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Nursing directors should 'over-recruit' by 10%, says top manager

Hospital managers should “over-recruit” nursing staff by 10% in order to ensure the best quality care for patients, according to a former nurse who is now chief executive of one of the UK’s leading acute trusts.

Dame Julie Moore, chief executive at University Hospitals Birmingham Foundation Trust, urged nursing directors to be bold and employ more staff in her keynote speech to the Florence Nightingale Foundation annual conference on Friday.

She said the policy, which meant wards were staffed by permanent employees rather than agency staff, not only led to better quality care but could also save trusts hundreds of thousands each year.

However, she said many nursing managers acted like this was “the hardest thing in the world”.

“I tell them to over-recruit but they’re not,” she said. “It’s like it is impossible to over-recruit because it is engrained in them not to go over their establishment.”

“If you interview two good staff nurses for one job then employ them both”

Julie Moore

She advised managers to aim for 10% over-recruitment with the expectation they would end up about 5% over.

“Never allow a good person not to be recruited,” she told the conference. “If you interview two good staff nurses for one job then employ them both.”

Dame Julie, a nurse by background, said she recalled the days when nursing chiefs were actively encouraged to employ around 20% agency staff.

But she said it was now clear that over-reliance on agency nurses harmed standards of care.

Dame Julie Moore

“More than two agency staff per shift on a ward can result in lower quality of care,” she said. “They are unfamiliar with the patients, unfamiliar with the ward and unfamiliar with the overall culture.”

She showed delegates how her own trust’s strong performance had faltered over the winter when a surge in patients meant it was forced to employ more agency staff.

Dame Julie also called on nursing professionals to embrace IT systems with the potential to dramatically improve the safety, efficiency and quality of care.

She said her trust had seen the number of prescription errors plummet after introducing a computerised system that actively stopped doctors and nurse prescribers making mistakes.

IT had also helped increase the speed of referrals and treatment and reduce the number of unnecessary tests.

“Electronically held data can be far more secure than a cardboard folder”

Julie Moore

The use of “clinical dashboards” meant nursing managers could get up to date information about each ward’s performance and compare that across the trust, according to Dame Julie.

“Ward sisters spend quite a lot of time looking at other areas,” she said. “They’re asking questions like ‘How do you get your assessments done so quickly?’ and there’s quite a lot of good competition going on.”

Despite concerns about the confidentiality of electronic patient records, she said she believed “security can be far more rigorous with IT”.

“We have had several high profile patients in our organisations and I think electronically held data can be far more secure than a cardboard folder that gets carried around,” she told delegates.

Readers' comments (10)

  • michael stone

    'But she said it was now clear that over-reliance on agency nurses harmed standards of care.

    “More than two agency staff per shift on a ward can result in lower quality of care,” she said. “They are unfamiliar with the patients, unfamiliar with the ward and unfamiliar with the overall culture.”'

    I wonder how long it took the NHS to 'prove that' - assuming it has been proved.

    Anyway, good luck to Dame Julie - she seems to have a fair grasp of 'common sense', which doesn't seem to be true of everyone in the upper-reaches of NHS management.

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  • In my trust posts must be approved by the executive before even advertising.

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  • tinkerbell

    Dame Julie, if only there were more like you half our struggle would be over and we could do our job.

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  • No, over-recruiting is just as bad as having too few staff as it degrades a staff members standing within the organisation as they know they can be easily replaced. Staff are more likely to toe the line and not raise concerns as they know the organisation isn't really dependent on them. Where's all the extra money coming from for all these nurses who aren't needed, has austerity not hit Birmingham yet? Why not just recruit the staff numbers you need?

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  • If you over recruit by 10% then money will be saved hand over fist. There will be no need for Bank staff or Agency staff that cost twice as much as permanent staff.
    There could well be less sickness as staff will not be physically and mentally over worked.
    There will be less mistakes so that will be more cost effective.
    Patients and staff will be happier and safer.
    If a hospital is well staffed it has no trouble with recruitment. A poorly staffed hospital always has recruitment problems.

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  • There is always a certain amount of staff turn over. Staff leave and then there are shortages because posts are not advertised until the person has left so there will be at least a three month gap before replacement staff can be employed.
    What is wrong with having a few extra staff to cover for all situations.
    Being 10% overstaffed settling at 5%. Is going to be more cost effective that being 5-10% understaffed and backed up by Bank and Agency staff.

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  • tinkerbell

    Sorry to barge in, didn't know where to stick this, probably someone might say somewhere choice, but this is serious! Please sign the petition below as talking about how many nurses we need might be academic if a lot of our hospitals are closed.

    38 degrees is not a political party, it is 'people power'.

    Have a look at this:

    https://secure.38degrees.org.uk/hands-off-our-hospitals

    As early as next week, parliament could award health secretary Jeremy Hunt sweeping new powers to ride roughshod over local patients and doctors and close any hospital in England.

    David Cameron and Nick Clegg have the power to scrap this mad plan - but so far, they've kept their distance. We need to associate this law with them asap if they're going to step in and act.

    I just became one of thousands of people who've signed a petition asking Cameron and Clegg to drop this plan.

    Please sign the petition now:

    https://secure.38degrees.org.uk/hands-off-our-hospitals

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  • I am amazed !

    Finally a nurse "leader" who speaks sense and cares about the well being of patients !

    This lady will be very unpopular with the Chief nurse honcho! Nothing said about how the "C" drivel cures all ills !

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  • When I worked in the prison I used IT to help administer medication. It had a few flaws then, in the program, but if by now the program is improved, then I will like to use IT again.
    It is good to hear some sense from a nurse manager.I was begining to believe they are all not competent for the job at the top. Too much failure at the top level. Something must be done.

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  • We are bound by a vacancy panel to approve any post before it is advertised- the panel made up of senior leadership who are so remote from the wards that you don't even know who they are. Money is the only concern here not quality care.

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