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JUL 28/2014

NICE's safe staffing plans for nursing care in wards

Staff in NHS nursing jobs will have a new set of standards to adhere to following the recent publication of fresh guidance from the National Institute for Health and Care Excellence (NICE) on the best ways of ensuring safe staffing levels are maintained in UK hospitals.

Coming as part of wider government efforts to ensure the staff balance within medical facilities is appropriate and sufficient to meet patient needs at all times, the detailed guidance offers a more practical view of how hospitals can achieve the necessary improvements.

Since the recommendations apply to all cases of nursing care provision in wards, it is important that staff make themselves aware of the ins and outs of NICE's plans at the earliest possible opportunity.

The guidance in detail
The overall priorities laid out by the guidance involve ensuring safe and efficient nurse staffing levels are always in place on hospital wards that provide overnight care for adult patients in England.

NICE calls on leaders to lay down new procedures to gauge and react to capacity issues as and when they occur, with senior nursing managers taking responsibility for updating rosters and other measures.

Responsiveness to unplanned changes is also highlighted as a key priority, as is staff training and education to ensure everyone working for a hospital understands what they are required to provide.

NICE's guidance also includes a number of formulas and universal guidelines that managers can use to determine whether they have the right staffing balance, as well as telltale signs to watch out for that suggest systemic failings are present.

Specifically, it details so-called 'red flag' events, benchmark indicators that should be used to warn nurses in charge of shifts that immediate action is necessary. These include patients not being provided with basic care, such as pain relief or help to visit the bathroom, with appropriate responses possibly including providing more skilled nurses or increasing numbers of staff.

Given that patients' needs differ on a day-by-day basis, it is not possible to set a single staff number that can be adequately applied across all wards in the NHS, but the guidance committee concluded that when each registered nurse is caring for more than eight patients, this is a signal to check that patients are not at risk.

At this point, senior management and nursing managers are recommended to closely monitor red flag events, analyse safe nursing indicator data and take any actions that may be necessary.

Implementation
Although NICE concludes that there will be upfront costs involved in putting its recommendations into practice - depending on existing staff levels - these initial fees are likely to eventually be offset by the long-term savings that accompany the provision of safer care.

For example, reducing the number of infections post-surgery could result in savings of up to £700 million a year, while preventing pressure ulcers could lead to a £1 billion reduction in NHS spending.

Jane Cummings, chief nursing officer for England, said: "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."

Meanwhile, Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, added: "These guidelines are based on best evidence and managers should be using this evidence alongside the expertise of nursing staff."

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