HCA/AP workforce is part of ‘safe staffing’, says NICE

Abstract

NICE publishes safe staffing advice NICE provides evidence-based guidance, quality standards and performance metrics and information services for professionals working in the NHS (www. nice.org.uk). In July, NICE published its safer staffing guideline for the NHS (NICE, 2014a). The guideline focuses on nursing in adult inpatient wards in acute hospitals. NICE makes explicit throughout that ‘nursing staff ’ refers both to registered nurses and HCAs and APs. While the guideline is focused on adult acute services, we can expect further work to examine maternity, mental health and other services in due course. Patient care is taken as the starting point of the guideline. The guideline emphasises that patients should receive high-quality care, regardless of the time of day, day of the week or type of clinical need. Nurse managers responsible for planning staff requirements are expected to consider both planned (e.g. annual leave) and predictable (e.g. seasonal variations) variations in demand for services and, therefore, staffing requirements. NICE emphasises the importance of staffing requirements being seen within the context of organisations as a whole. Thus, any deficits in the numbers of nurses, HCAs and APs on one ward should not comprise staff on another ward. So too plans should include provision for staff training and development. The guideline identifies a number of factors that could impact on staff requirements: Patient needs, including factors that can increase staffing, such as end-of-life care, difficulties with cognition and confusion. Ward layout and size, as well as expected patient turnover. Activities and responsibilities other than providing direct patient care, for example, communicating with relatives and carers and attending meetings. Managers responsible for ensuring patients’ nursing needs are met should systematically assess staffing requirements at least every 24 hours. In doing so they should monitor the occurrence of ‘red flag’ events (see Box 1). Additional events may also be added to the NICE list to meet the needs of each individual service. Services that reach red flag status should immediately escalate the issue. NICE considers ‘an appropriate response may be to allocate additional nursing staff to the ward’. NICE emphasises that there is no single staff-to-patient ratio that can be applied nationally. However, on the basis of the evidence reviewed, NICE considers there to be an increased risk of harm associated with a registered nurse caring for more than eight patients during day shifts.