Pilot staffing project in hospital wards showing real results in retention of nurses, reduction of agency staff and outcomes for patients
Harris announces expansion of the pilot scheme and three year programme of research funding
Minister for Health Simon Harris TD today (Tuesday) said that the Framework for Safe Nurse Staffing and Skill Mix, which has been operating on a pilot basis in six hospital wards, is showing real results in the retention of nurses, the reduction of agency staff and positive outcomes for patients. Minister Harris said “This is an exciting and innovative project which approaches safe nurse staffing and skill mix by matching the nursing resource to the type and number of patients on the ward and their particular needs. I am delighted to extend it to a further 10 wards, within the three current pilot hospitals. I am also pleased to announce the award of a three year programme of research focusing on the impact of the Framework to the team based at UCC, led by Professor Jonathan Drennan.
The Minister said “The extension of the pilot, coupled with the research programme will provide, for the first time in Ireland, a detailed examination of the nursing workforce and its important contribution to patient care. This Framework is about developing safe nurse staffing, which provides safe patient care and outcomes, along with a healthy work environment that attracts and retains our vital nursing staff. The report on the work so far shows that agency use has dropped considerably in some of our pilot wards. For example, one ward saw a decrease from agency use of twenty eight per cent before the pilot to nine per cent agency use after. Meanwhile on the pilot sites, job satisfaction has improved, as has intention to stay. These are all important factors in the retention of nursing staff. The report on the pilots also outlines how the occurrence of Nurse Sensitive Patient Outcomes Measures, such as hospital acquired pneumonia or sepsis, has begun to decrease and patients’ experiences of the health service are improving.”
The Minister concluded, “This project is a welcome demonstration of collaborative work between the Office of the Chief Nursing Officer within the Department of Health, the Health Research Board, and University College Cork led by Professor Jonathan Drennan. I am delighted to witness the positive outcomes so far and look forward to extending this pilot further in the future.”
Notes for Editors
The €2 million pilot project took place in three hospitals ranging in size from small-scale to large scale and incorporated a total of 6 wards. The pilot consisted of two phases- pre intervention phase and the post intervention phase. Some of the interventions required included an uplift of either nursing staff or Healthcare Assistants. This study, led by Professor Jonathan Drennan and supported by a research team from the School of Nursing and Midwifery, University College Cork, measured a number of outcomes associated with the introduction of an evidenced based approach to determining safe nurse staffing and skill mix levels in wards in three pilot hospitals. Data collection included both administrative data as well as the collection of data from patients and nursing staff. An economic evaluation of the cost implications of the programme and the resources required to deliver a national rollout was also undertaken.
The Framework for Staffing and Skill Mix for Nursing identifies four core assumptions which should be used in calculating the number and type of nurses to be deployed on any given ward:
• Individual patient need should be measured to identify the actual demand for nursing care through acuity and dependency measurement for example;
• The skill mix within the nursing team as a whole in addition to the nursing hours required to meet patient need should be assessed to determine the optimum skill mix and number to provide safe, effective and efficient care;
• Monitoring the ward and organisational culture are important indicators of effective leadership that can influence the ward and organisational climate and delivery of safe, effective and efficient care and staff experience;
• The monitoring of patient outcomes of quality and safety including: patient experience, pressure ulcers and falls, along with day to day measurement of safety triggers such as nursing care left undone, can provide a mechanism for both the necessary immediate response and recognition of patient safety concerns in addition to their medium to longer term management across hospitals.
Office of the Chief Nursing Officer
In 2013, the Department of Health appointed Dr Siobhan O’Halloran as its first Chief Nursing Officer at Assistant Secretary level. This appointment will ensure that the role of nursing and midwifery is represented at the highest level in terms of policy making for the health service. The development of the Office of the Chief Nursing Officer (OCNO) continued with the appointment of three Deputy Chief Nursing Officers in 2014 as follows; Dr Philippa Ryan Withero, with specific responsibility for Clinical Governance and Practice; Dr AnneMarie Ryan, with specific responsibility for Nursing and Midwifery Policy and Legislation and; Dr Susan Kent, with specific responsibility for Women’s Health, Child Health and Welfare and Primary Care Services. The purpose of these posts is to maximise the contribution of the nursing and midwifery professions by driving a culture of patient safety through the development of robust systems of accountability and responsibility.
Taskforce on staffing and Skill Mix for Nursing
The Programme for Government (2011-2016) contains commitments for radical reform and restructuring of the health services in Ireland. These include: the planned shift from acute hospital care to primary care; establishment of clinical care programmes; introduction of free GP care; establishment of hospital trusts in addition to financial reform to a “money follows the patient”/purchaser/provider system. There is a clear trend towards greater interdisciplinary integrated care underpinning these changes. The reforms collectively present diverse challenges and indeed opportunities for the nursing workforce.
There is a wide range of challenges associated with determining appropriate nurse staffing and skill mix levels in hospitals and community settings in Ireland. The subject of nurse staffing has been a topic of discussion for a number of years most notably since the publication of The Report of the Commission on Nursing (1998). Ensuring appropriate staffing and skill mix has been referenced in inquiries and investigations, demonstrated by research and is viewed by patients and their carers as a key element in influencing the quality of care.
Objective of the Taskforce
Deciding on an optimal number of nurses is not an easy task. There is a delicate balance to be struck to meet economic, efficiency and patient safety requirements. Achieving this requires that relevant expertise be applied to the decision making process. It was for this reason that Minister Reilly approved the establishment of a taskforce to develop a framework that will determine the staffing and skill mix requirements for the nursing workforce in a range of major specialities. The Taskforce began its work in September 2014. Phase I of the project focused on developing a staffing and skill mix framework related to general and specialist adult hospital medical and surgical care settings. Chaired by the CNO it has a partnership approach to its membership that includes representation from: HSE and Department of Health Acute Hospitals, HSE and Department of Health HR Division, HSE Director of Nursing and Midwifery Services, representatives from the National Clinical Programmes for Acute Medicine and Surgery, HSE Quality Improvement Division, the Irish Association of Directors of Nursing and Midwifery, Staff Associations INMO and SIPTU, and national and international experts in the topic.
The pilot tests the logic of each of the above components and how the framework as a whole can be reliably applied into practice. A pilot planning and implementation group is established to oversee the pilot test in a range of general and specialist medical and surgical wards across a range of acute hospitals of varying size.
The pilot tests:
1) Mechanisms for acuity and dependency measurement and nursing hours per patient day including the necessary ICT infrastructure to support these;
2) The framework safe staffing recommendations against the current staffing profile to determine the extent of the gap/overlap;
3) The extent to which the framework will impact on the stabilisation of the nursing workforce through conversion of agency/overtime;
4) The extent of the impact on patient safety and staff experience;
5) The requirements for future national rollout.