Transcript Safe Staffing in Acute Hospitals

Safe Staffing in Acute
Hospitals
Elaine Inglesby-Burke
Executive Nurse Director
Salford Royal NHS Foundation Trust
Staffing
Staffing levels should be:
Consistent with the scientific evidence
Adjusted to patient acuity and local
context
Made 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 Expectations
1.
2.
3.
4.
5.
6.
7.
8.
Boards take full responsibility
Processes are in place to enable staffing establishments
Evidence-based tools
Culture where staff feel able to raise concerns
Multi-professional approach
Sufficient time to fulfil responsibilities
Boards receive monthly updates on workforce information
Clearly display information about staff present on each
ward/department
9. Providers secure staff in line with their workforce requirements
10. 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.
Beds
Budgeted Establishment
wte
Registered Nurses
Un-registered Nurses
Registered Nurses
Un-registered
Nurses
Registered Nurses
Un-registered
Nurses
Nurse to bed ratio
28.37
28.48
26.77
26.68
27.52
26.99
31.70
17.80
25.24
92.99
18.28
17.38
17.01
16.85
17.80
16.86
22.52
12.80
21.80
65.40
10.09
11.10
9.76
9.83
9.72
10.13
9.18
5.00
3.44
27.59
64%
61%
64%
63%
65%
62%
71%
72%
86%
70%
36%
39%
36%
37%
35%
38%
29%
28%
14%
30%
0.76
0.72
0.71
0.70
0.74
0.67
0.90
1.07
2.18
1.19
0.42
0.46
0.41
0.41
0.41
0.41
0.37
0.42
0.34
0.50
1.2
1.2
1.1
1.1
1.1
1.1
1.3
1.5
2.5
1.7
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
T AU
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
16
23.70
18.20
5.50
77%
23%
1.14
0.34
1.5
6
10.40
7.21
3.19
69%
31%
1.20
0.53
1.7
18
16
17
20
18
25
35.26
26.31
17.57
34.27
33.76
43.62
22.06
13.11
12.97
17.05
15.32
27.37
13.20
13.20
4.60
17.22
18.44
16.25
63%
50%
74%
50%
45%
63%
37%
50%
26%
50%
55%
37%
1.23
0.82
0.76
0.85
0.85
1.09
0.73
0.83
0.27
0.86
1.02
0.65
2.0
1.6
1.0
1.7
1.9
1.7
10
34.18
17.18
17.00
50%
50%
1.72
1.70
3.4
27
37.48
21.33
16.15
57%
43%
0.79
0.60
1.4
#DIV/0!
#DIV/0!
MHDU
H7
H7
ASU
SRU
C1
C2
T he Maples
H3
ANU
Speciality
24
24
24
24
24
25
25
12
10
55
Ward
Division
Division of Salford Health Care
Division of Surgery
Division of Clinical
Support & Tertiary
Medicine
Division of Neurosciences & Renal Services
Gastrology
Cardiology
Care of Elderly
Endocrinology
Care of Elderly
Care of Elderly
Respiratory
Investigations unit
Heart Care Unit
Assessment Unit
High Dependency
Unit
L2
L3
L5
L6
L4
L8
H2
MIU
HCU
EAU
INRU
T otals /
Average
Current Skill
Mix %
Elective Neuro
surg
High Care Beds
Acute Stroke
Stroke Rehab
Neurology invest
Neuro Rehab
Continuing Care
Renal Med
Intermediate Neuro
Rehab
Acute Neuro Unit
1257.73
840.04
417.69
Wte Ratio per bed
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 can you do?
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?
Safe staffing is your smoke
detector for safe care and
improved performance
Know your business