[A Historical Account of Medical Union Efforts to Mandate Shift-Based Nurse-to-Patient Ratios in Taiwan]

Achieving optimal nurse-to-patient ratios, widely recognized as critical to improving care quality, has been a key stated goal of national healthcare policy in Taiwan since 2014. Although the "daily average nurse-to-patient ratio" was codified into law in 2019, this regulation only defined the maximum number of patients per nurse based on an average across all three shifts, hospital-wide, and over a one-month period. This averaging approach dilutes and distorts the actual workload of nurses and fails to adequately protect them from overwork. In response, nursing associations have for years called for the implementation of "three-shift nurse-to-patient ratios" that set specific workload caps for day, evening, and night shifts, respectively. In 2024, following the strain of the COVID-19 pandemic and subsequent wave of post-pandemic nurse resignations, the government announced a new policy addressing three-shift ratios. Nevertheless, the policy maintains the averaging method and, while providing incentives to institutions that achieve targeted levels, does not impose penalties on those that exceed threshold numbers. Thus, this new policy does not resolve the fundamental issues behind the nurse overwork problem in Taiwan. This article was written to delineate the efforts made by labor unions and nursing organizations to enshrine three-shift nurse-to-patient ratios into law. In addition, the use by unions of tools such as surveys, lobbying, and protest actions across the different phases of advocacy to pressure the government, push policy forward, and improve the working conditions for nurses is analyzed.