NICE announces the draft guideline for safe staffing in acute inpatient wards

Hospital staff

16 / 5 / 2014 10.56am

Following on from the announcement at the start of the week, that NICE has begun consultation into the guidance for safe staffing for nursing in adult inpatient wards in acute hospitals, we are now able to give you more information about the process plus a link to the draft guidance. Only stakeholders can comment formally on consultations, but organisations can register throughout the development process and contribute from that point onward. Find out more information

In response to the publication of the new draft guidelines, NHS Employers issued a media statement emphasising the importance of local evidence and judgement around staffing levels. Our chief executive, Dean Royles, said: 

"Patient safety is at the heart of the NHS and it’s vital that decisions on staffing are made locally and at the point of care, using robust evidence and looking at the whole picture. This is no easy quick-fix solution. It's not just about numbers, but the right staff with the right skills."

Dean talks further about his views on the draft guidance, in his latest blog Hitting the target but missing the point.

The NICE press release for the publication of the draft guidance is detailed below:

Patient needs must come first when determining safe staffing for nursing in wards 

NICE issues first draft guideline to help the NHS determine safe staffing for nursing on adult inpatient wards.

More than a year after the Francis report revealed care failings at the Mid Staffordshire NHS trust, there are still concerns about how best to ensure we have enough nurses to provide safe care for patients.  

Today, on the anniversary of the birth of Florence Nightingale, NICE has issued draft recommendations on safe staffing for nursing in adult inpatient wards in acute hospitals.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Following on from the Francis and Berwick reports, the Department of Health and NHS England asked NICE to develop evidence-based guidelines to advise the NHS about safe staffing. Our first draft recommendations respond to the immediate expectations set out by the National Quality Board and focuses on wards that provide overnight care for adult patients in acute hospitals.”

On individual wards, the draft guideline highlights the importance of the nursing team’s awareness of patient needs and ‘red flag events’ which are signals that require an immediate response, such as an urgent need for additional nurses. ‘Red flag events’ include patients not being provided with basic care requirements such as help with visits to the bathroom, being asked about their pain levels or delays in providing medicines.

The draft guideline recognises that if each registered nurse is caring for more than 8 patients during the day time on a regular basis, there is an increased risk of harm. It stresses the importance of checking if patient needs are adequately being met in these situations. The lead nurse should consider any ‘red flag events’ as indicators of the ward becoming in danger of being under-staffed and therefore tailor the number of available nursing staff as needed.

Professor Leng added: “There is no floor or ceiling number on the required number of nursing staff that can be applied across the whole of the NHS. What the safe staffing advisory committee concluded was that assessing patient needs was paramount when making decisions about the number of nursing staff and planning should allow for flexibility on a day-to-day or shift-by-shift basis.”

The draft guideline also calls for hospital boards and senior management to take greater responsibility and includes step-by-step guidance on how to determine the number of nursing staff that should be funded. Ensuring there are enough appropriately trained staff should be a consideration as the evidence shows providing a higher proportion of registered nurses in the skill mix contributes to better outcomes for patients.

To support use of the guideline in hospitals NICE will be assessing a range of practical toolkits designed to assist in estimating staffing requirements. Staffing toolkits which comply with guideline recommendations and meet specified criteria will be given the NICE endorsement.

Professor Leng added: “This guideline is an important step forward in addressing the issues of having adequate numbers of nursing staff within the NHS. It is vital that we have the views of relevant stakeholders and we now encourage registered stakeholders to submit their comments via the NICE website.”

The public consultation for the draft guideline closes on Tuesday 10 June 2014. 

Contact: Caroline Waterfield

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