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“Display staffing levels to show importance placed on safe care”


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


Readers' comments (6)

  • I hate contributing anonymously but I have to today.

    All that will happen when they are short of staff on the wards will be taking nursing staff from theatres and other critical care areas not covered by the staffing levels agreement.

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  • A ratio of 8 to 1 - I take it this is only during the day? Do patients not need the same quality of care during the night?

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  • What is an unregistered nurse. I don't know of such a title. A nurse is a registered nurse not a care assistant.


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  • I hope the system applies not just to wards but other patient areas such as day case settings and theatres?

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  • How does Featherstone know that a staffing level is " correct" ?

    Writing numbers on a board does not ensure good care and patient dependency levels can and do fluctuate from shift to shift and day to day !

    The admission of one or two confused elderly patients can result in chaos erupting on a ward !

    How does "super-nurse" Featherstone deal with ensuring that wards are indeed staffed according to patient dependency/workload on a shift to shift basis?

    Sounds like Featherstone in common with many "nurse managers" does not have a clue !

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  • Displaying staffing level on a board is just a tick box exercise I believe.

    Yeah the board will say X amount of staff are on duty, but the reality is as such and pointed out by J Jones in a previous comment box that patient dependency levels fluctuate from shift to shift.

    Risk assessment can determine the true number of staffing levels that are required especially within the mental health field.
    For example: A ward staff with 2 qualified 2 HCA day time / 2 qualified 1 HCA at night.

    For example A patient is on 1:1 nursing
    care as the level of risk is deemed high.

    Now during the day you are 1 quarter of you staff down and at night 1 third. During any shift if another patient requires A&E treatment / or escorting to another hospital / escorted leave / this impacts on your staffing numbers again.

    Day time staff levels are halved and at night by 2 thirds. It is difficult to provide adequate time and care to patients when working under these conditions all parties can suffer psychologically during these times.

    Now to ensure safe working practice and to provide an emergency response to staff or patient on other wards that may be in danger is near impossible.

    Just some of our everyday scenarios that we have to crisis manage during a course of a shift.

    First question i am asked by management is how many staff have you at the start of a shift, not how am i managing. So displaying numbers on a board helps them but not the staff on the floor.

    Taking staff from other wards or service only impacts on the wards providing staff as they then are short of staff for a period.

    I am sure many of you can identify with similar scenarios during the course of your shift whatever field of nursing you work in.

    I would love to know what formulation they are going to use to determine adequate staffing levels on a ward.

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