Delivering Care: Nurse Staffing in Northern Ireland

1. Delivering Care: Nurse Staffing in Northern Ireland 9th April 2014 WSCNTL 2014, Kings Hall Leading Care, Leading Teams - Innovating and Supporting Person-Centred Care

3. ‘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.’

4. Why? Professional To promote a shared understanding Finance HR Focus on safe, effective Person-centred Practice

5. 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

6. How did we define the ranges? • PHA • HSC Trusts • DHSSPS • NIPEC • HSCB • HR Reps • Staff side • PCC

7. Phase 1 Adult, hospital based acute care settings in: • General and Specialist Medicine • General and Specialist Surgery

8. 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

9. Outcomes

10. Delivering Care, Part 1

11. Assumptions of the Framework

12. 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.’

13. 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. • Evidence base: • Telford (1979) • Other professions: Consultant Contract Framework (2003) , BASW UK Supervision Policy (2011) • Auditor General Scotland (2002) • Comprises: • Annual leave • Sickness absence • Study leave

14. 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

15. Influencing Factors • Workforce • Environment and Support • Activity • Professional Regulatory Requirements

16. Influencing Factors • Workforce • Activity • Environment and Support • Professional Regulatory Activity

18. Nurse Staffing Range for General and Specialist Adult Hospital Medical and Surgical Care settings

19. So what?

20. How to Use the Framework Section 2 SCENARIOS

22. 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

23. Influencing Factors • Competence skill set to work flexibly • Management of absenteeism • Workforce • Activity • Environment and Support • Professional Regulatory Activity • % Bed Occupancy • Throughput • Acuity/Dependency • Length of Stay • Seasonal Variations • Specialities/ case mix • Geographical layout/room structure • Compliance with professional regulatory standards • Supervision • Accountability and governance requirements

24. Some numbers… 8 specialist beds:

25. 16 general beds:

26. 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)

27. Some numbers… 24 beds:

28. And finally….

29. 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.’

30. 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

31. Focus Groups

32. Focus Groups

33. Focus Groups

34. So..... How do we measure these? Some Questions.... • Is the indicator measurable? • Is this something I have direct influence over to impact? • Will the indicator change positively as a direct result of the implementation of 100% supervisory status? • If that status was removed would the indicator change negatively?

36. People we care for at the Centre Safe, Effective and Person Centred.....