospitals or private aged care providers.

Planning for implementing the ratios has already begun. SA Health is working closely with internal and external stakeholders, including the ANMF.

There will be a two-year rollout period to allow local health networks to reconfigure staffing and recruit where required.

During that time, there will be a moratorium on non-compliance. At the end of that two-year period, any deliberate or systematic breaches of the legislation as determined by the South Australian Employment Tribunal could attract a fine of up to $10,000.

Contact

If you have any questions, contact the Strategic Industrial Relations and Policy Unit, Workforce, Department for Health and Wellbeing by email at health.nmtpratios@sa.gov.au.