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Draft guidance advises 'systematic' approach to A&E safe staffing

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Draft nurse safe staffing guidance for urgent and emergency care services has been released by the regulator NHS Improvement, which backs a “systematic” approach to deciding how many nurses are needed instead of using specifically set ratios.

Previously, staffing work by the National Institute for Health and Care Excellence in 2015 was due to recommend specific ratios for emergency services, but the guidelines were never published after the programme was controversially suspended by the Department of Health and NHS England.

“Interdependence of the roles in the multi-professional team has a direct influence on the number and skill mix of the nursing component”

NHS Improvement

Instead, the new draft guidance published for consultation this week stated that data showing patient acuity and dependency, and consideration of the skills and experience of the multi-professional team should be considered over ratios.

“The interdependence of the roles in the multi-professional team has a direct influence on the number and skill mix of the team’s required nursing component. This makes it inappropriate to prescribe definitive nurse-to-patient ratios,” stated the document.

However, it said the exception was intensive care resuscitation areas, where “professional consensus guidance” – developed by the Faculty of Intensive Care Medicine and the Intensive Care Society in 2015 – had agreed 1:1 or 1:2 nurse to patient ratios were needed.

“We have worked hard to develop these draft resources, by building on existing evidence”

Ruth May

Today’s draft recommendations reflect guidance that NHS Improvement has previously released for other services by highlighting that nurse staffing calculations should be carried out using an evidence-based workforce planning tool, professional judgement and comparison with similar services.

The guidance is designed to help organsiations set and manage nursing establishments – defined by NHS Improvement as the number of registered nurses and heathcare support workers who work in a particular department or team.

The regulator said it was important to distinguish between the number of overall nursing staff that the organisation had budgeted for – the “funded establishment” – and the number of staff actually in post.

It said that in the future, organisations should consider the impact of the nursing associate role in urgent and emergency care departments.

But the regulator urged caution when comparing their use by other employers, noting that associates and other new roles may have different skills and experience at different organisations.

In addition, the guidance highighted that some nurses working as advanced clinical practitioners in emergency and urgent care services were working in roles traditionally occupied by doctors – and that these nurses should, therefore, be considered part of the medical establishment.

The regulator said the amount of time lead nurses spent on supervision should be decided by individual trusts – and advised referring to a recommendation made in the Mid Staffordshire inquiry report that ward nurse managers should operate in a supervisory capacity.

Meanwhile, NHS Improvement said, that while evidence-based tools did exist for calculating nursing staffing levels in emergency departments, none had been validated for use across all services.

“This resource does not endorse any particular tool for implementation,” it said, but added that the guidance provided a list of tools that “can be useful” when considered as part of “the systematic approach” to overall workforce planning.


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Ruth May

Ruth May, executive director of nursing at NHS Improvement, said: “When patients present with urgent and emergency care needs it is important that hospitals have the right staff, with the right skills, at the right time to ensure that they can respond quickly and effectively.”

“We recognise the workforce challenges in the NHS, this resource importantly recommends ways in which trusts can support their teams to be flexible and ensure are there to care for patients,” she said.

“We have worked hard to develop these draft resources, by building on existing evidence and taking the advice of clinicians, academics and stakeholders,” she added

Dr May, who is also deputy chief nursing officer for England, also invited NHS staff, patients and the public to provide feedback on the draft guidance.

“We’re concerned that this new resource…only has the status of advice, rather than being a binding requirement”

Stephanie Aiken

However, the Royal College of Nursing responded by saying it was concerned that today’s draft recommendations would not be viewed as a “binding” requirement.

“Our research shows that across hospital settings, the shortfall of nursing staff is greatest in A&E departments. This demonstrates that there is a clear need for guidance on staffing A&E areas safely,” said RCN deputy director of nursing Stephanie Aiken.

“However, we’re concerned that this new resource from NHS Improvement on staffing in urgent and emergency care only has the status of advice, rather than being a binding requirement,” she said, noting that the RCN was calling for a legal requirement on safe staffing levels.

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Readers' comments (1)

  • Since we are in the UK, not the USA, I take it that you actually mean draught guidance.

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