More than half of district nurses say workforce planning is controlled by finance rather than patient need, according to survey results shared with Nursing Times.
The Queen’s Nursing Institute said the research was evidence of serious inadequacies in methods for working out caseloads, nurse numbers and skills mix – with decisions often simply based on what budgets allow or the “way things have always been done”.
“It is imperative that commissioners and providers have the right tools to enable them to minimise risks associated with workforce shortfall”
Staffing needs were determined by “available budget”, according to 52% of respondents to the QNI’s survey of 150 district nurses. Only 15% said “size of caseload” was the determining factor.
The research also revealed that nursing teams found it almost impossible to plan staffing needs, even in the short term. Asked what period ahead their team was able to forecast staffing requirements, 40% said a week, 11% a month and 47% said that they were unable to predict at all.
In addition, nearly a quarter of survey respondents, 23%, said time was their allocated in 15 minute slots, rather than continuing as required until all patients were seen.
Feedback from the survey revealed district nurses felt under pressure from increasing demand for services without any increase in staff numbers. “Stress has increased among the teams resulting in increased sickness and nurses leaving the services,” said one respondent.
The survey was carried out as part of a wider QNI study into the district nursing workforce, which concluded deployment was based on flawed plans that failed to take into account the needs of local communities and the demands of the job.
The study, commissioned by NHS England, revealed a patchy picture of workforce planning, with much still done on a fairly ad-hoc basis. For example, there was often reliance on the judgement of team leaders and over-simplistic standard caseload sizes, despite the existence of new tools and systems to improve planning.
In many places, rostering and record-keeping was still done manually and team structures were based on “standard caseloads or subjective decisions”, which ignored local factors such as deprivation, number of care homes and geographical spread of patients.
In addition, efforts to assess service quality were hampered by inconsistent reporting that often focused on “contacts and not time, quality or complexity”.
“Decision-making remains decentralised, not supported by robust data, and often ignores the complexity associated with local factors,” stated the report.
The QNI said its findings highlighted the need to improve workforce planning and that it intended to start work on developing a standard District Nurse Strategic Workforce Planning Tool, which could be used everywhere and make it easier to compare data and share good practice.
The QNI has submitted a bid to the Department of Health to carry out the work in 2014-15, but noted this may be passed to Health Education England as part of its work on community nurse workforce planning.
QNI chief executive Crystal Oldman said: “It is imperative that commissioners and providers have the right tools to enable them to understand and minimise risks associated with workforce shortfall.”