Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland 2018

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

The Taskforce on Staffing and Skill Mix for Nursing began its work in September 2014. The core objective of the Taskforce is to develop frameworks to support the determination of safe nurse staffing and skill mix (whereby nurse staffing refers to the nursing team including both the nurse and healthcare assistant roles) in a range of major specialities.

The stimulus to establish the Taskforce included the recommendations from:

• an increasing number of high profile health inquiry reports such as the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) and the HIQA Tallaght Hospital Report (2012b)
• the increasing body of research evidence linking components of the nursing resource to patient outcomes. Simultaneously, the Irish health service was and continues to undergo some of the most radical reforms in its history, and collectively these changes and evidence acted as the catalyst to the establishment of the Taskforce

Phase I of the work of this Taskforce focused on the development of a framework for safe nurse staffing and skill mix in general and specialist, medical and surgical care settings.

This final report provides an overview of the approach to the development and testing of the Phase I Framework, and importantly sets out the key information to guide services on how to determine safe nurse staffing and skill mix in general and specialist medical and surgical care settings.

In addition, there are a number of additional supporting evidence documents that are set out further below, and can be read here.

The objectives of the Taskforce were to:

• develop a staffing (nurse and healthcare assistant) and skill mix ranges framework related to general and specialist medical and surgical care settings in acute adult hospitals based on best available international evidence
• set out clearly the assumptions upon which the staffing and skill mix ranges are determined
• make recommendations around implementation and monitoring of the framework including the necessary education, training, and guidance required
• present a written report to the Minister for Health

On this basis this final report:

• provides an overview of the approaches taken to develop the framework, including key findings and summary recommendations from evidence and engagement. An overview of this is provided in Section 1; Chapter 2.
• provides an overview of the approach to testing the Framework components in Section 1, Chapter 2.
• outlines the Framework components, inclusive of a step-by-step guide to calculate the ward nurse staffing establishment (Section 2 Chapter 3)
• sets out a high level financial model to support national implementation

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

This report outlines the methods and results of the programme of research that has evaluated the implementation of the Framework in three pilot sites. It builds on two previous reports of research that evaluated the pilot between July 2016 and June 2017: Evaluation of the Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-Mix – Report 1 (Drennan et al. 2017a) and, Evaluation of the Pilot

Implementation of the Framework for Safe Nurse Staffing and Skill-Mix – Report 2 (Drennan et al. 2017b). This report further evaluates the implementation of the recommendations in the Framework in six pilot wards from July 2017 to October 2017.

Read the Evaluation of the Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-Mix here.