15.07.14
Hospitals get new guidelines on ‘safe’ nurse staffing levels
Under strict new guidelines hospitals in England must ensure nurse staffing levels across each of their wards meet satisfactory requirements to ensure safe patient care – but no absolute minimum number has been set.
The National Institute for Health and Care Excellence (NICE) has stated that there is no single nursing staff-to-patient ratio that can be applied across the whole range of wards to safely meet patients’ nursing needs.
However, its latest guidance makes several recommendations to improve nurse staffing levels, which are based around five areas: Focus on patient care; Accountability for ward nursing staff establishments; Responsiveness to unplanned changes; Monitor adequacy of ward nursing staff establishments; and Promote staff training and education.
In particular, the guidelines set out a series of ‘red flag events’ which warn when nurses in charge of shifts must act immediately to ensure they have enough staff to meet the needs of patients on that ward.
The document also wants to ensure patients receive the nursing care they need, including specialist nursing, regardless of the ward to which they are allocated, the time of the day or the day of the week. This includes planning to locate patients where their clinical needs can best be met.
In addition, senior nursing managers must be accountable for the nursing staff roster that is developed from the ward nursing staff establishment.
Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “Safe staffing is more complex than setting a single ratio. The emphasis should not just be on the available number of staff, it should be on delivering safe patient care and making sure that hospital management and nursing staff are absolutely clear on best practice to do this.”
“The guideline states that patient needs must come first when making decisions about safe staffing for nursing on acute wards.”
NICE estimated that implementing the guidance could cost £200m – about 5% of the cost of employing nurses on hospital wards – although it said that in the long run it would save money through improvements in care.
Health secretary Jeremy Hunt said the guidelines were a step forward. He added: “The NHS will be able to give safer care, and patients can have confidence that the right number of nursing staff are on duty.”
The guidance also applies to Wales, although it will now be up to ministers there whether it will be applied.
Commenting on the new NICE guidelines, Prof Sir Mike Richards, chief inspector of hospitals at the Care Quality Commission, stated that he supports the principle that staffing on hospital wards should be based on the needs of patients.
Jane Cummings, chief nursing officer for England, added that each ward needs the right team of staff to provide high quality care for their patients and their individual needs.
“This doesn’t happen by accident – it requires an evidence based approach, clinical judgment and regular monitoring, with the flexibility to quickly adapt to changing circumstances,” she said. “NICE have brought together expert evidence to produce a set of guidelines that hospitals can use to ensure that patients are always at the centre of every staffing decision.”
The Royal College of Nursing has also stated that the NICE guidelines are a positive step which will help hospitals to plan and provide levels of nursing staff to ensure safe and compassionate care.
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