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Delivering Care: Nurse Staffing in Northern Ireland 9th April 2014 WSCNTL 2014, Kings Hall Leading Care, Leading Teams - Innovating and Supporting Person-Centred Care ‘Mrs Harry denies a series of charges dating between 1998 and 2006 and related to alleged failures to ensure adequate nursing staffing levels and appropriate standards of record keeping, hygiene and cleanliness, administration of medication, provision of nutrition and fluids and patient dignity.’ Why? Professional To promote a shared understanding Focus on safe, effective Person-centred Practice Finance HR Why Define a Range? • Reasonable starting point • Not prescriptive for every minute of each shift • Variety of factors influence planning processes Page 4, 2.10 - exceptions How did we define the ranges? • • • • • • • • PHA HSC Trusts DHSSPS NIPEC HSCB HR Reps Staff side PCC Phase 1 Adult, hospital based acute care settings in: • • General and Specialist Medicine General and Specialist Surgery Process Underpinned by: • Existing academic knowledge • Existing information of current workforce picture from HSC trusts • International and national intelligence around workforce planning in nursing • External Critical Review • Engagement with stakeholders Outcomes Delivering Care, Part 1 Assumptions of the Framework Staffing Ranges Assumptions of the Framework Key Performance Indicators PUAA Skill Mix Management of Recruitment Influencing Factors Key Performance Indicators Phase 1 Organisational: • absence rates within nursing and midwifery teams; • normative staffing ranges - including vacancy rates. Safe and Effective Care: • incidence of pressure ulcers • falls • omitted or delayed medications Patient Experience: • consistent delivery of nursing/midwifery care against identified need • involvement of the person receiving care in decisions made about their nursing/midwifery care • time spent by nurses and midwives with the patient ‘Should quality indicators begin to fall below the accepted level of achievement, staffing levels should be reviewed as one of the lines of enquiry of attributable causes.’ Planned and Unplanned Absence Allowance What is it? Periods of absence from work, which are expected or unexpected and, therefore, factored into the workforce planning process. Comprises: • Annual leave • Sickness absence • Study leave Year 2013 Annual Leave: 15% Evidence base: • Telford (1979) • Other professions: Consultant Contract Framework (2003) , BASW UK Supervision Policy (2011) • Auditor General Scotland (2002) Sick Leave: Study Leave: 5% 4% Total Allowance 24% Assumptions of the Framework • Skill Mix – 70:30 general medicine and surgery; other care settings will vary • Management of Recruitment- nursing vacancies are filled within a prompt timescale • Influencing Factors Influencing Factors • Workforce • Environment and Support • Activity • Professional Regulatory Requirements Influencing Factors • Workforce Term Used How is this defined? Impact? % Bed Occupancy A measurement of the percentage of time that beds are occupied, measured at midnight. Day cases and ward attendees are excluded from the calculation. Average Daily Occupied Beds ----------------------------------------Average Daily Available Beds x 100 Capturing bed occupancy at 12.00 midnight only can result in substantial activity and workload being omitted. Comparing bed occupancy at 12.00 midday and 12.00 midnight can provide valuable management information. The Government’s Emergency Services Action Team (ESAT) report in 1997 included analyses showing that in acute hospitals, average bed occupancy rates over 85% are associated with rapidly growing problems in handling emergency admissions. • Activity • Environment and Support • Professional Regulatory Activity Nurse Staffing Range for General and Specialist Adult Hospital Medical and Surgical Care settings So what? How to Use the Framework Section 2 SCENARIOS WS/CN WS/CN WS/CN/ • Use the influencing factors • Analyse care setting • Use existing workforce tool • Determine Required Funded Establishment • Calculate point on the range • Discuss findings • Agree action plan ADN/LM EDoN/ ADN • Approve plan Painting a Picture… 24 bedded medical ward with: • 8 specialist respiratory beds for people with increasing dependency related to respiratory needs e.g. use of Non-Invasive Ventilation (NIV) • 16 general medical beds Influencing Factors • Competence skill set to work flexibly • Management of absenteeism • Workforce • Activity • • • • • • % Bed Occupancy Throughput Acuity/Dependency Length of Stay Seasonal Variations Specialities/ case mix • Environment and Support • Geographical layout/room structure • Professional Regulatory Activity • Compliance with professional regulatory standards • Supervision • Accountability and governance requirements Some numbers… 8 specialist beds: 16 general beds: Some numbers… Total registered staff = 24.63 WTE Total unregistered staff = 10.32 WTE Funded Establishment = 34.95 WTE Total Nursing / bed = 1.46 (1.79(8)/ 1.29 (16)) Skill mix = 70:30 (does not include any time for Ward Sister Charge Nurse Allocation) Some numbers… 24 beds: And finally…. Ward Sisters/Charge Nurses.... Page 10, Part 1, Section 1 states: ‘Skill mix should take account of an allocation of 100% of a Ward Sister’s/Charge Nurse’s time to fulfil their: ward leadership responsibilities; supervise clinical care; oversee and maintain nursing care standards; teach clinical practice and procedures; be a role model for good professional practice and behaviours; oversee the ward environment and assume high visibility as nurse leader for the ward.’ Supervisory....... What they said.... • Highly visible • Visible to patients and their families/carers • Visible to other members of the Multi-professional team • Leading and directing towards shared goal and vision • Support and teach team • Role model • Deal with underperformance of staff members efficiently • General performance management Focus Groups Personal and professional Team Patient and family/carers Increased job satisfaction Improved support Improved patient experience Better time management Improved visibility Patients, families and carers better informed Better planning Improved team morale Patient flow improved Less stress Increased team job satisfaction Key Performance Indicators and dash boards improving Less work completed at home Training needs met Diffusing difficult issues Being visible Reduction of SAIs Reduced length of stay Being able to complete managerial tasks Improved team communication Promote good standards of care Focus Groups Personal and professional Team Patient and family/carers Implement new initiatives Valuing team and individual contributions Promote communication Better overview of the ward Teach staff Improve the patient journey Better management of sick leave Training needs met Expedite discharge Able to attend multiprofessional meetings Recognise teams strengths and weaknesses Manage – not crisis manage Improved handovers Able to be a role model Improved induction for new staff Be able to get breaks! Succession planning Focus Groups Personal and professional Team Record keeping up-todate Pastoral support and care of team Dash board figures up-todate Complete appraisals Oversee standard of care Talk to patients and their families/carers Heaven! Patient and family/carers So..... How do we measure these? Some Questions.... 1. Is the indicator measurable? 2. Is this something I have direct influence over to impact? 3. Will the indicator change positively as a direct result of the implementation of 100% supervisory status? 4. If that status was removed would the indicator change negatively? Personal and professional Indicators Team Indicators Patient and family/carers Indicators Increased job satisfaction through survey Increased referrals to Occ. Health Improved standards of care – KPIs and audits Evidence of keeping clinical skills up-todate Increase in return to work interviews Increased standard of patient experience – patient satisfaction surveys Reduction in SAIs and near misses Improved competence Reduction in formal complaints Increase in number of appraisals being completed Increased job satisfaction – survey Increase in written compliments Increase in supervision being completed Training needs correctly identified Reduced length of stay Reduction in personal sickness/absence rates Evidence of celebration of good performance Evidence of improved discharge processes Increase in number of audits completed Evidence of succession planning Increased numbers of emails being responded to Reduction in sickness/absence rates Improved standard of record keeping practice Increased frequency in team meetings Evidence of increased numbers of innovations being introduced to ward Increased frequency in safety briefings Better management of off duty rosters Mandatory training for all staff up-todate People we care for at the Centre Safe, Effective and Person Centred.....