The debate around staffing levels is often hotly contested. Recent reports such as Francis, Keogh and Berwick, have reignited the passion felt by many in the profession about the need for safe staffing levels and raised debate over the most effective way to set establishment levels.
At Salford Royal Foundation Trust (SRFT), we have embraced the concept of essential safe staffing levels based on research from Southampton University, King’s College London and the National Nursing Research Unit. This research indicates the quality of outcome-based care decreases if the ratio of registered nurses to patients drops below one to eight; however, we view one to eight as the minimum.
Twice a year we use a validated establishment-setting tool (AUKUH tool) based on acuity and dependency to ensure our staffing levels are accurate. This, combined with professional judgement, ensures we get staffing right for the patients we serve. Daily staffing levels at SRFT are further enhanced by assigning an additional supervisory shift-coordinator on day shifts and allowing a band 7 ward manager to adopt a supervisory role.
None of this is unique to Salford Royal - many trusts in the UK follow a similar approach, certainly in terms of using an establishment setting tool. However, at Salford, we have added two additional concepts to provide assurance to the trust as well as reassurance for patients that we are paying adequate attention to staffing levels. Our senior nursing team has introduced a daily conference call, similar to the organisational daily safety brief used by Cincinnati Children’s Hospital.
The teleconference is chaired by the deputy directors of nursing and includes senior nursing representation from across the acute trust and community services. The aim is to provide an overview of staffing levels on each ward and department and it is an opportunity to assess areas of immediate concern - typically this is done within 24 hours, with a wider window on Fridays to cover the weekend. Swift action can then be taken to address staffing issues. Capacity planning meetings are also held four times daily, in which staffing issues are discussed.
The trust’s Safe Staffing Steering Group has also trialled, and now implemented, staffing boards that are displayed at the entrance to all wards and departments. The boards are one of the first things visitors see when they come on to the ward and provide them with details of the shift coordinator, the numbers of registered and unregistered nurses the ward should have for each shift, and the numbers they actually do have.
The aim of displaying the boards is to share staffing levels with our patients, families and staff in an open and transparent way, to demonstrate the importance we place on maintaining safe staffing levels. Staff were initially concerned that this would lead to potentially difficult conversations with patients and families, but this has not materialised, and in fact we believe the boards provide reassurance that the trust takes staffing seriously, giving patients and families a greater sense of safety.
Simon Featherstone is deputy director of nursing at Salford Royal Foundation Trust