Staffing for quality care: new guidance

Following the publication of the Keogh¹ and Francis Reports,² both of which commented on the results of poor nursing staff levels in wards, The National Institute for Health and Care Excellence (NICE) was invited by the Department of Health and Public Health England to devise some guidance on safe staffing levels³ – a difficult task, at the best of times. There are tools which provide an evidence base for the decisions, which have yet to be assigned the NICE seal of approval, although this will be the next set of documents to emerge. NICE, however, has recently released its framework for identifying safe staffing levels, which is designed to review capacity and capability and, on a shift-by-shift basis, publicise the data to patients at the ward entrance. There will be a requirement for the Board to regularly review the figures and for them to be discussed at a public Board meeting every six months.

Rapidly changing patient acuity and thus dependency has always made assessment of nursing numbers very difficult, and many of the tools developed have required many hours of dedicated time and training to use them effectively. The nuances of skill mix require an experienced head to plan the staffing numbers required on any one shift, and then adjust the staffing according to patient dependency closer to the time. There are a number of important questions to be asked of a recommendation for safe staffing – some of which we can explore here.

Safe staffing