Employers have said they want more information from the Welsh government about how senior nurses in charge of calculating staffing levels will be held accountable under new laws in Wales, as well as further details on the sanctions that could be applied to health boards.
The NHS trusts and health boards also said they wanted to see a clear statement about which nurse should hold the responsibility for calculating nurse staffing at each organisation, when the Nurse Staffing Levels (Wales) Act 2016 is fully introduced next year.
Their comments come in response to a government consultation on statutory guidance that will be used to bring in the new law on NHS adult acute medical and surgical inpatient wards from April 2018.
- Welsh Assembly passes ‘historic’ nurse staffing levels bill
- Welsh nurse staffing levels bill receives royal assent
The draft guidance states a “designated person” at each local health board or NHS trust must calculate nurse staffing levels and that they must be a registered nurse or midwife.
It says this person should carry out the calculation on behalf of the board and should be of “sufficient seniority” – suggesting this could be the director of nursing.
But following the consultation, which ran from December until April, it was revealed that 25% of the 12 local health boards, NHS trusts and other affiliated bodies taking part in the consultation believe the guidance should state that the designated person must be the executive director of nursing.
In addition, 67% of the 21 individual NHS staff members responding to the consultation said the designated person would need to have “an acute understanding” of the issues on the ground and that ward managers should be able to feed into staffing decisions.
Meanwhile, in a report on the consultation published last month, concerns were frequently raised by around a quarter of the health boards and NHS trusts about how the designated person would be held accountable, and how the health board would be sanctioned, if they did not comply with the new legislation.
The act requires the designated person to calculate staffing levels using professional judgement, an evidence-based workforce planning tool, and by considering the acuity of patients and how far they are sensitive to nursing care.
- Nurse delegation to HCAs covered by Wales staffing law
- What new Welsh legislation means for frontline nurses
Meanwhile, health boards and NHS trusts in Wales will be legally required to ensure nurse staffing levels are worked out and maintained at the calculated level.
Just over 40% of health boards and NHS trusts said a specific workforce planning tool should be identified within the guidance.
A quarter of employers also said it should be “clearly stated that it would be the designated person from the professional nursing structure… that advises on professional judgement”.
In addition, almost a fifth of employers noted that if a specific workforce planning tool were not named in the statutory guidance, the use of professional judgment would be less robust.
When factoring in the acuity of patients, the draft guidance states the designated person should consider patient falls, pressure ulcers and medication administration errors.
Almost one in five trusts and health boards said that acute deterioration should also be included in the list of indicators.
Around half of all 59 employers, organisations and staff taking part in the consultation said further guidance for health boards and trusts was needed to explain the workforce planning required to comply with the legislation.
In particular, 58% of employers said it was needed, with a quarter requesting step-by-step tools that are available online.
The Welsh government said it was now redrafting the statutory guidance, taking into consideration the suggestions made during the consultation. It is expected that the final guidance will be published later this autumn.