Wales is one step closer to becoming the first UK nation to enshrine safe nursing staff levels in law.
On Wednesday afternoon Welsh Assembly members voted through proposals drafted by Liberal Democrat Kirsty Williams to create a legal duty for safe staffing levels.
Her bill will now progress to the committee stage where it will be debated in detail.
Other UK nations have shied away from legislating on safe staffing but Ms Williams told the assembly this was a chance for Wales to “lead the rest”.
Outlining her proposals, she cited examples from abroad where she said laws on safe staffing have been successfully introduced.
In California a law to maintain nurse to patient ratios in acute settings has seen a significant reduction in mortality rates.
Meanwhile, in the Australian state of Victoria, a law on minimum staffing introduced in 2012 led to better recruitment and retention of nurses and reduced reliance on agency staff, as well as other benefits, said Ms Williams.
“Our NHS cannot become an easy target when it comes to balancing the books”
She warned that workforce planning and non-compulsory guidelines on safe staffing were simply not working in Wales.
“The fact is that we already have guidance on staffing levels from the chief nursing officer and those levels are not being met consistently across Welsh health boards,” she said.
“We need legislation to provide the strong backing that managers need to ensure that the workforce in our NHS cannot become an easy target when it comes to balancing the books.”
Assembly members from all parties agreed to allow the proposals to proceed to the next stage with 39 voting in favour, 12 abstentions and no votes against.
But some, including Welsh health minister Mark Drakeford, questioned the need for a new law warning it could have “unintended consequences”.
There was a risk minimum levels would “become the maximum” and community hospitals could be stripped of nurses to fulfil staffing requirements in acute care, he said.
Set ratios removed the flexibility for nurses to exercise their own professional judgment about what acceptable and could damage integrated working as the health service evolved, he added.
Mr Drakeford said there remained “high and substantial hurdles” to overcome in order to create workable legislation, which had “no doubt contributed to decisions elsewhere in the UK not to proceed in this way”.
Other assembly members questioned whether the law would apply to community settings and where specialist nurses fitted in.
Ms Williams said nurse-patient ratios would not be put on the face of the bill as that was for “the profession to decide”.
She said ratios for community settings could be included at a later stage, but at the moment the evidence of the benefits was less strong.
“There can be no compromise on the need for mandated, minimum registered nurse staffing levels”
Tina Donnelly, director of the Royal College of Nursing in Wales, said: ”We are pleased that our assembly members have been listening to nurses and patients about the importance of nurses having time to care and the need for adequate staffing levels.
“There can be no compromise on the need for mandated, minimum registered nurse staffing levels,” she added. “There is a growing body of evidence which shows that nurse staffing levels make a difference to patient outcomes and patient experience, quality of care, recruitment and retention of nursing staff and the economic efficiency of care delivery.”