Safe Staffing in Acute Hospitals

Elaine Inglesby-BurkeExecutive Nurse Director

Salford Royal NHS Foundation Trust

Staffing levels should be:Consistent with the scientific evidenceAdjusted to patient acuity and local contextMade public and easily accessible to patients and carers

NICE will produce definitive guidance on safe and efficient staffing levels in a range of NHS settings

Staffing

Staffing Expectations

1. Boards take full responsibility2. Processes are in place to enable staffing establishments3. Evidence-based tools4. Culture where staff feel able to raise concerns5. Multi-professional approach6. Sufficient time to fulfil responsibilities7. Boards receive monthly updates on workforce information8. Clearly display information about staff present on each

ward/department9. Providers secure staff in line with their workforce requirements10. Commissioners get assurance that the right people, with the right

skills, are in the right place at the right time

The Patient Experience Report provides information about feedback received from Salford Royal’s patients and includes: 1. Near Real-time Patient Feedback question changes

Highlighting the reduction of questions asked 2. The Nursing Assessment and Accreditation System (NAAS) Continually improving picture. 25 wards now at ‘SCAPE’ status. The Community Assessment and Accreditation System

(CAAS) recommenced January 2014 following the recruitment of a Corporate Matron.

The Outpatient Assessment and Accreditation System (OPAAS) commenced in May 2013. 6 areas assessed, 5 green, 1 amber.

3. Staffing Overview Update - link to patient experience, SRFT approach and current actions described within the paper.

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L2 Gastrology 24 28.37 18.28 10.09 64% 36% 0.76 0.42 1.2L3 Cardiology 24 28.48 17.38 11.10 61% 39% 0.72 0.46 1.2L5 Care of Elderly 24 26.77 17.01 9.76 64% 36% 0.71 0.41 1.1L6 Endocrinology 24 26.68 16.85 9.83 63% 37% 0.70 0.41 1.1L4 Care of Elderly 24 27.52 17.80 9.72 65% 35% 0.74 0.41 1.1L8 Care of Elderly 25 26.99 16.86 10.13 62% 38% 0.67 0.41 1.1H2 Respiratory 25 31.70 22.52 9.18 71% 29% 0.90 0.37 1.3

MIU Investigations unit 12 17.80 12.80 5.00 72% 28% 1.07 0.42 1.5HCU Heart Care Unit 10 25.24 21.80 3.44 86% 14% 2.18 0.34 2.5EAU Assessment Unit 55 92.99 65.40 27.59 70% 30% 1.19 0.50 1.7

MHDUHigh Dependency

Unit 8 23.92 18.80 5.12 79% 21% 2.35 0.64 3.0

B1 General Surg 25 26.97 16.98 9.99 63% 37% 0.68 0.40 1.1

B2 General Surg 25 26.97 16.98 9.99 63% 37% 0.68 0.40 1.1

B5 Elective Ortho 12 13.55 7.84 5.71 58% 42% 0.65 0.48 1.1

B6 Ortho Trauma 32 47.53 27.24 20.29 57% 43% 0.85 0.63 1.5

H4 Urology 24 30.86 16.97 13.89 55% 45% 0.71 0.58 1.3

H5 Short Stay surgery 22 18.24 12.73 5.51 70% 30% 0.58 0.25 0.8

H8 IFU 21 35.69 28.35 7.34 79% 21% 1.35 0.35 1.7

DCU Day case unit 19 15.16 12.00 3.16 79% 21% 0.63 0.17 0.8

ICU Critical Care 18 107.90 95.44 12.46 88% 12% 5.30 0.69 6.0

SHDU Critical Care 12 46.29 35.76 10.53 77% 23% 2.98 0.88 3.9

NHDU Critical Care 8 31.68 26.75 4.93 84% 16% 3.34 0.62 4.0

CHU Haematology 8 21.91 16.24 5.67 74% 26% 2.03 0.71 2.7

M3 Dermatology 14 14.00 9.50 4.50 68% 32% 0.68 0.32 1.0

B7 Acute NSU 25 37.71 22.79 14.92 60% 40% 0.91 0.60 1.5

B8 Acute NSU 25 37.71 22.79 14.92 60% 40% 0.91 0.60 1.5

TAU Trauma assess 30 52.99 32.99 20.00 62% 38% 1.10 0.67 1.8

Spinal Unit Short Stay surgery 13 8.65 4.35 4.30 50% 50% 0.33 0.33 0.7

Spinal Unit Complex Spine 17 30.91 17.04 13.87 55% 45% 1.00 0.82 1.8

H7Elective Neuro

surg16 23.70 18.20 5.50 77% 23% 1.14 0.34 1.5

H7 High Care Beds 6 10.40 7.21 3.19 69% 31% 1.20 0.53 1.7

ASU Acute Stroke 18 35.26 22.06 13.20 63% 37% 1.23 0.73 2.0SRU Stroke Rehab 16 26.31 13.11 13.20 50% 50% 0.82 0.83 1.6C1 Neurology invest 17 17.57 12.97 4.60 74% 26% 0.76 0.27 1.0C2 Neuro Rehab 20 34.27 17.05 17.22 50% 50% 0.85 0.86 1.7

The Maples Continuing Care 18 33.76 15.32 18.44 45% 55% 0.85 1.02 1.9H3 Renal Med 25 43.62 27.37 16.25 63% 37% 1.09 0.65 1.7

INRUIntermediate Neuro

Rehab10 34.18 17.18 17.00 50% 50% 1.72 1.70 3.4

ANU Acute Neuro Unit 27 37.48 21.33 16.15 57% 43% 0.79 0.60 1.4

Totals / Average

1257.73840.04 417.69

#DIV/0! #DIV/0!

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Ratios – of what to what? Staff erosion – from plans to reality

Planned staffing (Full budgeted establishment)

Employed staff in post (Establishment minus vacancies)

Available Staff (staff in post minus absent staff)

Planned staff for each shift (off-duty)

Actual staff per shift (Planned minus unfilled gaps)

What’s your role in ensuring staffing levels are safe? Have you got it right in your organisation? What tools are being used to plan staffing to match patient need and workload? Do you know the RN:pt ratios where you work? How do they compare to elsewhere? Are professional guidelines (eg. in to ITU, neonates) followed? Would normative staffing help? How do you know when you've got it right...or wrong? How is quality being measured? Is it being related to differences in staffing?

What can you do?

Safe staffing is your smoke detector for safe care and

improved performance

Know your business