News
Minimum numbers of staff set for urgent care services National Institute for Health and Care Excellence recommends nurse-to-patient ratios By Erin Dean and Nick Lipley NURSE-TO-PATIENT STAFFING ratios are expected to be at the top of the agenda of next month’s annual conference of the RCN Emergency Care Association (ECA). The topic is due to feature strongly at the two-day conference in Manchester following publication of proposed staffing levels in emergency care by the National Institute for Health and Care Excellence (NICE). ECA chair Janet Youd told Emergency Nurse: ‘The conference theme this year is competence, which is relevant to the current debates about staffing. ‘We must consider skill mix, which necessitates defining competency levels, or it will be assumed that any nurse counts, leading to increased patient safety risks.’ NICE proposes, for example, a ratio of at least two registered nurses to one patient with major trauma or cardiac arrest,
at least one nurse to four cubicles in major and minors sections, and at least one nurse to two cubicles in resuscitation areas. The institute also recommends that nurses look for, and where necessary report immediately, signs that staffing levels are too low. These signs may include patients’ untreated pain, falls or unnoticed departure from departments. The ratios are set out in the panel, below left. Uplift The consultation comes as demand on emergency departments (EDs) reaches unprecedented levels and as waiting times are at their longest for a decade. Ms Youd is concerned, however, that the minimum ratios will be regarded as the standard. ‘The minimum staffing levels represent the number of nurses needed for a number
NICE recommendations on staffing ratios in emergency departments ■ One registered nurse to four cubicles in majors and minors areas. ■ One registered nurse to one cubicle in triage areas. ■ One registered nurse to two cubicles in resuscitation areas. ■ One band 7 registered nurse on every shift at all times. ■ Two registered nurses to one patient with major trauma. ■ Two registered nurses to one patient with cardiac arrest. ■ One registered nurse to one priority ambulance patient. ■ One family liaison registered nurse to one patient’s family. ■ One children’s nurse on every shift.
EMERGENCY NURSE
of cubicles or resuscitation bays, but do not take into account the number of ill patients in the waiting room or on trolleys in corridors,’ she said. ‘Another concern is that NICE talks about allowing an uplift during staff holidays, training days and sick leave, but does not recommend what it should be. Many trusts’ uplifts are insufficient and result in inadequate education provision.’ Referring to the recent drop in ED performance, RCN general secretary Peter Carter said: ‘NICE has recognised this is not just a winter crisis. Only long-term planning can tackle staffing issues.’ Consultation on the NICE proposals closes on February 12. Other topics at the RCN Emergency Care Association conference include: ■ Identifying and managing delirium. ■ Getting the best use from social media. ■ Clinical updates on hand injuries, blood gas analysis and a limping child. ■ Ensuring best practice in preceptorship. ■ Routes to advanced practice. ■ Nurse-led mental health pathways. See also analysis, pages 8-10 Find out more Details of the NICE proposals are available at tinyurl.com/l7zvt7l
Dragon breathes life into organ campaign
Morgan the dragon with his creator, Sophie Green
VISITORS AT Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) are being welcomed by a dragon called Morgan. Morgan, pictured left with his creator, artist Sophie Green, is sponsored by the Norfolk and Norwich Organ Donation Committee. He is one of a series of sculptures making up a dragon ‘trail’ to raise awareness about organ donation throughout the city. Specialist nurse in organ donation at NNUH Marie Garside said: ‘We give every family the choice to donate when medical circumstances allow. More than 100 patients have been donors over the past ten years, saving and changing the lives of hundreds of people.’
February 2015 | Volume 22 | Number 9
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Minimum numbers of staff set for urgent care services National Institute for Health and Care Excellence recommends nurse-to-patient ratios By Erin Dean and Nick Lipley NURSE-TO-PATIENT STAFFING ratios are expected to be at the top of the agenda of next month’s annual conference of the RCN Emergency Care Association (ECA). The topic is due to feature strongly at the two-day conference in Manchester following publication of proposed staffing levels in emergency care by the National Institute for Health and Care Excellence (NICE). ECA chair Janet Youd told Emergency Nurse: ‘The conference theme this year is competence, which is relevant to the current debates about staffing. ‘We must consider skill mix, which necessitates defining competency levels, or it will be assumed that any nurse counts, leading to increased patient safety risks.’ NICE proposes, for example, a ratio of at least two registered nurses to one patient with major trauma or cardiac arrest,
at least one nurse to four cubicles in major and minors sections, and at least one nurse to two cubicles in resuscitation areas. The institute also recommends that nurses look for, and where necessary report immediately, signs that staffing levels are too low. These signs may include patients’ untreated pain, falls or unnoticed departure from departments. The ratios are set out in the panel, below left. Uplift The consultation comes as demand on emergency departments (EDs) reaches unprecedented levels and as waiting times are at their longest for a decade. Ms Youd is concerned, however, that the minimum ratios will be regarded as the standard. ‘The minimum staffing levels represent the number of nurses needed for a number
NICE recommendations on staffing ratios in emergency departments ■ One registered nurse to four cubicles in majors and minors areas. ■ One registered nurse to one cubicle in triage areas. ■ One registered nurse to two cubicles in resuscitation areas. ■ One band 7 registered nurse on every shift at all times. ■ Two registered nurses to one patient with major trauma. ■ Two registered nurses to one patient with cardiac arrest. ■ One registered nurse to one priority ambulance patient. ■ One family liaison registered nurse to one patient’s family. ■ One children’s nurse on every shift.
EMERGENCY NURSE
of cubicles or resuscitation bays, but do not take into account the number of ill patients in the waiting room or on trolleys in corridors,’ she said. ‘Another concern is that NICE talks about allowing an uplift during staff holidays, training days and sick leave, but does not recommend what it should be. Many trusts’ uplifts are insufficient and result in inadequate education provision.’ Referring to the recent drop in ED performance, RCN general secretary Peter Carter said: ‘NICE has recognised this is not just a winter crisis. Only long-term planning can tackle staffing issues.’ Consultation on the NICE proposals closes on February 12. Other topics at the RCN Emergency Care Association conference include: ■ Identifying and managing delirium. ■ Getting the best use from social media. ■ Clinical updates on hand injuries, blood gas analysis and a limping child. ■ Ensuring best practice in preceptorship. ■ Routes to advanced practice. ■ Nurse-led mental health pathways. See also analysis, pages 8-10 Find out more Details of the NICE proposals are available at tinyurl.com/l7zvt7l
Dragon breathes life into organ campaign
Morgan the dragon with his creator, Sophie Green
VISITORS AT Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) are being welcomed by a dragon called Morgan. Morgan, pictured left with his creator, artist Sophie Green, is sponsored by the Norfolk and Norwich Organ Donation Committee. He is one of a series of sculptures making up a dragon ‘trail’ to raise awareness about organ donation throughout the city. Specialist nurse in organ donation at NNUH Marie Garside said: ‘We give every family the choice to donate when medical circumstances allow. More than 100 patients have been donors over the past ten years, saving and changing the lives of hundreds of people.’
February 2015 | Volume 22 | Number 9
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 08, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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