The Framework for Safe Nurse Staffing and Skill mix sets out, for the first time in Ireland, a methodology to determine the appropriate number of nurses and healthcare assistants required for our medical/surgical wards.
Before I formally launched the Framework in April 2018 it was piloted in three sites. Results from the pilots were very positive with evidence of improvements in the quality of care such as reduction in nurse sensitive outcomes, a reduction in care left undone events, increases in staff and patient satisfaction, a reduction in length of stay and absenteeism and reduction in spend on agency costs.
The unique point of the Framework is that it determines the required nurse staffing and skill mix by matching the nursing resource to the type and number of patients on an individual ward and individual patients’ needs. It is built on a rigorous methodology involving complex calculations of a number of elements, including the required nursing hours per patient day, patient acuity and dependency, bed occupancy, indirect nursing hours required, the skill mix required to meet patient needs, patient outcomes and staff and patient experience. As such accurate whole time equivalent requirements and associated costs will only be available when all medical and surgical areas are assessed as part of the implementation of the Framework.
The pilot sites did indicate that additional resources, both nursing and healthcare assistants, were required in those pilot sites. These were met through a mix of additional recruitment and agency conversion. Indicative average figures from one model 4 hospital in the pilot identified additional average recruitment as 2.5 whole time equivalent per ward. (1.1 Health Care Assistant and 1.4 Staff Nurse). This uplift was in addition to conversion of agency. This uplift is an average figure and the pilot demonstrated that some wards required no uplift, some required a skill mix adjustment, some required Health Care Assistants only and some did require more than the 2.5 uplift.
The HSE is currently working on an implementation plan to rollout the Framework to all Model 4 hospitals. An essential part of the implementation is the acquisition and introduction of the supporting ICT system. The procurement process is at an advanced stage.