Three-Shift Nurse-to-Patient Ratios to Be Phased In; Ministry Proposes Salary Incentives to Retain Talent and Prevent Bed Closures

(Central News Agency, reporter Chen Jieling, Taipei, June 8) The amendment to the Medical Institution Establishment Standards is expected to be announced as early as tomorrow, with the three-shift nurse-to-patient ratio to be implemented in phases. Amid concerns that a shortage of nursing staff could lead to hospital bed closures, the Ministry of Health and Welfare (MOHW) has proposed measures including 'unequal pay for unequal work,' base salary monitoring, and optimized incentives for meeting the three-shift nurse-to-patient ratio to stabilize the workforce and ensure public access to medical care.

The nurse-to-patient ratio refers to the number of inpatients each nurse is responsible for during a shift. The specific numbers vary by hospital level and shift type. For example, in medical centers, the day shift ratio is 1:6. The draft amendment to the Medical Care Act passed its third reading on May 8 this year, formally enshrining the three-shift nurse-to-patient ratio into law.

Minister of Health and Welfare Shih Chung-liang attended a press conference titled 'Friendly Retention, Adding Value to Taiwan's Healthcare' organized by the National Union of Nurses' Associations, Republic of China, today. In his speech, he stated that the relevant amendments to the Medical Institution Establishment Standards would be announced as early as tomorrow, with a 30-day public comment period.

Shih said the staffing standards for the three-shift nurse-to-patient ratio would follow the version published in 2024. In response to President Lai Ching-te's declaration of a phased implementation, medical centers are expected to implement the new ratios on May 20, 2026; regional hospitals from January 1, 2028; and district hospitals, as well as hospitals of all levels in mountainous areas, outlying islands, and the Hualien-Taitung region, from May 1, 2028.

According to MOHW statistics, as of the end of May this year, the number of registered practicing nurses was 198,076, an increase of over 4,900 compared to the same period last year. The number of licensed nurses reached 315,112. The average age of nurses is 40. There are 9,772 male practicing nurses (4.9%) and 188,304 female practicing nurses (95.1%).

Shih pointed out that besides continuously improving retention rates, attracting nurses who have left the profession to return is also a crucial task. 'The government's goal is not just to meet the three-shift nurse-to-patient ratio standards, but to ensure an adequate nursing workforce to prevent bed closures due to staff shortages, which would affect people's right to medical care,' he said.

Regarding improving the nursing workforce, Shih stated that the government will continue to allocate budgets, increasing nursing fees for acute general wards for four consecutive years. The principle of 'unequal pay for unequal work' will also be gradually implemented. The ministry is currently considering further increasing health insurance resources related to the nursing workforce in next year's total health insurance budget.

Shih said the MOHW will establish a salary monitoring mechanism for nurses, using changes in health insurance insured salaries as a monitoring indicator to ensure continuous growth in nurses' base pay. The existing incentives for meeting the three-shift nurse-to-patient ratio will be further strengthened. If individual hospitals achieve a nurse-to-patient ratio better than the legal standard, the ministry will consider providing additional rewards through the health insurance payment mechanism.

Chen Li-chin, Chairperson of the National Union of Nurses' Associations, Republic of China, stated that the inclusion of the three-shift nurse-to-patient ratio in law is a milestone for Taiwan's nursing profession, but it is only the starting point of healthcare reform. She raised three main demands. First, nurses want their salaries to reflect increases in base pay, not short-term bonuses or subsidies, so they can truly feel the improvement in treatment and be willing to enter the workforce. Second, there should be earmarked funds and flow monitoring; the government should clearly monitor the flow of resources, including the proportion allocated to salary increases and workplace improvements, to ensure the working environment is improved and workflows are simplified. Third, nurses need channels for expressing opinions, flexible shift options, and career planning. In addition to existing incentives for net increases in staff, they also hope for the establishment of retention bonuses. (Editor: Chen Ching-fang) June 8, 2026