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Draft NHS staffing guidance issued for children's wards and neonatal services

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NHS Improvement has released draft safe staffing guidelines covering children and young people’s inpatient wards, and also acute inpatient neonatal services.

The draft guidance documents were published on Monday by the regulator, along with similar guidance for urgent and emergency services.

As there is not currently a standard model for children and young people’s inpatient wards, NHS Improvement said its guidance was for all inpatient wards caring for infants, children and young people under the age of 18.

Similar to its other staffing documents, NHS Improvement recommended a “systematic” approach that uses an evidence-based workforce planning tool, professional judgement and comparison with staffing decisions made on similar wards – to act as a “sense check”.

It also highlighted that, while nursing establishments included registered nurses and healthcare assistants, ward staffing may include allied health professionals and other support workers.

According to the document, all children and young people should have access to a registered children’s nurse 24 hours a day, which should be factored into the budgeted establishments.

“This is particularly important in acute trusts and district general hospitals where the children’s service is frequently a small department,” stated the guidance.

In addition, each ward should always have at least two registered children’s nurses on duty, irrespective of its size or layout, said the document.

“This improvement resource offers clinical managers clear and easy guidance”

Michelle McLoughlin

Any workforce planning tools used should take into account the acuity and dependency of patients – and should also factor in the impact of parents and carers on the ward team.

“Most parents or carers will stay in the hospital, making a significant contribution to their child’s care and wellbeing. However, they also require support, information and often education and training to enable them to care for their child in partnership with hospital staff,” noted the guidance.

“In some circumstances it may prove difficult for parents and carers to stay, visit daily or remain for long periods with the child or young person…The child or young person will then depend more on staff for fundamental care, stimulation and emotional support,” it added.

In addition, the effect of escort and specialling duties on workload needs to be considered when making staffing decisions, it said.

If a workforce planning tool does not cater for this, the guidance said “local data collection and analysis may help in determining a percentage to add to the establishment to ensure staffing can respond to daily patient care need”.

Meanwhile, organisations should increase staffing levels on top of their calculation to account for time spent away from the ward by staff – such as for training or maternity leave – commonly known as “uplift”.

“Even under the most restricted of budgets…it is still possible to create the right teams to care for children… in the best possible way”

Michelle McLoughlin

When drawing up the guidance, experts reviewed research on staffing systems for children and young people’s wards, and found organisations included an uplift of between 21.6% and 23.5%.

“Time-out percentages (uplift) should be explicit in all ward staffing calculations. Managers should articulate any reasons for deviation from the 21.6% to 25.3% range emerging from the evidence review,” said NHS Improvement in its guidance.

Work on both sets of new draft guidance was led by Michelle McLoughlin, chief nurse at Birmingham Women’s and Children’s NHS Foundation Trust.

In the introduction to the children’s document, she said: “This improvement resource offers clinical managers on the front line clear and easy guidance to help them understand all the information that’s out there and adapt it to suit their needs – something that’s never been available before.

“And even under the most restricted of budgets, this approach proves that it is still possible to create the right teams to care for children, young people and their families in the best possible way,” she added.

Meanwhile, in the draft staffing guidance for neonatal services, Ms Mcloughlin reiterated that staffing decisions should be made using a workforce planning tool that accounts for dependency, professional judgement, and comparison with other services.

The guidance recommends the Dinning neonatal nurse staffing tool should be used alongside information from the BadgerNet database, which sets out workload based on activity.

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As per existing government guidance, the document said the minimum number of nursing staff to neonatal babies should be 1:1 in intensive care, 1:2 for high dependency care and 1:4 for special care.

Among nursing staff, the minimum proportion of registered nurses or midwives should be 80% for intensive and high dependency care, and 70% for special care, said the draft guideline.

Ruth May, executive director of nursing at NHS Improvement, said the regulator was now seeking input on the draft guidance from NHS staff, among others, before the final versions were published.

“Children and young people are cared for across our NHS, from local hospitals to national specialist centres and we have an international reputation for great neonatal, children and young people care,” she said.

“Our latest staffing improvement resources in neonatal and children and young people set out clearly that when designing the staffing for these services, organisations must focus on the needs of young people,” she added.

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Readers' comments (1)

  • Being a registered nurse, neonatal trained, I cannot understand how only 80% of staff caring for infants requiring intensive or high dependency care need to be 'registered nurses or midwives'. How many mothers would be happy for anyone without the neonatal intensive care course to care for their infant, and what could they possibly do for these infants who are supposed to be cared for 1:1. As for the ratio of 1 member of nursing staff to 4 special care babies, obviously no member of staff will ever take a break for food or any other reason. With 30 unregistered staff caring for the special care babies, who will have overall responsibility? Surely not the registered nurse who also has 4 'special' babies to care for. Remember these are the difficult feeders, the oxygen dependent and the neonatal abstinence syndrome babies weaning on morphine and who need constant cuddling and attention. Could this be the reason there is such a shortage of neonatal nursing staff!

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