The National Quality Board(NQB) has set out the immediate expectations of NHS providers in providing safe staffing levels. Their guide to nursing, midwifery and care staffing capacity and capability brings together tools, resources and examples of good practice as a practical guide to help NHS providers and commissioners.
To take this forward in the longer term, the National Institute for Clinical Excellence (NICE) has been asked to conduct a comprehensive review of the evidence in this area and produce definitive guidelines on safe staffing to support local decisions at ward and organisational level.
All NHS Trusts are required to make use of this guidance in the review and ongoing monitoring of safe nurse staffing levels.
Birmingham Community Healthcare NHS Trust provides an overview of the inpatient nurse staffing levels for the Board of Directors and to be shared within the public domain via NHS Choices.
The monthly analysis and reporting on NHS Choices contains data from the recent exercise using the safer Nursing Care Tool (SNCT) and a comparison of planned versus actual staffing levels for all wards in the Trust.
It also provides information on the actions which are underway to ensure that all wards achieve the percentage of registered and unregistered nurses which were agreed by the Board of Directors in May this year.
Also available on this page are the reports which show, for each ward, a range of measures of the quality of care, including numbers of incidents, quality of nursing care planning, level of harm free care and patient complaints and compliments. This information can be viewed alongside the safe nurse staffing information to look at the impact staffing levels may be having on patient safety and quality.
Any patient or visitor to a ward will be able to view the Safe staffing information Boards which are situated at the entrance to each ward and give an update on the planned and actual staffing numbers for that day’s shifts. The boards also include information on harm free care and details of the shift leader, ward consultant and matron.
This page also gives a guide for patients and the public on the different types of uniform worn by nursing staff, and a brief description of their roles to help people to identify the staff who are providing care to them.
Where the planned staffing levels are not achieved, this is escalated to a matron and extra support staff are sought from BCHC's temporary staffing resource, the Trust Bank. It can also be from a nursing agency and in extreme situations staff are moved from a ward with less dependent patients to ensure safe care at all times. There is an escalation process in place which supports staff decision making.
Senior nurses, often called matrons, as well as the Trust's director of nursing and therapies or their deputies have discussed and debated the nurse staffing requirements for each area, ensuring consistency with other previous assessments using similar tools.
This method therefore consists of experienced nurses considering a range of issues associated with a ward, from its layout, the range of associated support staff such as ward receptionists, and therapists and the types of patient and their dependencies and skill mix within the team.
Our approach reviewed the staffing and skill/grade mix needs for every day in the week, for day and night shifts both for registered nurses and unregistered staff.
The results were considered by matrons and clinical leads. BCHC is working towards adjusting the skill mix to achieve the changes needed to achieve the high quality staffing levels required on our wards. This recognises that patient needs require a higher level of nursing care. In the meantime we are using temporary staffing solutions to supplement existing teams.
The challenge of delivering the changes in skill mix continue to show in the results attached where there is a higher than required fill rate for care staff and in some instances a lower than required fill rate for registered nurses. Please see the table of documents below for the full report.
It is noted that the care staff employed in our units have enhanced skills in the care of frail older adults and adults with rehabilitation needs where activities of living form a large part of the plan of care.
We have a comprehensive plan for recruitment of registered nurses and redesign of care staff roles in order to address this in the coming months.
Our nursing staff and clinical teams treat those in their care with compassion and respect, in patients' homes, wards and clinics across the Trust.
From May 2014, all hospitals are required to publish information about the number of nursing and midwifery staff working on each ward, together with the percentage of shifts meeting safe staffing guidelines.
The ‘Hard Truths’ commitments represent the Government’s response to the report written by Robert Francis QC about the poor care identified at Mid Staffordshire NHS Foundation Trust.
The guidance highlights the need for transparent reporting of staff working on shifts in every inpatient area. This reporting involves two things:
1. Clearly displaying information about the nurses and care staff present on each ward, on each shift.
Ensuring all inpatient wards have staffing and care boards in place in plain sight in public areas, which detail staffing levels on a shift by shift basis.
2. Our Trust Board receiving monthly updates on workforce information.
This will include the number of actual staff on duty during the previous month, compared to the planned staffing level, the reasons for any gaps and any actions being taken to address these. The Trust Board will take full responsibility for the quality of care provided to patients, and as a key determinant of quality, take full and collective responsibility for nursing and care staffing capacity and capability.
Boards ensure there are robust systems and processes in place to assure themselves that there is sufficient staffing capacity and capability to provide high quality care to patients on all wards, clinical areas, departments, services or environments day or night, every day of the week.
The staffing report will be published here and on Birmingham Community Healthcare's page on NHS Choices on a monthly basis from June 2014.
There is a Trust-wide safer staffing group which is chaired by the Director of Nursing and Therapies. The work of this group is to:
- agree and monitor effectiveness of systems in managing staffing levels
- provide update reports to the quality governance and risk committee
- support and guide the recruitment and retention strategy for nurses
- ensure Board papers are published and easily accessible on the internet
- ensure escalation of staffing policies are in place
- support and develop the e rostering and safe care module
- develop a daily response and an overview monthly exception when establishments not achieved.