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Nurses develop tool to ensure safe staffing levels

Senior nurses have developed a simple way of assessing the safe number of nurses needed for a ward, which health workforce experts say can be used to argue against post cutting.    

Nursing teams can use the Safer Nursing Care Tool to work out safe staffing on hospital wards by putting in information about patients’ conditions.

They can also match staffing levels with nursing performance in areas such as pressure sores, nutrition and falls, and compare results with similar wards and departments at their hospital or other hospitals.

The tool – launched online this month after extensive trials – builds on the Association of UK University Hospitals’ acuity/dependency tool and was developed by strategic health authority chief nurses with the NHS Institute for Improvement and Innovation.

Project lead Katherine Fenton, chief nurse at University College London Hospitals Foundation Trust, told Nursing Times it tied in with recommendations from last year’s Mid Staffordshire inquiry report, which concluded chronic staffing shortages were largely to blame for substandard care.

She said: “It shows what numbers you should have for the acuity and dependency of the patients you’ve got, and gives nurses the ability to evidence what staff they need to care for patients safely and effectively.”

She added: “We are starting to link that to nurse sensitive outcome indicators, like pressure sores, and identifying a possible link between the two, although that work is in its early stages.”

It was initially tested at three trusts – North Tees and Hartlepool Foundation Trust, Nottingham University Hospitals NHS Trust and Royal Wolverhampton Hospitals NHS Trust – and in July 2010 was rolled out to a further 20 across seven SHAs.

Rachel Finn, senior improvement lead at Nottingham University Hospitals, said the trust had used the tool on 70 adult wards and it had helped ensure nurses were deployed “in the right place”.

“It has helped us identify where we’re performing well and where improvements need to be made and, of course, that is going to drive standards up,” she said. “Where staffing has been increased because the tool showed we needed more staff, then we have seen metrics improve.”

She admitted some nurses had been sceptical at first and worried it would take too much time, but they found it took just 10 to 15 minutes a day and was “robust, reliable and easy to use”.

Ms Finn added: “Some people have had their budgets reduced and some have had theirs increased, so there have been no net job losses. We have also been able to identify specific performance issues and take action.”

For example, she said the tool had helped identify a need for more nurse training on hospital-acquired pressure sores in critical care.

She said the tool was not used in isolation but alongside professional judgement, dependency scores and benchmarking.

James Buchan, professor of health sciences at Edinburgh’s Queen Margaret University, told Nursing Times the tool could be used to argue against job cuts.

He said: “It could demonstrate the risks associated with running at low staffing levels and provide an additional tool in the armoury of ward sisters and matrons.”

Chief nursing officer for England Christine Beasley described the resource as “valuable and timely”.

She told Nursing Times: “It is one of a number of tools that can help directors of nursing get nurse staffing in acute hospitals right. It has a strong evidence base, has been widely tested and links staffing to quality outcomes for patients.”

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Readers' comments (10)

  • Outstanding! Not that those in charge are listening, or even care.

    The evidence that we are chronically short staffed (of QUALIFIED staff) across the board and this is directly affecting patient care has been around for a long time and in huge numbers. But noone listens, they just blame us when things go wrong.

    Perhaps we are now getting angry enough and vocal enough to start demanding change? I hope this tool is just the start of that!

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  • This sounds like good news...ish. Over the years as a nurse manager (now thankfully voluntarily redundant/retired) I used a number of tools to attempt to measure patient dependency as a adjunct to professional opinion to argue for increased nursing resources. Sometimes successfully, but the lack of a nationally accepted and 'ratified' formula always worked against me...so hopefully this might just be the breakthrough that is needed, particularly in the current climate. It's interesting to note that Nottingham have used the formula to rob Peter to pay Paul - but it's a start but I think that in the current climate it's probably unlikely to expect anything else.
    Just as a post script, for those who are interested, my first nurse manager post was in mental health in 1979, the month after the Conservative government were elected. I moved into medicine/health care of the elderly in a large acute teaching trust in the late 80's but it was not until 1997 when the Blair government were elected that I ever benefitted from development monies to increase the nursing establishment. OK - I know that things were not perfect but I always felt that it was a government that genuinely did want to improve services for all.

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  • deja vue, we had ' Monitor', not to be confused with the more recent 'monitor', aimed to do the same years and years ago. It worked until financial constraints ensued.

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  • We spent almost as much time filling in forms and trying to calculate PRN scores for patient dependency and staffing levels at midday and the end of the morning shift as we did by the bedside. This time spent in the office at the end of the morning shift often made us late for distributing the patients' lunch, the drug round, our own half an hour meal break and created overtime for those going off duty. It put the team under a lot of extra stress to get everything done and complete the forms.

    They were a rough guide rather than an accurate measure as the condition of patients and the care they need is constantly changing and also the perception of the care needed was subject to the individual perceptions of nurses filling in the forms!

    The system was purchased at great expense from Canada ten years after its inception in hospitals there where it had been written off as a failure!

    We had to hand them in once every 24 hours to the administration but never notice any effect on increasing staffing levels when we had a higher level of dependent patients and when needed.

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  • Been there and done it all years ago and it was a complete waste of time and money.It took up too much nursing time and will be worse now as staffing levels are worse than theyve ever been.I have just retired but still bank after 50 years in NHS as trained nurse.This was just a paper exercise taking more and more time away from patient care.When it showed we were short staffed and at danger levels nothing at all was done about it.It was an utter load of rubbish and just extra paperwork.I dread to think how nurses will cope nowadays with this with a workload that is already bogged down with unnecessary paperwork.I only bank now and again but everytime i go in there is yet more paperwork.How come that money can be wasted on this rubbish that has already been done, and took time away from patients. Yes it did prove that we needed more staff but nothing at all was done about .Its disgraceful to repeat this using money again from an overspent NHS

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  • When I was in nurse management back in the 80's we were fortunate to have had a very forward thinking/looking director of nursing. She came to the NHS from the private sector and brought with her a wealth of experience.

    She very quickly set up a well tried a tested tool for calculating nursing time versus workload. It was the nurse manager that used it based on information from each ward on predicted workload.

    It also served to ~prove~ statistically our required nursing establishment.
    When each round annually came around to decrease nursing establishment, for financial reasons, arguments were thrown out of the window and each year the nurse managers won their arguments and maintained, indeed, at times even increased establishments. But...in those days, we had balls. I dont think they do nowdays.

    Patient advocacy should go all the way to the top. So NEVER stop fighting their corner

    Lets hope this tool functions as well as it should and here's hoping that nursing powers that be have the balls that we did.

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  • nurses with balls? is this a new variety or were they all male?

    unfortunately we can no longer compare what happened in the 80s - 20 years ago with current day nursing. it is totally different.

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  • GRASP (Grace Reynolds Application and Study of PETO)

    A patient classification system that identifies direct care activities, determines total hours of care, and projects nursing interventions and required staff.

    Anyone remember doing this. Points were given for certain tasks! And points made nurses - according to the managers!

    I remember doing this every night on night shift after midnight and it included the following days staff and tasks set out in order to perform an audit for "time and motion". Allegedly it was the most accurate method of determining how many staff were required on specific wards! Most wards actually posted that they were over staffed! Yet nurses were ran ragged each shift!

    So new tools are simply going over old ground unless they are revolutionary!!

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  • I suppose it is up to us to develop the tools as we are the only ones truly aware of what our job entails and the number of staff hours required.

    the problems in nursing is that we rely too much on exterior non-clinical management.

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  • Anonymous | 22-Mar-2011 11:42 pm

    You're right! The difference between these locally developed 'tools' and nursing Monitor is that Monitor was extensively tested and validated.

    This new local method is only as good as their development and testing processes. And I'm not seeing any references to peer reviewed and published research material here, so I think it's a Mickey Mouse job and probably comes up with the answer they wanted in the first place. Garbage In, Garbage Out!

    And there was me thinking we were to be an evidence based profession...

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