Taskforce on Staffing and Skill Mix

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

Phase 1 of the Taskforce was completed in 2018. The Final Report of Phase 1 can be accessed here.

Phase 2 of the Taskforce is focused on developing a staffing and skill mix framework for the ED care settings. It is in progress, with the Pilot phase expected to roll out in the 3rd quarter of 2018.

Detailed information regarding the Taskforce Phase 1 and Phase 2 Steering Groups can be accessed here.

The Taskforce is a group of experts selected for the development of a framework to determine the staffing and skill mix requirements for the nursing workforce in all care settings. It considers many influencing factors, including patient acuity, dependency, ward type, nurse/HCA to patient ratio and skill mix.

Phase 1 of the Taskforce focused on studying the optimal staffing and skill mix in general and specialist medical and surgical care settings in adult hospitals. The initial assumptions were presented at a series of national consultations and tested through a Pilot phase, which ran in a number of wards in 3 Irish hospitals in 2016 and 2017.

Phase 2 is focusing on developing a staffing and skill mix framework related to emergency care settings. The initial Assumptions are in development. The Pilot phase is expected to commence in the 3rd quarter of 2018.

Detailed information regarding the Taskforce Phase 1 and Phase 2 Steering Groups can be accessed here.

The Programme for Government (2011-2016) contained commitments for radical reform and restructuring of the health services in Ireland, with 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 verified and referenced in many inquiries and investigations. Research has demonstrated the correct staffing and skill mix has a positive influence on the quality of care and it is viewed that 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 was established to provide this expertise.

The main aim of the Taskforce is to develop and validate a Framework that would provide safe staffing levels and appropriate skill mix.

The Framework on Safe Nurse Staffing and Skill Mix is based on four pillars:

• Patient Elements – underpinned by the belief and evidence that all patients are not the same and therefore their care needs are different. Thus the elements influencing the determination of safe nurse staffing and skill mix are those directly related to the patient. Included in this pillar are: acuity and dependency measurements, one to one specialising and professional judgement
• Nurse Staffing- underpinned by the belief and the evidence that the size and skill mix of the nursing care team is important to delivering high-quality, safe care to patients. The elements influencing the determination of nurse staffing and skill mix are those directly related to the nursing care team across general and specialist medical and surgical adult in-patient settings in acute hospitals. Included in this pillar are: staffing profiles, skill mix (nurse to healthcare assistant ratio), recruitment, planned and unplanned absences and Tipping points
• Organisational Factors– underpinned by the belief and the evidence that features of the organisational environment do impact nursing number and skill mix. Factors including ward climate, organisational culture, ward leadership, ward/organisational care processes, ward size and ward layout have a direct impact on the ability of the nursing team to deliver safe effective care. More positive the organisational culture and ward climate, where staff are respected, supported, developed and listened to, have shown to provide better outcomes for both patients and staff
• Outcomes– based on the belief and the evidence that the nurse staffing and skill mix resource has a direct impact on patient and staff outcomes. Monitoring nurse sensitive patient outcomes is necessary to determine if the nurse staffing and skill mix resource is at a safe level and is capable of adequately meeting patients’ needs. Included in this pillar are: nurse sensitive Key Performance Indicators, staff and patient experiences and Safety CLUEs (Care Left Undone Events), such as incidences of falls or pressure sores

The Taskforce developed a staffing and skill mix framework related to general and specialist medical and surgical settings in adult hospitals, 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 pilot the Framework in the Emergency Care settings, make recommendations around the implementation and monitor the framework, including the necessary education, training, and guidance. Finally, the Taskforce will present a written report to the Minister for Health.

The framework to develop staffing and skill mix requirements for nursing must retain flexibility in the system while ensuring the safety of patients. The framework must also consider specific requirement of nurse staffing and skill mix depending on the size and the type of ward (medical surgical, emergency, paediatrics, gerontology etc.) and other factors. For each phase of the project, a number of pilot sites, selected as the most representative in the given type of care area, will be tested over a number of months. The results will be then reviewed against the assumptions to validate the Framework.

International projects on the safe staffing and skill mix in nursing and midwifery include the UK’s National Institute for Health and Care Excellence (NICE) study, which resulted in the publication of the NICE Safe Staffing Guideline in 2014, and the Normative Staffing Ranges for Northern Ireland, currently in Phases 2, 3 and 4, covering Emergency Departments, District Nursing Teams and Health Visiting Teams.

Phase I

The Evaluation of the ‘Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-Mix’ Report 1 was published in February 2016. Report 1 set out the background, literature review, methods and findings in regard to the first stage of the evaluation – pre-intervention.

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 in January 2017 by the UCC Team led by professor Jonathan Drennan.

Report 2 by the UCC Team set out the detail from Report 1, alongside the comparison between the data from Phase I (pre-intervention) and Phase 2 (post-intervention/ application of the Framework), including the findings from the Evaluation of the Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-MixReport and Recommendations on Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Acute Hospital settings was published in June 2017. Professor Drennan’s Report 3 presents the final outcomes from the pilot sites including economic analysis and patient experience.

The Final Report of Phase 1 of the Taskforce on Staffing and Skill Mix for Nursing and Midwifery was published in April 2018. It 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.

All Taskforce publications can be accessed here.

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 are being compiled. Currently work is underway to develop a draft framework. The Pilot of Phase 2 is expected to commence in quarter 3 of 2018. An Interim Report for Phase 2 is expected to be published in Quarter 1 of 2019.

Phase II: Development of the Framework continues to progress. Pilot site selection is complete.