Dr. Aled, in Portugal, our National Nursing Order has published a few weeks ago the regulation do determine staff levels in hospitals, primary care and long term care (published in Government). The skill mix is only used in staffing levels at the hospitals. If you want, I can translate the main issues of the document (we have the document only in Portuguese). Regards

http://www.ordemenfermeiros.pt/legislacao/Documents/LegislacaoOE/PontoQuatro_Norma_de_DotacoesSeguras_dos_Cuidados_de_Enfermagem_AG_30_05_2014_aprovado_por_maioria_proteg.pdf

That's very kind Tiago, thanks.

I've saved the document but I would be very grateful if you could provide me with a quick understanding of the main issues. Thanks again.

Dr. Aled, I will send you as soon as possible. Regards.

Hello I am sending an article I believe that perhaps could help him.

Thank you Rafael. I will read with interest. 

The link below is the NSW Nurses and Midwives Association (nurses & midwives union) in NSW, Australia.  This sets Nursing Hours per Patient per day depending on the type of facility and ward.  This may be of assistance.  In my experience, they are more flexible than straight 'ratios' in that you have the option of adding extra staff if necessary in the case of overly heavy workloads.

http://www.nswnma.asn.au/wp-content/uploads/2013/07/Public_Health_System_Nurses_and_Midwives_State_Award_MOU_-_2010_-_2013.pdf

Victoria, Australia, was the first state to enact nurse:patient ratios.  They are generally, depending on the ward, are 1:5 or 1:6 I believe.  The attached file contains a journal article on it that may of interest.

An 'issues paper' was produced in 2009 by the Australian Nursing Federation titled "Ensuring quality, safety and positive patient outcomes" which looked at the research surrounding patient ratios.  This can be found at:  http://anmf.org.au/documents/reports/Issues_Ensuring_quality.pdf

I hope this is of assistance to you.  Good luck

Sarah

Thanks Sarah, much appreciated.

This article may be of help to you.  13 states in the US have passed laws dealing with safe staffing levels.  http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatios  

California is the only state in the US that mandates minimum nurse to patient ratios all the time.  The following article has a table with proposed minimum staffing mandates. http://futurehealth.ucsf.edu/Content/29/2000-12_Minimum_Nurse_Staffing_Ratios_in_California_Acute_Care_Hospitals.pdf 

Check out this website.  It is from 2009:  

Assessing the Impact of California's Nurse Staffing Ratios on Hospitals and Patient Care.  http://www.chcf.org/publications/2009/02/assessing-the-impact-of-californias-nurse-staffing-ratios-on-hospitals-and-patient-care

This article may be of help as well.   It is a current article from 2013:

Nurse-Patient Staffing Ratios 

AJN, American Journal of Nursing

Issue: Volume 113(8), August 2013, p 21, 22

Copyright: © 2013 Lippincott Williams & Wilkins. All rights reserved.

Publication Type: [ AJN Reports]

DOI: 10.1097/01.NAJ.0000432956.03387.bd

ISSN: 0002-936X

Accession: 00000446-201308000-00017

RAFAELA system has been used to state the optimal nursing intensity level. The method has been tested in hospital care as well as primary care. You can found lot of articles were the method are described. 

Frilund et al, 2009, Fagerström et al 2004, 2013, 2014  Mostly of the articles are written of Fagerström  and her research team. 

Many thanks to Susan and Marianne for your contributions to this thread.