‘A light at the end of the tunnel’

Northern Ireland is implementing a new nurse staffing model, backed by £12 million in extra funding. As well as a 70:30 skill mix between registered and unregistered staff, the model allows for ward sisters to focus solely on their supervisory role. Other major benefits include an increased availability of permanent posts and reduced reliance on bank staff.

It is not only the NHS in England that has been examining its nurse staffing levels over the past year or so; commissioners, trusts and healthcare professionals in Northern Ireland have been working together to develop a new model for staffing that is now being implemented.

An additional £12 million has been found for staffing on medical and surgical wards after a comprehensive review across Northern Ireland. Other areas will also be considered in a phased approach that will extend to emergency departments, district nursing teams and health visitors.

Northern Ireland chief nursing officer Charlotte McArdle says front line nurses are under pressure: ‘This is a commitment to them that we recognise the pressure and we are actively trying to enable them to provide the level of care they want to provide,’ she says.

RCN Northern Ireland director Janice Smyth describes the staffing model as ‘light at the end of the tunnel – it is a significant milestone’. She says many nurses feel overstretched, while ward sisters and charge nurses are often expected to provide clinical care and carry out management and administrative tasks.

The model set out in Delivering Care: Nurse Staffing in Northern Ireland is the culmination of a major piece of work involving the Health and Social Care Board (HSC), the five trusts, the Public Health Agency and the RCN.

This work looked at evidence and produced a range of staffing ratios appropriate for medical and surgical wards, taking into account factors such as patient acuity, ward ergonomics, as well as planned and unplanned leave.

Picture credit: Alamy

As well as a 70:30 skill mix between registered and unregistered staff, the model allows for ward sister and charge nurse roles to be wholly surpervisory. Ms McArdle says this will allow them to spend more time overseeing and supporting nurses. In return, ward sisters and charge nurses will be expected to report on achievement against key performance indicators.

Ratio range

The staffing ratio range set out in the model is between 1.25 and 1.8 staff per bed. An example in the Delivering Care document says this would mean around 22 registered staff and nine unregistered staff for a 24-bed medical ward. A ward sister is also needed, but as this role is supervisory the hours do not form part of the clinical count.

The plan is that trusts should be able to redirect some spending from temporary to permanent staff. Funding of the model also assumes a staff sickness rate of 5%; current rates are above this.

HSC director of nursing Mary Hind says: ‘We only have one pot of money and we have to make sure it is spent well. But it is a wonderful example of commissioning being a tool for change and reform.’

The five trusts must now produce plans to implement the model over the next year. The RCN wants to hear about nurses’ experiences during this implementation, says Ms Smyth. With as many as one in five shifts currently being covered by bank staff, she expects a move to more permanent posts.

A safe staffing case study

The Southern Health and Social Care Trust has assessed staffing needs on its medical and surgical wards and is already increasing its workforce.

An extra £4.5 million was required to implement the new levels, which represent an extra 84 whole time equivalent members of staff – an increase of around 15%. Commissioners have provided £2 million of this and the trust is working with them to find the remaining money needed.

The review looked at workforce profile and skill mix, as well as the level of patient medications and interactions that might require different staff input. The trust also examined possibilities for changing how staff worked, and how additional costs should be offset by reduced use of agency and bank staff.

Nursing director Francis Rice says: ‘There was some trade off, negotiation and compromise, but the bottom line is the safety of patients. We have found there are benefits from involving the commissioners in this process.’

He adds: ‘We have started to offer new rotational programmes to make us more attractive. Previously we could not offer jobs on a permanent basis – and they were less attractive on a bank or agency basis.’

RCN Northern Ireland head of professional development Rita Devlin says that use of temporary staff is one of the indicators that will be monitored. ‘We hope it will have a positive effect on patients and staff,’ she says.

In the longer term, Ms Smyth argues that the wider workforce issues will need to be addressed. Independent nursing homes, for example, are struggling to recruit and many of these homes are a vital part of the health and social care system.

‘We need to look at the population needs and train the appropriate number of skilled and qualified nurses,’ says Ms Smyth. ‘Until we accept the responsibility for doing this as a society we are going to be in a vicious circle’.

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