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Staffing levels law will empower frontline nurses

Chief nursing officer for Wales Jean White explains how the Nurse Staffing Levels (Wales) Act responds to changing healthcare needs.
Welsh_Staffing_Levels

Sustaining a sufficient, well-educated nursing workforce that can meet growing healthcare needs is an important challenge in many countries.

Meeting this challenge is leading to greater diversity in the nursing workforce, with new roles being created, existing roles being enhanced and more delegation to other workers.

Some of these changes are being supported through professional regulation, but in Wales they are also supported by legislation.

Phased introduction

The Nurse Staffing Levels (Wales) Act 2016 received royal ascent in March and will be introduced in phases until April 2018. After this, reporting requirements, including to the National Assembly for Wales in 2021, will begin.

This phased introduction will allow the elements of the act to be aligned with the annual planning cycle in NHS Wales.

It will also allow time for the development of guidance on how the act should be

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Sustaining a sufficient, well-educated nursing workforce that can meet growing healthcare needs is an important challenge in many countries. 

Welsh_Staffing_Levels
Picture: Alamy

Meeting this challenge is leading to greater diversity in the nursing workforce, with new roles being created, existing roles being enhanced and more delegation to other workers. 

Some of these changes are being supported through professional regulation, but in Wales they are also supported by legislation.

Phased introduction

The Nurse Staffing Levels (Wales) Act 2016 received royal ascent in March and will be introduced in phases until April 2018. After this, reporting requirements, including to the National Assembly for Wales in 2021, will begin. 

This phased introduction will allow the elements of the act to be aligned with the annual planning cycle in NHS Wales.

It will also allow time for the development of guidance on how the act should be applied in practice. This guidance will be developed with the help of experts, such as the RCN.

The act focuses on two areas:

  • A general duty that requires Welsh NHS organisations to consider what nurse staffing levels are needed to care for patients sensitively.
  • Specific instructions on determining nurse staffing levels in acute adult inpatient medical and surgical wards. 

The general duty comes into force in April 2017 and the specific requirements for the medical and surgical wards come into force in April 2018. 

Nurse decisions

The act is intended to ensure that nurses and managers meet requirements for an appropriate nursing workforce when they are planning and delivering services. 

Unlike other nurse staffing legislation, the act does not depend on minimum numbers or staff-to-patient ratios. Instead, senior nurses determine the nursing establishment appropriate for the patients in specific areas by: 

  • Using an approved workforce tool.
  • Considering patient outcomes, for example in pressure ulcers and falls, on the ward.
  • Applying professional judgement, for example about ward layout and staff experience. 

This triangulated methodology will be described in guidance that is being developed and consulted on this year. The guidance will ensure that all staff are clear about how to create the right nursing establishment. 

Future extension

Improving the nurse workforce in NHS Wales has been a priority for me for many years. A set of working principles has been in place since 2012, and the numbers of funded nursing establishments for medical and surgical wards have increased. 

While these developments augur well for the introduction of the act, its success and extension into other areas depend on the availability of registered nurses. But filling nursing posts will be difficult in the short term because, despite a recent increase in commissions for nurse education places, there is a shortage of nurses internationally.

The Welsh Government is committed to extending the act when the time is right. The development of evidence-based tools is a key preparatory step in this process and such tools are being tested in other service areas, including mental health inpatient wards, community nursing teams, paediatric inpatient and health visiting

These developments have been achieved with the support of nurses from across Wales, and I would like to thank each and everyone one of them for their contributions. 


About the author

Jean_White

Jean White is chief nursing officer for Wales  

 

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