This practice question was published with the kind permission of the Royal College of Nursing
The Royal College of Nursing published a safe staffing for older people’s wards toolkit. Can it be used by nurses to determine whether staffing levels are safe on their wards?
The toolkit provides a practical way to explore nursing staff levels on older people’s wards and to determine if they meet RCN recommendations for safe care. The initial RCN recommendations on safe staffing for older people’s wards were developed in response to public concerns about care quality and patient experience. There is no easy answer to care quality and staffing issues, which probably explains why concerns have been mounting over the past few years. The high profile media coverage afforded to a number of national reports have kept these concerns in the public eye and put nursing in the spotlight (Care Quality Commission 2011, Older People’s Commissioner for Wales 2011, Parliamentary and Health Service Ombudsman 2011, Patients Association 2011, Age UK et al 2012).
The college’s response has pointed out that poor standards of care are often accompanied by an underlying failure in ensuring safe staffing levels and the right level of skill. The RCN supports a focus on the leadership role of the ward sister or charge nurse, but also highlights the need for hospitals and care homes to employ safe numbers of nurses with the correct skill mix. These issues have not been satisfactorily resolved, as the RCN safe staffing work has identified.
Threshold for ideal care
After exploring staffing levels and care quality on older people’s wards across the UK, the RCN report identified that a typical 28-bed hospital ward has six staff on duty for a day shift, on a 50:50 skill mix. This is below a staffing threshold at which care becomes compromised (Figure 1), particularly the aspects that are valued by patients and carers; that is, communicating and comforting. For ideal care it is necessary to improve the skill mix on wards from the average level of 50:50 registered nurse: healthcare assistant/assistant practitioner to the RCN recommended level of 65:35, as well as increasing the total staffing numbers. For a 28-bed ward this equates to eight members of staff on duty for a day shift.
Obviously, it is important that we do not look at staffing numbers in isolation, as having the right number of staff but the wrong attitudes, skills or leadership will not lead to improved care. The full recommendations cover much more than staffing numbers and the full range of factors that are necessary to support safe care are addressed there and in the toolkit.
The toolkit can be downloaded free from the RCN website and applied by anyone who has an interest in improving care in hospital – this might also be a manager, a commissioner or a governor, working together with front line staff to review the structures that are in place.
Safe staffing is everyone’s business, with accountability resting at many organisational levels. Therefore, a co-operative, transparent approach to staffing review is essential. In the current economic climate it is also essential that services demonstrate value and provide an evidence-based rationale for any proposed change. Any call for investment in staffing must further be supported by evidence that patient outcomes will improve and that all measures to work smarter and more effectively have been properly addressed.
References
Age UK, NHS Confederation, Local Government Association (2012) Delivering Dignity: Securing Dignity in Care for Older People in Hospitals and Care Homes. A Report for Consultation. http://tiny.cc/qaocnw (Last accessed: November 5 2012.)
Care Quality Commission (2011) Dignity and Nutrition Inspection Programme: National Overview. CQC, Newcastle upon Tyne.
Older People’s Commissioner for Wales (2011) ‘Dignified Care?’ The Experiences of Older People in Hospital in Wales. Older People’s Commissioner for Wales, Cardiff.
Parliamentary and Health Service Ombudsman (2011) Care and Compassion? Report of the Health Service Ombudsman on Ten Investigations into NHS Care of Older People. The Stationery Office, London.
Patients Association (2011) We’ve Been Listening, Have You Been Learning? Patients Association, Harrow.
Royal College of Nursing (2012a) Safe Staffing for Older People’s Wards: an RCN Toolkit. http://tinyurl.com/cxwz8lz (Last accessed: November 5 2012.)
Royal College of Nursing (2012b) Safe Staffing for Older People’s Wards: RCN Summary Guidance and Recommendations. http://tinyurl.com/cr884ku (Last accessed: November 5 2012.)