Authors' objectives: The National Institute for Health and Care Excellence (NICE) recently issued guidance on setting safe nurse staffing levels for hospitals. This is partly in response to reports into failures in the NHS (including the Mid Staffordshire inquiries) and research showing the importance of having the right numbers of nurses on wards to ensure safe care. NICE recommends a systematic approach to setting staffing levels. NICE endorsed a tool that estimates staff requirements by assigning patients to one of five categories, based on how ill they are and the typical time taken to care for similar patients (known as acuity/dependency). This tool is the Safer Nursing Care Tool (SNCT). The standard approach to using the SNCT sets staffing to meet the average needs of a sample of patients. There is little evidence that shows how often this means there are enough nurses on the ward to meet patient need or whether other approaches might give better results. For example, if wards often have patients with far higher need for nursing care than average, staffing will often be too low unless the hospital can employ extra staff through an agency (which might be expensive) or move staff within the hospital from wards with excess staff. It might be more cost effective to routinely employ more staff. On the other hand, using the tool this way could mean that there are often too many nurses on some wards. It might be better to plan lower regular staffing, with extra nurses sent to a ward when needed. Our study will examine how patients need for nursing care, as measured by the SNCT, varies from day to day. This will allow us to see how often staffing shortfalls or excess occur, and to explore the costs and consequences of different ways of using the tool and deploying nurses. We will collect information on ward nurse staffing, nurses assessment of whether they have adequate staff and the SNCT measures of patient acuity/dependency in 4 hospitals every day for 1 year. We will compare the daily nursing hours available for each ward to the required hours as calculated by the SNCT, and nurses judgment of the number of staff needed. Using this information, we will develop computer simulation models that consider variability in patient need and availability of nurses to explore scenarios where nurse staffing is based on different approaches to using the SNCT. For example, we will compare the recommended approach with a scenario where regular staffing is set to meet the maximum requirement for nursing care that is likely to occur and a flexible staffing scenario, where routine staffing is set to meet minimum requirement with any additional need met by temporary staff. For each scenario we will estimate costs and how often critical shortfalls of nurses happen, putting patients at risk. We will consider whether staff are likely to be available to fill any shortfalls by looking at the numbers of wards with more staff than required. We will estimate the impact on patient outcomes using results from other studies showing the increased risk of poor outcomes, including death, for patients who experience low nurse staff levels in hospital. The study will provide evidence for the usefulness and accuracy of the SNCT, which is widely used in the NHS. The results of the study will give guidance on the best way of using tools like the SNCT and the costs to the NHS and consequences for patients of different approaches to meet daily change in demand for nursing.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/1419421

Year Published: 2020

URL for published report: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419421/#/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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