Safe staffing levels

Safe

staffing

levels

Nurse staffing levels matter

• Research evidence
• Effect of insufficient staffing

(eg. Mid Staffs, CQC report)

• Efficiency message – ‘avoidable complications’ only avoidable with sufficient nursing input….
• Effects on patient AND staff outcomes – (Magnet hospitals, Boorman)

But staffing not the only thing

RN4Cast - variation in staffing

How best to achieve a safe level of staffing?

Are mandated minimums the best option?

Some think so...

"The RCN believes that there is a compelling case for mandatory staffing levels to be introduced in England and Wales."

Policy Briefing, March 2012

“ The Board must, in exercise of its functions, mandate for health services on the maximum number of patients per registered nurse.”

Baroness Audrey Emerton. Amendment to Health & Social Care Bill. 3 Nov 2011

Legislation... in USA

And in parts of Australia

Reported Benefits

BUT....

•Inflexible – too blunt?

•Defining minimum – does it become the ‘average’ or maximum?

• Measuring minimum – how is it calibrated in relation to workload?

• How can compliance be assured?

• What are the penalties for non compliance?

• What are the costs/implications of compliance - will other staffing be reduced as a consequence?

‘The last thing we want is a minimum standard

becoming a ceiling rather than a floor.’

(NHS Employers)

“Minimum staffing levels are an example of inflexible regulation”

“Regulation is a blunt instrument and regulating staffing levels is as blunt as you can get.”

“Mandatory staffing levels can not guarantee safe care.

We do not believe that imposing a crude system of staffing ratios is the right way to tackle poor care. Each NHS hospital and service has different demands on its services. Arbitrary ratios could limit organisations' ability to plan care in a way that is best for the patient.

"Mandated minimums are the best way of achieving safe staffing''

• Are you confident that you have it right in your organisation?
• Are staffing levels ever unsafe?
• What does it take to make safe staffing happen?
• Do different times/climates call for different measures?
• Would more detailed recommended levels or guidelines be helpful or is it too crude to be useful?
• Are the professional guidelines set to ITU, neonates etc. followed?
• Do guidelines need to be backed up by regulation or legislation to have an impact?
• Do you have the tools and data to plan staffing to match patient need and workload?
• How do you know when you've got it right...or wrong?

(What are the key indicators?)

• Who is accountable for safe staffing? What's your own role?

Harry Cayton, CHRE. HSJ March 2012

Dean Royles, director of NHS Employers:

Discussion Questions

• Simple to implement and understand
• Using an average ratio across the whole team ensures that there is predictability and flexibility in determining appropriate still room for professional judgment levels of care (AUS)
• Provides standard approach (reduces need for complex systems)
• If mandatory, can ensure compliance from all employers
• Improved ability to recruit and retain nurses during a global ‘nursing shortage’ (AUS)
• Greater workforce stability in the short and long term (AUS)
• Increased job satisfaction for nurses, more workplace stability and reduced stress (AUS)
• Lower Mortality Rates (CALIF- Aiken et al)