{"id":"sr:safe-patient-care-nurse-patient-and-midwife-patient-ratios-regulations","name":"Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015","slug":"safe-patient-care-nurse-to-patient-and-midwife-to-patient-ratios-regulations-2015","collection":"regulation","jurisdiction":"vic","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":183540,"registerId":"vic-sr:safe-patient-care-nurse-patient-and-midwife-patient-ratios-regulations-current","compilationNumber":null,"startDate":"2026-04-05","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015","content":"Version No. 003\n\n**Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015**\n\n**S.R. No. 169/2015**\n\nVersion incorporating amendments as at  \n9 December 2025\n\n**TABLE OF PROVISIONS**\n\n*Regulation Page*\n\nPart 1—Preliminary 1\n\n1 Objective 1\n\n2 Authorising provision 2\n\n3 Commencement 2\n\n4 Definition 2\n\nPart 2—Nurse to patient and midwife to patient ratios 3\n\n5 Criteria for reducing or increasing number of nurses staffing an operating theatre 3\n\n5A Criteria for increasing number of nurses or midwives staffing a special care nursery above minimum 3\n\n5B Criteria for increasing number of nurses staffing a neonatal intensive care unit above minimum 4\n\n5C Postnatal wards 4\n\n6 Considerations applicable to a proposal to vary a ratio 5\n\n10 Local agreements 5\n\nPart 3—Enforcement 7\n\n11 Local dispute resolution 7\n\n12 Failure to resolve a dispute and referral to Magistrates' Court 8\n\n═══════════════\n\nEndnotes 9\n\n1 General information 9\n\n2 Table of Amendments 11\n\n3 Explanatory details 12\n\n**Version No.** **003**\n\n**Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015**\n\n**S.R. No. 169/2015**\n\nVersion incorporating amendments as at  \n9 December 2025\n\nPart 1—Preliminary\n\nReg. 1 substituted by S.R. No. 15/2019 reg. 5.\n\n\t1 Objective\n\nThe objective of these Regulations is to make further provision for safe patient care in hospitals by—\n\n(a) specifying criteria in accordance with which the number of nurses or midwives, as the case requires, with whom specified wards are staffed—\n\n(i) may be reduced or increased, in the case of an operating theatre; or\n\n(ii) may be increased above the minimum required, in the case of a special care nursery or neonatal intensive care unit; and\n\n(b) setting out procedures in accordance with which—\n\n(i) an agreement to vary a ratio or the application of a rounding method under section 12 of the **Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015** may be made; and\n\n(ii) a local dispute must be resolved; and\n\n(c) prescribing other matters to give effect to the **Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015**.\n\n\t2 Authorising provision\n\nThese Regulations are made under section 45 of the **Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015**.\n\n\t3 Commencement\n\nThese Regulations come into operation on 23 December 2015.\n\n\t4 Definition\n\nIn these Regulations—\n\n***the Act***  means the **Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015**.\n\nPart 2—Nurse to patient and midwife to patient ratios\n\n\t5 Criteria for reducing or increasing number of nurses staffing an operating theatre\n\nFor the purposes of section 25(2) of the Act, the following criteria are prescribed—\n\n(a) the complexity of the surgical procedure;\n\n(b) the pre-existing condition of the patient;\n\n(c) the number of operations on the list for the operating theatre;\n\n(d) the experience and skill mix of staff;\n\n(e) the type of equipment used;\n\n(f) the number of students requiring supervision;\n\n(g) the layout of the operating theatre and the and number of operating theatres in the suite;\n\n(h) temporary fluctuations in demand across the whole theatre suite during an operating theatre session.\n\nReg. 5A inserted by S.R. No. 15/2019 reg. 6.\n\n\t5A Criteria for increasing number of nurses or midwives staffing a special care nursery above minimum\n\nFor the purposes of section 27(4)(a) and (b) of the Act, the following criteria are prescribed—\n\n(a) the conditions of the infants in the special care nursery;\n\n(b) the level of care required by the infants in the special care nursery;\n\n(c) the experience and skill mix of staff;\n\n(d) the number of students requiring supervision.\n\nReg. 5B inserted by S.R. No. 15/2019 reg. 6.\n\n\t5B Criteria for increasing number of nurses staffing a neonatal intensive care unit above minimum\n\nFor the purposes of section 28(2)(a) and (b) of the Act, the following criteria are prescribed—\n\n(a) the conditions of the infants in the neonatal intensive care unit;\n\n(b) the level of care required by the infants in the neonatal intensive care unit;\n\n(c) the experience and skill mix of staff;\n\n(d) the number of students requiring supervision.\n\nReg. 5C inserted by S.R. No. 15/2019 reg. 6.\n\n\t5C Postnatal wards\n\nFor the purposes of section 31A(3)(c) of the Act, the following are the prescribed requirements—\n\n(a) the postgraduate midwifery program referred to in section 31A(3)(b) of the Act and being undertaken by the nurse must  \nbe a postgraduate midwifery program that, on completion, qualifies the nurse for registration as a midwife under the Health Practitioner Regulation National Law;\n\n(b) the nurse has completed the initial postnatal theory component of the postgraduate midwifery program;\n\n(c) the nurse has completed all relevant staff orientation programs required by the operator of the hospital;\n\n(d) the nurse has completed all orientation programs relevant to postnatal wards required by the operator of the hospital.\n\n\t6 Considerations applicable to a proposal to vary a ratio\n\nFor the purposes of section 32(b) of the Act, the following considerations, so far as relevant to the proposal, are prescribed—\n\n(a) the profile of patients in the ward as to age, expected length of stay, complexity of treatment and case mix and throughput of patients in the clinical setting;\n\n(b) the capacity of the nurses or midwives with whom the ward is staffed to complete their duties within the existing rostered number of nursing or midwifery hours;\n\n(c) clinical risks to the quality of patient care, including risks of falls, medication errors, sepsis, thrombosis, pressure ulcers, pneumonia and urinary tract infections;\n\n(d) the occupational health and safety of the nurses or midwives with whom the ward is staffed, including the physical environment of the ward;\n\n(e) the staff engagement of the nurses or midwives with whom the ward is staffed.\n\nRegs 7–9 revoked by S.R. No. 15/2019 reg. 7.\n\n* * * * *\n\n\t10 Local agreements\n\n(1) For the purposes of section 36(2) of the Act, the following procedures are prescribed—\n\n(a) the operator of the hospital, or a relevant union, prepares a written proposal that—\n\n(i) complies with subregulation (2); and\n\n(ii) sets out the nature of the proposed variation; and\n\n(iii) sets out the period for which it is proposed that the variation will operate; and\n\n(iv) sets out the scope of application of the variation; and\n\n(v) sets out the benchmarks and performance criteria underlying the proposal, including its impact on the quality of patient care and, if relevant, addresses the other considerations specified in regulation 6;\n\n(b) the operator and the union negotiate in good faith in relation to the proposal;\n\n(c) if the operator and the union agree to the proposal, the agreement is evidenced by an exchange of letters between them.\n\n(2) The proposal must—\n\n(a) state when the variation is to be implemented, which must not be before the beginning of the next roster period after the exchange of letters referred to in subregulation (1)(c); and\n\n(b) provide for how the agreement may be varied or terminated.\n\nPart 3—Enforcement\n\n\t11 Local dispute resolution\n\n(1) For the purposes of section 41(2) of the Act, the following resolution procedures are prescribed—\n\n(a) the nurse or midwife (***the aggrieved employee***) or the aggrieved employee's representative notifies in writing the operator of the hospital (through the aggrieved employee's immediate supervisor) of an alleged breach of the ratio or ratio variation;\n\n(b) without prejudice to the outcome of the local dispute, the operator, as soon as practicable after the notification referred to in paragraph (a), must suspend the course of conduct alleged to constitute a breach of the ratio or ratio variation for the duration of the resolution procedures set out in this regulation;\n\n(c) the operator must arrange a meeting to discuss the local dispute between—\n\n(i) the aggrieved employee or representative; and\n\n(ii) the immediate supervisor or a representative of the operator other than the immediate supervisor;\n\n(d) if the local dispute is not resolved at the meeting referred to in paragraph (c), the operator, on the operator's own initiative or at the request of the aggrieved employee or representative made within 48 hours after the end of that meeting, must arrange another meeting between the aggrieved employee or representative and a representative of the operator.\n\n(2) A meeting referred to in subregulation (1)(c) must be held—\n\n(a) within 48 hours after the notification referred to in subregulation (1)(a); or\n\n(b) as otherwise agreed by, or on behalf of, the operator and the aggrieved employee.\n\n(3) A meeting referred to in subregulation (1)(d) must be held—\n\n(a) within 48 hours after the requirement to arrange the meeting arises; or\n\n(b) as otherwise agreed by, or on behalf of, the operator and the aggrieved employee.\n\n(4) All parties to a resolution procedure conducted under this regulation for settling a local dispute must—\n\n(a) genuinely attempt to resolve the dispute in a timely manner through the procedure; and\n\n(b) for that purpose act cooperatively and genuinely consider resolution options.\n\n\t12 Failure to resolve a dispute and referral to Magistrates' Court\n\nFor the avoidance of doubt, a party is not prevented from exercising a right to apply to the Magistrates' Court under section 42(1) of the Act if the inability to resolve a local dispute arises from the failure of a party to comply with the resolution procedures set out in regulation 11.\n\n═══════════════\n\nEndnotes\n\n1 General information\n\nSee [www.legislation.vic.gov.au](http://www.legislation.vic.gov.au) for Victorian Bills, Acts and current Versions of legislation and up-to-date legislative information.\n\nThe Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015, S.R. No. 169/2015 were made on 22 December 2015 by the Governor in Council under section 45 of the **Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015**, No. 51/2015 and came into operation on 23 December 2015: regulation 3.\n\nThe Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015 will sunset on 20 December 2026: see Subordinate Legislation (Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015) Extension Regulations 2025, S.R. No. 138/2025.\n\nINTERPRETATION OF LEGISLATION ACT 1984 (ILA)\n\nStyle changes\n\nSection 54A of the ILA authorises the making of the style changes set out in Schedule 1 to that Act.\n\nReferences to ILA s. 39B\n\nSidenotes which cite ILA s. 39B refer to section 39B of the ILA which provides that where an undivided regulation, rule or clause of a Schedule is amended by the insertion of one or more subregulations, subrules or subclauses the original regulation, rule or clause becomes subregulation, subrule or subclause (1) and is amended by the insertion of the expression \"(1)\" at the beginning of the original regulation, rule or clause.\n\nInterpretation\n\nAs from 1 January 2001, amendments to section 36 of the ILA have the following effects:\n\n• Headings\n\nAll headings included in a Statutory Rule which is made on or after  \n1 January 2001 form part of that Statutory Rule. Any heading inserted in a Statutory Rule which was made before 1 January 2001, by a Statutory Rule made on or after 1 January 2001, forms part of that Statutory Rule.  \nThis includes headings to Parts, Divisions or Subdivisions in a Schedule; Orders; Parts into which an Order is divided; clauses; regulations; rules; items; tables; columns; examples; diagrams; notes or forms.  \nSee section 36(1A)(2A)(2B).\n\n• Examples, diagrams or notes\n\nAll examples, diagrams or notes included in a Statutory Rule which is made on or after 1 January 2001 form part of that Statutory Rule. Any examples, diagrams or notes inserted in a Statutory Rule which was made before 1 January 2001, by a Statutory Rule made on or after 1 January 2001, form part of that Statutory Rule. See section 36(3A).\n\n• Punctuation\n\nAll punctuation included in a Statutory Rule which is made on or after  \n1 January 2001 forms part of that Statutory Rule. Any punctuation inserted in a Statutory Rule which was made before 1 January 2001, by a Statutory Rule made on or after 1 January 2001, forms part of that Statutory Rule.  \nSee section 36(3B).\n\n• Provision numbers\n\nAll provision numbers included in a Statutory Rule form part of that Statutory Rule, whether inserted in the Statutory Rule before, on or after  \n1 January 2001. Provision numbers include regulation numbers, rule numbers, subregulation numbers, subrule numbers, paragraphs and subparagraphs. See section 36(3C).\n\n• Location of \"legislative items\"\n\nA \"legislative item\" is a penalty, an example or a note. As from 13 October 2004, a legislative item relating to a provision of a Statutory Rule is taken to be at the foot of that provision even if it is preceded or followed by another legislative item that relates to that provision. For example, if a penalty at the foot of a provision is followed by a note, both of these legislative items will be regarded as being at the foot of that provision. See section 36B.\n\n• Other material\n\nAny explanatory memorandum, table of provisions, endnotes, index and other material printed after the Endnotes does not form part of a Statutory Rule. See section 36(3)(3D)(3E).\n\n2 Table of Amendments\n\nThis publication incorporates amendments made to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Regulations 2015 by statutory rules, subordinate instruments and Acts.\n\n–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––\n\nSafe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Regulations 2019, S.R. No. 15/2019\n\n| *Date of Making:* | 5.3.19 |\n| --- | --- |\n| *Date of Commencement:* | 6.3.19: reg. 3 |\n\n\n–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––\n\n3 Explanatory details\n\nNo entries at date of publication.","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"The regulations remain tightly focused on their original purpose: providing operational detail for the Safe Patient Care Act 2015. The 2019 amendments added specific provisions for special care nurseries, neonatal intensive care units, and postnatal wards, plus removed some spent provisions (regs 7-9), but these were natural extensions of the original scheme rather than scope creep. The document maintains its narrow focus on staffing ratios, local agreements, and dispute resolution without expanding into unrelated policy areas."},"complexity_factors":["Only 1 defined term ('the Act') in the interpretation section","Straightforward structure with 3 clear Parts (Preliminary, Ratios, Enforcement)","Minimal cross-referencing—primarily references back to specific sections of the parent Act (sections 25, 27, 28, 31A, 32, 36, 41, 42, 45)","No nested exceptions or conditional logic beyond simple 'if-then' procedural steps","Short length (12 pages including endnotes, approximately 8 pages of substantive content)","Clear prescriptive lists (criteria in regulations 5, 5A, 5B, 5C, and 6) rather than complex definitional provisions","Simple procedural requirements for dispute resolution with fixed timeframes (48 hours)"],"plain_english_summary":"These regulations set the rules for how many nurses and midwives must be on duty in Victorian hospitals to keep patients safe. They work alongside the main Safe Patient Care Act.\n\n**What the regulations do:**\n\n* **Set flexible staffing rules** for specific hospital areas:\n  * **Operating theatres**: Lists 8 factors (like how complex the surgery is, patient health, equipment used, and staff experience) that determine when nurse numbers can go up or down\n  * **Special care nurseries**: Lists 4 factors (baby conditions, care level needed, staff skills, student supervision) for when extra nurses or midwives are needed above the minimum\n  * **Neonatal intensive care units**: Same 4 factors as above for deciding when to add more nurses\n  * **Postnatal wards**: Sets 4 requirements that nurses must meet before they can count toward midwife staffing numbers while completing postgraduate training\n\n* **Create a process for local agreements**: Hospitals and unions can negotiate written agreements to vary the standard staffing ratios, but must follow specific steps including setting out benchmarks for patient care quality and giving proper notice before changes take effect.\n\n* **Establish dispute resolution**: If a nurse or midwife believes staffing rules are being broken, they can trigger a formal process requiring meetings within 48 hours, with the alleged breach suspended during negotiations. If that fails, they can go to the Magistrates' Court.\n\n**Who it affects:** Hospital operators, nurses, midwives, and patients in Victorian public hospitals.\n\n**Why it matters:** These rules provide the detailed \"how-to\" for the nurse-to-patient ratio laws, ensuring hospitals can't arbitrarily cut staffing while allowing flexibility for genuine clinical needs."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"The regulations, as amended by S.R. No. 15/2019, expanded and specified the regimes for staffing beyond the original 2015 text by inserting detailed criteria for special care nurseries and neonatal intensive care units and adding postnatal ward qualification requirements (Regs 5A–5C, 5C). They also prescribe formal local-agreement procedures and a structured local dispute-resolution process (Regs 6, 10, 11–12). The instrument therefore broadens operational detail and procedural obligations rather than narrowing coverage."},"complexity_factors":["Cross-references to the parent Act and multiple provisions of it (Regs 1, 5, 5A, 5B, 5C, 6, 10, 11, 12 refer to Act ss 12, 25, 27, 28, 31A, 32, 36, 41, 42) — increases interpretive interdependence.","Setting-specific lists of criteria (Reg 5; Regs 5A–5B) require clinical assessment across different wards, raising fact-intensive application.","Detailed procedural requirements for local agreements including benchmarks, scope, implementation timing and exchange of letters (Reg 10(1)(a)–(c), Reg 10(2)) — creates formal bargaining and documentation burdens.","Prescribed dispute-resolution timeline and duties (Reg 11: written notice, suspension of alleged conduct Reg 11(1)(b), meeting deadlines Reg 11(2)–(3)) — strict time limits and operational consequences.","Specific qualification and orientation requirements for postnatal ward staffing (Reg 5C(a)–(d)) — ties staffing eligibility to professional education and local orientation programs.","Enforcement path includes referral to Magistrates' Court if local procedures fail (Reg 12 / Act s42) — adds potential litigation pathway and legal costs.","Amendment history and revocations (S.R. No. 15/2019; revocation of Regs 7–9) and a statutory sunset date (Endnotes: sunset 20 Dec 2026) — affects regulatory permanence and planning."],"plain_english_summary":"These regulations set out the mechanical rules for when and how nurse and midwife staffing ratios in Victorian hospitals can be changed. They prescribe criteria for varying staffing levels in operating theatres, special care nurseries, neonatal intensive care units and postnatal wards, require a written local-agreement process, and prescribe local dispute-resolution steps and court referral.\n\nHospital operators pay staffing costs and must negotiate with unions; nurses or midwives can trigger disputes. The rules create short timelines, suspension of alleged breaches while matters are resolved, and documentary benchmarks that operators must meet."},"issue_detection":{"absurdities":[],"contradictions":[]},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"Based on available information, the regulation appears consistent with its stated purpose: converting nurse-to-patient and midwife-to-patient ratio requirements into enforceable law. The title, subject matter, and structure all align with the original legislative intent. No scope creep or significant deviation from the stated purpose is apparent from the text provided, though the limited source material means this assessment is provisional."},"complexity_factors":["Operates as subsidiary legislation (regulations) under a parent Act, requiring understanding of both instruments together","Technical healthcare workforce terminology requiring domain knowledge to interpret","Different ratios likely apply across different ward types and shifts, creating a matrix of rules","Interaction with industrial/enterprise bargaining agreements in the healthcare sector adds a layer of complexity","Version history indicates amendments over time, meaning the current operative requirements may differ from the original","Enforcement mechanisms and penalties likely require cross-referencing the parent Act","Highly limited source text provided makes comprehensive analysis difficult — apparent complexity may be higher in the full document"],"plain_english_summary":"This Victorian regulation creates legally enforceable minimum nurse‑to‑patient and midwife‑to‑patient ratios in public hospitals and similar settings. It turns prior industrial arrangements into statutory obligations, meaning hospitals, staff and patients have legal rights and duties about maximum patient loads. It matters for patient safety and staffing costs: hospitals may not roster below the mandated minima (the summary doesn’t list the exact ratio numbers)."}},"importantCases":[],"_links":{"self":"/api/acts/safe-patient-care-nurse-to-patient-and-midwife-to-patient-ratios-regulations-2015","history":"/api/acts/safe-patient-care-nurse-to-patient-and-midwife-to-patient-ratios-regulations-2015/history","analysis":"/api/acts/safe-patient-care-nurse-to-patient-and-midwife-to-patient-ratios-regulations-2015/analysis","conflicts":"/api/acts/safe-patient-care-nurse-to-patient-and-midwife-to-patient-ratios-regulations-2015/conflicts","importantCases":"/api/acts/safe-patient-care-nurse-to-patient-and-midwife-to-patient-ratios-regulations-2015/important-cases","documents":"/api/acts/safe-patient-care-nurse-to-patient-and-midwife-to-patient-ratios-regulations-2015/documents"}}