CHRIS RICE
Getting the nurse numbers right A staffing tool developed by nurses has been endorsed by NICE. But will it ensure safe care? Erin Dean investigates The link between staffing levels and quality of care should be beyond debate by now. Many high-profile documents, including the Francis report into failures of care at Mid Staffordshire NHS Foundation Trust and the Berwick report on improving patient safety, have highlighted the need for safer staffing. But how to achieve this in care settings is not always clear. Now the National Institute for Health and Care Excellence (NICE) has, for the first time,
backed a nursing staffing tool to help senior nurses check that they have the right number of staff on duty. The Safer Nursing Care Tool can be used alongside guidance for the staffing of acute adult wards published by NICE in July. NICE says it chose this tool because it provides for fluctuations in planned and predictable staffing variations, such as leave time, and allows for a preferred ratio between registered and unregistered
staff on each ward. It lets nurses use their professional judgement, and encourages analysis of patient acuity and dependency on each ward.
Validation
The tool was developed ten years ago by Katherine Fenton, chief nurse at University College London Hospitals NHS Foundation Trust, and Hilary Chapman, chief nurse at Sheffield Teaching Hospitals NHS Foundation Trust.
22 november 26from :: vol 29 no 13by:: ${individualUser.displayName} 2014 STANDARD Downloaded RCNi.com on Nov 21, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
SUMMARY
The National Institute for Health and Care Excellence (NICE) has approved a nursing staffing tool to help senior nurses check that they have the right number of staff on acute adult wards. Developed a decade ago by nurses Katherine Fenton and Hilary Chapman, the tool aims to ensure that staffing levels reflect patient levels of acuity and dependency. Author Erin Dean is a freelance journalist
Over the past decade it has been used by many hospitals across the UK and independently validated. Professor Chapman believes it remains the best tool available for checking the staffing of acute wards. ‘There was nothing to help nurses determine what establishments were needed in wards to enable the delivery of high-quality care,’ she says. ‘Establishments had been rolled on, year on year, and were generally historical, and didn’t take into account how patient needs were changing. ‘The Safer Nursing Care Tool is an evidence-based tool driven by patient needs. It is simple to use and it is free.’ The tool is a spreadsheet that can give recommended nursing staff numbers for a ward based on the acuity of patients being cared for. It should be used on a ward over 20 consecutive weekdays in January and June. The member of staff using the tool will give each patient on the unit that day one of five grades, depending on their needs. This takes into account patient requirements, such as whether they need complex post-operative care, have a severe infection, or are on an end of life care pathway. The higher the grading, the greater amount of care a patient should have. The tool also automatically includes a 22 per cent uplift to allow for staff leave and training. Professor Chapman stresses that it should not be used in isolation. ‘We have to look at outcomes, and also professional judgement, so we must always listen to our staff.’
The implementation resource pack recommends the use of nurse-sensitive indicators, such as complaints, drug errors, infection and pressure ulcer rates, and the number of falls. In 2012 a major revision of the tool took account of the increased number of patients who require a great deal of nursing care, including those who are confused and need constant supervision, who require help with most or all activities of daily living, are on an end of life care pathway, or have complex intravenous drug regimens. ‘Providing nursing care to patients who need help with fundamental or daily activities is one of the most skilled areas,’ says Professor Chapman. Versions of the tool are being developed for mental health services, emergency and assessment services. Some trusts use the tool more frequently than was originally intended. Guy’s and St Thomas’ NHS Foundation Trust in London has used the tool on a daily basis on inpatient wards for the past four years.
Counting staff Other methods available to calculate staffing requirements are: The Professional Judgment model (Telford method) – simple to use and takes into account clinical staff views but is seen to be subjective, has no evidence base and is not sensitive to workload intensity. Staff-to-bed ratio – allows benchmarking but assumes that base staffing levels are accurate and reflect patient need, and is insensitive to changes in workload. Activity Monitoring (GRASP) – uses care plans/ care pathways and related nursing time, but is task-oriented, can be time-consuming and may require support from commercial systems. Nursing hours per patient day (NHPPD) – this method is widely used in the United States and Australia. It calculates the number of nurses and nursing assistants required in relation to activity levels. Regression methods (Teamwork) – this is not easily understood by nurses and there is an underlying assumption that all wards are efficient and effective. Source: Safer Nursing Care Tool Implementation Pack
When staff numbers fall below the establishment recommended by the tool, or staff absence is 3 per cent or higher, email alerts are sent to senior nursing staff, who then review staffing levels. If required, nursing staff are moved from low acuity areas to those where extra nurses are needed, or temporary staffing is arranged.
Workforce review
The trust’s senior nurse for workforce Neil Webb welcomes the tool as an additional daily source of data. It also informs the chief nurse workforce reviews, that are carried out every six months. ‘In some areas and specialties, it has given some evidence to adjust a ward’s funded establishment,’ he says. ‘But it hasn’t provided all the answers to our workforce questions, and we didn’t expect it to. The key to any nursing workforce planning is the triangulation of data with professional judgement.’ But for some health professionals, the NICE guidance, and the tool that supports it, lack clout. The Safe Staffing Alliance, a group of senior nurses calling for a minimum of one registered nurse to every eight patients, says that NICE’s refusal to mandate safe staffing levels means that inexperienced chief nurses may struggle to convince trust boards. Susan Osborne, chair of the alliance and an independent management and nursing consultant, says almost one third of directors of nursing have been in post for less than a year, and their arguments for safe staffing may not be listened to. ‘The tool is there, but how will it be used effectively and what are the sanctions and consequences for chief executives if safe staffing levels are not implemented? This is a real problem’ NS Safer Nursing Care Tool: Implementation Resource Guide tinyurl.com/safer-care-tool
NURSING november 26 other :: voluses 29 no 13 :: permission. 2014 23 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 21, 2015. For personal use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
Getting the nurse numbers right A staffing tool developed by nurses has been endorsed by NICE. But will it ensure safe care? Erin Dean investigates The link between staffing levels and quality of care should be beyond debate by now. Many high-profile documents, including the Francis report into failures of care at Mid Staffordshire NHS Foundation Trust and the Berwick report on improving patient safety, have highlighted the need for safer staffing. But how to achieve this in care settings is not always clear. Now the National Institute for Health and Care Excellence (NICE) has, for the first time,
backed a nursing staffing tool to help senior nurses check that they have the right number of staff on duty. The Safer Nursing Care Tool can be used alongside guidance for the staffing of acute adult wards published by NICE in July. NICE says it chose this tool because it provides for fluctuations in planned and predictable staffing variations, such as leave time, and allows for a preferred ratio between registered and unregistered
staff on each ward. It lets nurses use their professional judgement, and encourages analysis of patient acuity and dependency on each ward.
Validation
The tool was developed ten years ago by Katherine Fenton, chief nurse at University College London Hospitals NHS Foundation Trust, and Hilary Chapman, chief nurse at Sheffield Teaching Hospitals NHS Foundation Trust.
22 november 26from :: vol 29 no 13by:: ${individualUser.displayName} 2014 STANDARD Downloaded RCNi.com on Nov 21, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
SUMMARY
The National Institute for Health and Care Excellence (NICE) has approved a nursing staffing tool to help senior nurses check that they have the right number of staff on acute adult wards. Developed a decade ago by nurses Katherine Fenton and Hilary Chapman, the tool aims to ensure that staffing levels reflect patient levels of acuity and dependency. Author Erin Dean is a freelance journalist
Over the past decade it has been used by many hospitals across the UK and independently validated. Professor Chapman believes it remains the best tool available for checking the staffing of acute wards. ‘There was nothing to help nurses determine what establishments were needed in wards to enable the delivery of high-quality care,’ she says. ‘Establishments had been rolled on, year on year, and were generally historical, and didn’t take into account how patient needs were changing. ‘The Safer Nursing Care Tool is an evidence-based tool driven by patient needs. It is simple to use and it is free.’ The tool is a spreadsheet that can give recommended nursing staff numbers for a ward based on the acuity of patients being cared for. It should be used on a ward over 20 consecutive weekdays in January and June. The member of staff using the tool will give each patient on the unit that day one of five grades, depending on their needs. This takes into account patient requirements, such as whether they need complex post-operative care, have a severe infection, or are on an end of life care pathway. The higher the grading, the greater amount of care a patient should have. The tool also automatically includes a 22 per cent uplift to allow for staff leave and training. Professor Chapman stresses that it should not be used in isolation. ‘We have to look at outcomes, and also professional judgement, so we must always listen to our staff.’
The implementation resource pack recommends the use of nurse-sensitive indicators, such as complaints, drug errors, infection and pressure ulcer rates, and the number of falls. In 2012 a major revision of the tool took account of the increased number of patients who require a great deal of nursing care, including those who are confused and need constant supervision, who require help with most or all activities of daily living, are on an end of life care pathway, or have complex intravenous drug regimens. ‘Providing nursing care to patients who need help with fundamental or daily activities is one of the most skilled areas,’ says Professor Chapman. Versions of the tool are being developed for mental health services, emergency and assessment services. Some trusts use the tool more frequently than was originally intended. Guy’s and St Thomas’ NHS Foundation Trust in London has used the tool on a daily basis on inpatient wards for the past four years.
Counting staff Other methods available to calculate staffing requirements are: The Professional Judgment model (Telford method) – simple to use and takes into account clinical staff views but is seen to be subjective, has no evidence base and is not sensitive to workload intensity. Staff-to-bed ratio – allows benchmarking but assumes that base staffing levels are accurate and reflect patient need, and is insensitive to changes in workload. Activity Monitoring (GRASP) – uses care plans/ care pathways and related nursing time, but is task-oriented, can be time-consuming and may require support from commercial systems. Nursing hours per patient day (NHPPD) – this method is widely used in the United States and Australia. It calculates the number of nurses and nursing assistants required in relation to activity levels. Regression methods (Teamwork) – this is not easily understood by nurses and there is an underlying assumption that all wards are efficient and effective. Source: Safer Nursing Care Tool Implementation Pack
When staff numbers fall below the establishment recommended by the tool, or staff absence is 3 per cent or higher, email alerts are sent to senior nursing staff, who then review staffing levels. If required, nursing staff are moved from low acuity areas to those where extra nurses are needed, or temporary staffing is arranged.
Workforce review
The trust’s senior nurse for workforce Neil Webb welcomes the tool as an additional daily source of data. It also informs the chief nurse workforce reviews, that are carried out every six months. ‘In some areas and specialties, it has given some evidence to adjust a ward’s funded establishment,’ he says. ‘But it hasn’t provided all the answers to our workforce questions, and we didn’t expect it to. The key to any nursing workforce planning is the triangulation of data with professional judgement.’ But for some health professionals, the NICE guidance, and the tool that supports it, lack clout. The Safe Staffing Alliance, a group of senior nurses calling for a minimum of one registered nurse to every eight patients, says that NICE’s refusal to mandate safe staffing levels means that inexperienced chief nurses may struggle to convince trust boards. Susan Osborne, chair of the alliance and an independent management and nursing consultant, says almost one third of directors of nursing have been in post for less than a year, and their arguments for safe staffing may not be listened to. ‘The tool is there, but how will it be used effectively and what are the sanctions and consequences for chief executives if safe staffing levels are not implemented? This is a real problem’ NS Safer Nursing Care Tool: Implementation Resource Guide tinyurl.com/safer-care-tool
NURSING november 26 other :: voluses 29 no 13 :: permission. 2014 23 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 21, 2015. For personal use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
