NHS FIFE
Board Meeting on 29TH OCTOBER 2014
ADULT GENERAL INPATIENT NURSING WORKFORCE REVIEW 2014
1.
PURPOSE OF PAPER
A comprehensive workforce review has been conducted across all 810 general adult
inpatient beds in the acute and community hospitals involving 38 wards across 7 NHS Fife
sites.
This paper summarises the work undertaken to ensure compliance with the emerging
evidence regarding nurse staffing levels; the work progressed in response to this
proposition, and an investment plan to improve the utilisation of current establishments
within General Adult Inpatient Wards.
Please note this review does not include mental health, learning disability, maternity,
community nursing, paediatric nursing or specialist nursing as these workforce reviews, for
a number of reasons, will be undertaken on a phased basis over 2014/15 and 2015/16.
2.
INTRODUCTION/BACKGROUND
NHS Fife employs 8,834 (7,179 WTE) staff; the highest proportion of clinical staff are
nurses and midwives accounting for 48% (3,437 WTE) of all NHS Fife employees.
Currently, approximately 29% (1,163 staff, 992 WTE)of all nurses in Fife work in adult
inpatient wards across both acute and community hospitals.
This review was initiated primarily as a response to CEL 32 (2011) recommending that
Boards will apply a suite of Nursing and Midwifery Workload Workforce Planning
(NMWWP) tools to inform the decision making of senior nurse managers to support safe,
effective and person centred care.
In undertaking this review consideration was given not only to the outcomes of the tools
but also to the growing evidence base regarding safe staffing levels and emphasis was
placed on staff engagement at all stages of the process resulting in a very robust
workforce review.
This review has been clinically led via nursing and extremely well supported by general
managers and colleagues within finance, human resources and staff side, thus ensuring a
partnership approach throughout.
3.
THE WORKFORCE REVIEW FRAMEWORK
In conducting this workforce review we considered both hard and soft data including:
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Applying the Nursing and Midwifery Workforce tool
Local context
Professional Judgement of Senior Charge nurses
Registered Nurses to Patient Ratio
Registered to Non-registered Nursing Ratio’s
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Quality Data including complaints, clinical quality indicators and DATIX incident
reports
Supplementary Staffing including bank and agency
Roster Management
Supervisory time for Senior Charge Nurses
Staff Experience
Patient Experience
Senior Professional Judgement of Associate Nurse Directors
These data were considered individually and were also triangulated in order to inform an
overall assessment of the staffing needs within each ward.
As a result of this process we are in a position to:
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Identify what general inpatient wards require investment, and by what quantum
Support investment in the role of Senior Charge Nurses by offering protected time to
undertake the range of functions associated with their leadership role to support safe,
effective and person centred care within wards
Outline further pieces of work that are required to support sustainability including
improving roster management and reduction in supplementary staffing.
4. OUTCOMES
Investing in nursing within NHS Fife Adult General Inpatient wards offers the opportunity
to optimise our future workforce to support safe, effective and person centred care as
summarised below:
Workforce
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Ensure safe, minimal nurse staffing levels and staff and public confidence therein
Implement effective rostering
Bank staff will only be used in exceptional circumstances
Create conditions for protected Senior Charge Nurse supervision
All Staff will have an annual KSF review and PDP in place
Core training needs of staff will be met
Person Centred Care
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Reduce complaints regarding nursing care, attitude and behaviours
Improve patient and staff experience
Safe and Effective Care
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Monitor dashboard indicators of quality
Clear escalation processes are in place and used
Optimise likelihood of reductions in falls, pressure ulcers and catheter associated
urinary tract infections
Enhance the role of the Senior Charge Nurse at ward level
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Organisational Effectiveness
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Evidence timely implementation of learning from Significant Adverse Event Review
(SAER) and Rapid Event Investigation (REI)
Improve clinical communication and use of data
Support effective patient flow
Investment in Registered Nurses and Change in Skill Mix
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As outlined in the table below, this workforce review has identified that NHS Fife
should invest in 101 additional registered nursing staff with General Adult Inpatient
Wards. Through improving skill-mix there will be reduction of 34 non-registered
nurses. In total this will require substantive investment of £3,149,446. Due to the
clinical need driving this investment NHS Fife has already committed to a significant
amount of this sum as described in the chart overleaf.
Prioritisation of Spend and progress to date
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The outcome of the work in all wards was subject to further scrutiny by the senior
nursing team, in collaboration with staff side colleagues, resulting in a prioritised list
of all 38 wards in order of need for investment. The table below highlights the
priorities identified in each of the delivery units and also summarises the progress to
date in recruiting to the identified need.
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Investment in the Senior Charge Nurse Role
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Optimising effective leadership by releasing 0.2 of the Senior Charge Nurse to
provide a supervisory role within wards will actively support staff to ensure that
patients experience quality care. The visibility of the Senior Charge Nurse at visiting
times will also ensure that the needs of relatives are met.
Ensuring Sustainability
A range of work is being undertaken in tandem to this workforce review to support
sustainability moving forward:
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Reducing spend on Agency and Bank staff: Reducing supplementary staffing by
having adequate substantive staffing in place will support efficient use of resource. In
addition it should improve quality by enhancing continuity of care and team working,
which is directly linked to patient safety and improved patient and staff experience.
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Supporting effective roster management: Any investment plan in nursing must be
supported by effective and efficient roster management. A project is being
undertaken between now and March 2015 to offer (a) education for senior charge
nurses, (b) every ward having an independent roster review resulting in a tailored
ward level action plan, and (c) a follow up review being undertaken to review
outcomes and support sustainable change.
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Recruitment Processes: Student nurses were recruited on completion of their
training in September. Targeted advertising to promote nursing within acute and
community hospital is underway. Block interviews are planned for 27th October 2014.
Advertising and block recruitment process will be taken forward on a planned basis
according to need.
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Promoting Nursing Careers in NHS Fife: A promotional campaign will commence
in November 2014 including (a) launching a nursing career framework and displaying
posters widely across NHS Fife, (b) increasing the information on nursing careers
available on the intranet and internet, (c) road show across Fife, and (d) use of social
media including Facebook and Twitter.
GOVERNANCE REQUIREMENTS
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Clinical Governance
The Adult General Inpatient Nursing Workforce Review 2014 report comes directly
to the Board as workforce is essential todelivering safe, effective and personcentred care.
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Staff Governance
The workforce review was undertaken in partnership with colleagues in staff side
and has been discussed at both Local Partnership fora and the Area Partnership
Forum.
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Financial Governance
There are additional funding requirements outlined clearly within this paper. This has
been developed in partnership with the Director of Finance.
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6.
Information Governance
A strong emphasis has been placed on sharing information at all stages of this
process with the workforce support open and transparent communication.
EQUALITY & DIVERSITY
There are no direct implications for equality & diversity. Any recruitment processes will
be managed in accordance with recruitment standards.
7.
SERVICE USER INVOLVEMENT
Consideration was given to patient experience as part of this review including the
Scottish Patient Survey results (2014) and complaints data as a key quality measure.
8.
RECOMMENDATIONS
This review provides NHS Fife Board with an understanding of the methodology and
engagement process applied to produce the proposal for the investment required within
general adult inpatient wards, and to meet evidenced based recommendations in
relation to safe nurse staffing levels.
The proposal raises staffing levels in general adult inpatient wards by way of the
recruitment of 101 WTE Registered Nurses and a reduction of 34.5 non-registered posts.
Investing in nursing services offers the opportunity to improve both staff and patient
experience as we strive towards delivering high quality care within inpatient services.
Fife NHS Board is asked to approve the investment in the nursing workforce as
described.
PROFESSOR SCOTT MCLEAN
Director of Nursing
NHS Fife
29 July 2017
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