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NICE-approved staffing tool helps make strong case for more nurses


A safe staffing tool officially endorsed by the National Institute for Health and Care Excellence will help nurses make a strong case for extra funding and jobs, according to one of its creators.

The Safer Care Nursing Tool gained the stamp of approval from NICE last week to be used alongside its new guidelines for safe staffing in adult inpatient wards, which were launched in July.

The tool recommends appropriate staffing levels based on patients’ sickness and dependency. As well as helping nursing managers set nursing staff establishments, it involves monitoring nurse sensitive indicators – such as infections rates, complaints, pressure ulcers and falls – to check staffing is sufficient to ensure the best care.

“It helps make the case for more funds where more nurses are needed”

Kath Fenton

The tool was created more than 10 years ago by Professor Hilary Chapman, chief nurse at Sheffield Teaching Hospitals Foundation Trust, and Professor Katherine Fenton, chief nurse at University College London Hospitals Foundation Trust.

The tool was devised using evidence from more than 1,000 top performing wards and data from thousands of episodes of patient care. It went on to be adopted by the Shelford Group of 10 leading teaching hospitals and is already used by many other acute trusts.

Professor Fenton told Nursing Times she was “over the moon” the tool had now been endorsed by NICE and hoped this would encourage more organisations to use it. She said it was a powerful resource to back up requests for more nurses on wards, but also to ensure trusts with tight budgets were making the best use of qualified staff.

Fenton_kathKath Fenton

“To me, as a chief nurse, [it means] I have got an evidence-based methodology that tells me what staffing I need on each ward based on the acuity and dependency of patients,” she said.

“It means the rest of the executive team are more likely to agree with what I am saying because I’m not coming from an emotional perspective, I’m coming from an evidence-based factual perspective,” she told Nursing Times.

“In my own organisation I can explain exactly how it works and can then say that whatever it comes up with, we need to fund that for each ward,” she said. “If the ward needs less, then fine, but if we need more, then we need to put the money in.

“It helps make the case for more funds where more nurses are needed, but also helps us make good decisions if somewhere has got too many” added Professor Fenton.

“National recognition of the importance of safe and robust staffing is a great step forward”

Hilary Chapman

She said the tool was also valued by frontline nurses who had found previous methods of working out staffing levels “hugely labour intensive”.

“They like using this because it is simple and easy,” she said. “They see the evidence after they have run the data collection and see the staffing levels change.”

However, she stressed the tool did not over-ride nurses’ professional judgement and the results were only valid if the tool was used correctly following a series of “red rules”.

Professor Chapman added: “National recognition of the importance of safe and robust staffing is a great step forward.”


Readers' comments (8)

  • I have been asking for an intelligent tool for years to help with allocation of safe staffing levels.
    I do not know anything about this tool, but it appears the professor is happy with it, so I am grateful for a positive step. I am sure in years to come as with any progression it can be adapted with the use of updated technology.
    I have seen too many wards' allocations that are so unbalanced, its almost unbelieveable in this advanced age. It's almost like allocations are done by someone with no or little understanding of nursing and caring.

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  • Unfortunately for community staff we have no cap on the amount of patients are added to our caseload. On a ward when your beds are occupied you can't fill them with more patients, that is what working in the community is like, having an unlimited number of patients being allocated to your bed spaces.

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  • It's great to have a 'tool' for working out staff/patient ratios. However,in a profession where the needs of patient's healthcare is constantly in a state of fluctuation, it will be impossible to put into practice in the current management of the NHS strategic plan.
    Patient care, in my opinion, should be carried out by experienced nurse practioners, but with the attitude adopted by the present minister of health responsible for running his department, there is little to no support what so ever.
    He claims there isn't enough money in the NHS budget to give staff a 1% pittance of a pay rise this year! without making further cut backs in staff.
    Yet, as with all the other MP hypocrites in government, will be paid a 9% pay award, in addition to all their, so called expense, and, I believe a £300 for just turning up to work as an MP.

    Yes, money is wasted in the NHS, but it should not be the reduction of frontline nurses who take the brunt of it all.

    I was lucky, I was born just around the time the NHS was started, and as a working adult, I was only too pleased to work within it to show my appreciation. By the time I retired, aged 50yrs, under a Tory government, I was glad I could get out of a rapidly deteriorating service, because I was no longer able to offer patients the high standard of care. Needless to say, I was sad to leave my profession, but the workplace became a nightmare for me and I became depressed and no longer felt I could cope with the stress my managers imposed upon me.

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  • I remain unconvinced that the SNCT is evidence-based in the usual scientific meaning of the term. The references and bibliography section of their standard brochure (to which your article links) contains nothing that looks like peer-reviewed research, and includes an item (Hurst, 2005) that was commissioned by directors of nursing at AUKUH hospitals, many of which overlap with the Shelford Group.
    While I agree that something is better than nothing when it comes to setting staff numbers at a safe level, the SNCT is a very blunt instrument indeed.

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  • Surely a tool should be made compulsory rather than trusts being encouraged to use it. This tool would not work in the area where I work - busy outpatient area which is constantly understaffed. Nursing takes place in areas other than wards!

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  • michael stone

    Anonymous | 16-Oct-2014 12:21 pm

    Peer-review does not necessarily mean that research is sound (although it can help) and this one is clearly not easy to quantify. But some sort of 'evidence-based' tool, helps.

    But more fundamentally, the question is 'where do we spend the money' - so it comes down to choices between 'more nurses or more of 'X'', etc.

    And I am also suspicious, about goverment intentions re the NHS. I told someone at my local CCG about 6 months ago, that in my opinion this goverment supported the PCT-to-CCG change, mainly because it knew NHS cash was going to be very squeezed, and the goverment wanted to be able to say 'But WE don't make those decisions any more - YOU and YOUR GPs make the decisions'. I heard a minister (or perhaps a DH spokesperson - can't remember which) saying exactly that on the radio, yesterday I think.

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  • no worries stone always has the answer and will dispute always anything the experts say. better if you donned the uniform and went and got on with the job. we will willingly hand you ours! we are off to look after those, real sick patients, who really need and appreciate expert care and not in the UK.

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  • michael stone

    Anonymous | 20-Oct-2014 7:23 pm

    I only dispute with experts, things they say which I think are flawed. And I definitely do not 'always have the answer' !

    And I'm NOT suggesting that most nurses are anything other than caring and hard-working.

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