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'Safe staffing guidance is an opportunity too good to miss'


In July 2014, the National Institute for Health and Care Excellence launched its stafe staffing guideline in adult acute wards. This is long overdue, says Liz Rix, but this is also an opportunity too good to miss

This month the guideline from the National Institute for Health and Care Excellence to determine nursing staff requirements in adult acute wards was launched. It is the first specific area to be looked at - others will follow - with NICE currently working on guidance for accident and emergency, as well as maternity staffing. Will this guidance really make a difference?

Having been a nurse for the past 30 years I know we all assess the wards we are working on and the patients we care for, judging whether we feel we have enough staff. This is using our experience and professional judgement.

These first guidelines are a landmark in standardising the setting of nurse staffing establishment at an organisational and ward level. It will help those of us working in acute hospitals to deliver high-quality care that meets patients’ needs and supports our professional judgement. This is the absolute difference. It is not about the number of staff per bed, per shift or per ward, it is about ensuring we have enough staff to meet patient needs on a shift-by-shift basis. For the first time, clarity is given on the processes and factors that should be used systematically to determine the nurse staffing and skill mix needed at any given time.

At University Hospital of North Staffordshire Trust we chose to field test the guideline. It stipulates that required staffing levels must be based on individual patient need. This is important. It demands a bottom-up approach; the ward sister/charge nurse must be involved in setting their staffing establishments. The guidance provides a framework for a systematic approach that takes into account all factors: the patient, the needs of an individual and his/her relatives; the ward environment; the duties of nursing staff; the management of whole teams and the provision of help and support to others.

This guideline must be supported by a toolkit that helps assess patient need. In time, NICE will endorse these.

Once an organisation has set its establishments, the important factor is that these staffing levels are reviewed across the whole organisation biannually, and at ward level on every shift. This must be done using the nursing red flags and monitoring the safe nursing indicators alongside staff and patient-reported indicators.

Feedback from our field test on the guidance has been positive. Nurses found it provided standardisation with an evidence base that could be used and referenced when looking at staffing, which supported their own thought processes. So will the guidance make a difference? Yes, I believe it will.

This evidence-based guidance is long overdue and we embrace the focus on getting nurse staffing right. This is an opportunity to ensure we have consistency in setting numbers, and transparency for boards, staff and our patients. It is an opportunity that is too good to miss.

Liz Rix is chief nurse, University Hospital of North Staffordshire Trust; vice-chair, Association of UK University Hospitals; member of NICE Safe Staffing Advisory Committee.

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Readers' comments (3)

  • This is a commendable action, as long as acute ward follows the good practice and takes into account as to how many staff are on escorts and how many staff stay on the ward on each shift. If for example, the ward has 2 qualified nurses and three nursing assistants to care for 15 patients, it shows transparency
    at this stage. However, if 2 staff are sent away to escort a patient outside the unit, the ward is left short which does not resolve the staffing crisis.

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  • You discuss safe number of staff and that's great but you can have the numbers not the skills. So the tool should take the grades & skill requirements that need to be met

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  • When these figures are being worked out, can someone please give a thought to the staff in care homes whose hours, pay and working conditions are set by owners whose motivation is increasing their own profits. 1 nurse and 2 carers to look after 22 patients for 12 hours is not enough! But hey, the owner lives in Alderley Edge and couldnt give a monkeys! Care Homes need legislation too!

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