Taskforce on Staffing and Skill Mix

The Taskforce on Staffing and Skill Mix for Nursing was established in July 2014.

1.     What is the Taskforce on Staffing and Skill Mix for Nursing?

The Taskforce is a group of experts that will develop a framework to determine the staffing and skill mix requirements for the nursing workforce that take account of a number of influencing factors. Phase I will focus on developing a staffing and skill mix framework related to general and specialist adult hospital medical and surgical care settings.

Phase II will focus on developing a staffing and skill mix framework related to emergency care settings.

Membership of the Taskforce on Staffing and Skill Mix

 2.     Why is the Taskforce needed?

The Programme for Government (2011-2016) contains commitments for radical reform and restructuring of the health services in Ireland. There is a clear trend towards greater interdisciplinary integrated care underpinning these changes. 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. 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. The Taskforce will provide the expertise.

 3.     What are the aims of the Taskforce?

The main aim of the Taskforce is to stabilise the nursing workforce. It will do this by developing a framework to determine the staffing and skill mix requirements for nursing in general and specialist adult hospital medical and surgical care settings (Phase 1) and emergency care settings (Phase II). Further phases will follow that will build on the learning from Phase I and II.

 4.     How will the Taskforce achieve its aims?

The Taskforce developed a staffing and skill mix framework related to general and specialist adult hospital medical and surgical settings based on best available international evidence. This approach is being replicated in relation to emergency care settings (Phase II). The Taskforce will set out clearly the assumptions upon which the framework is determined. It will also make recommendations around the implementation and monitoring of the framework including the necessary education, training, and guidance. Finally, the Taskforce will present a written report to the Minister for Health.

5.     Factors to consider

The framework to develop staffing and skill mix requirements for nursing must retain flexibility in the system while ensuring the safety of patients.

6.     Has anything like this been done before?

In 2014, the NICE Safe Staffing Guideline was published in the UK and Normative Staffing Ranges for Northern Ireland were also published.

7.     What has the Taskforce done so far?

Phase I

An Interim Report and Recommendations on Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Acute Hospital settings has been developed.

To inform the work the Taskforce undertook a range of engagement activities and evidence gathering including the following:

  • it held 14 Regional Meetings across 7 sites, along with an on-line survey option, to gather the opinions and recommendations of front line nurses on the development of the framework and on the draft of the framework;
  • it facilitated a range of presentations and discussion forums with national and international experts, totalling 9;
  • it held specific stakeholder briefings with groups, for example the Irish Association of Assistant Directors of Nursing and Midwifery;
  • it undertook a review of the relevant literature and research evidence;
  • it also circulated 6 newsletters at key project milestones out to clinical services and key stakeholders.
  • In 2016 a pilot to test the capability of the Framework to deliver on its intended outcomes was commenced. The pilot is being undertaken across 3 hospital sites. A 3 year programme of research to develop, test and evaluate the longitudinal impact of the Framework is being undertaken in collaboration with the HRB and UCC. To date there are 2 Policy Impact Research reports available.
  • A project of work is also being undertaken to review and pilot a new approach to deliver Enhanced Care (previously 1 to 1 specialling).

Phase II

The Steering Group for Phase II was established in January 2017. A similar approach to that of Phase I is being undertaken to develop this Framework, which focuses on Emergency Care settings. Draft assumptions were compiled and presented a t a series of national consultations. Overall 4 consultation sessions were undertaken across the country. 3 briefing sessions for stakeholders were also hosted. The feedback from these sessions was collated and utilised to amend the Assumptions. Currently work is underway to develop a draft framework.

8.     So what’s next?

Phase I

Testing the capability of the Framework to deliver on its intended outcomes is ongoing with the latest Policy Research Impact Report due shortly.

Phase II

Development of the Framework continues to progress.

Interim Report and Recommendations by the Taskforce on Staffing and Skill Mix for Nursing.

Evaluation of the ‘Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-Mix’