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Today Minister for Health Stephen Donnelly launched the Report on Phase 2 of the “Framework for Safe Nurse Staffing and Skill Mix in Adult Emergency Care Settings in Ireland”.
This is the second Report of the Framework for Safe Staffing and Skill Mix - the policy for determining nurse staffing levels and skill mix in Irish care settings.
This Report sets out, for the first time, a methodology to determine the appropriate number of nurses and healthcare assistants required for Emergency Departments and Injury Units based on the number of patients presenting and their care needs.
The Framework incorporates international evidence, consultation with key stakeholders and is rigorously tested through a pilot test which took place across three Emergency Departments: The Mater Misericordiae University Hospital, Cork University Hospital, South Tipperary University Hospital, and one Injury Unit, in the Mid-Western Regional Hospital Ennis.
Testing of the Framework was underpinned by a programme of research conducted by Professor Jonathan Drennan, University College Cork, specifically measuring patient, staff, and organisational impacts.
Speaking at the launch in The Pillar room, Mater Misericordiae University Hospital, Minister Donnelly said:
“The pilot programme demonstrated compelling evidence that having the correct nurse staffing levels and skill mix, based on patient need, has many positive impacts for patients, organisations and the staff themselves”.
Implementation of the framework demonstrated, in addition to reduced waiting times, other positive patient benefits including a significant reduction in the proportion of patients that leave Emergency Departments without being seen for treatment. Nursing staff reported an increase in job satisfaction during the pilot and improvements in quality of care being delivered. The pilot also showed some encouraging evidence of financial benefits with a decrease in the use of agency staff.
This Report on Phase 2 of the Framework follows on from Phase 1, Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Acute Hospitals in Ireland 2018. This first phase is currently being implemented by the HSE on a phased basis nationally with €25 million invested to date for this purpose.
Today Minister for Health Stephen Donnelly launched the Report on Phase 2 of the “Framework for Safe Nurse Staffing and Skill Mix in Adult Emergency Care Settings in Ireland”.
This is the second Report of the Framework for Safe Staffing and Skill Mix - the policy for determining nurse staffing levels and skill mix in Irish care settings.
This Report sets out, for the first time, a methodology to determine the appropriate number of nurses and healthcare assistants required for Emergency Departments and Injury Units based on the number of patients presenting and their care needs.
The Framework incorporates international evidence, consultation with key stakeholders and is rigorously tested through a pilot test which took place across three Emergency Departments: The Mater Misericordiae University Hospital, Cork University Hospital, South Tipperary University Hospital, and one Injury Unit, in the Mid-Western Regional Hospital Ennis.
Testing of the Framework was underpinned by a programme of research conducted by Professor Jonathan Drennan, University College Cork, specifically measuring patient, staff, and organisational impacts.
Speaking at the launch in The Pillar room, Mater Misericordiae University Hospital, Minister Donnelly said:
“The pilot programme demonstrated compelling evidence that having the correct nurse staffing levels and skill mix, based on patient need, has many positive impacts for patients, organisations and the staff themselves”.
Implementation of the framework demonstrated, in addition to reduced waiting times, other positive patient benefits including a significant reduction in the proportion of patients that leave Emergency Departments without being seen for treatment. Nursing staff reported an increase in job satisfaction during the pilot and improvements in quality of care being delivered. The pilot also showed some encouraging evidence of financial benefits with a decrease in the use of agency staff.
This Report on Phase 2 of the Framework follows on from Phase 1, Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Acute Hospitals in Ireland 2018. This first phase is currently being implemented by the HSE on a phased basis nationally with €25 million invested to date for this purpose.
In addition, €3 million has been made available to the HSE to now progress implementation of this new framework specific to emergency care settings.
ENDS
In April 2014, the then Minister for Health Dr James Reilly TD, approved the establishment of a Taskforce on Staffing and Skill Mix for Nursing. The Taskforce began its work in September 2014 and has continued to be supported by every successive Health Minister; Leo Varadkar TD, Simon Harris TD and Stephen Donnelly TD.
The core objective of the Taskforce is to develop frameworks to support the determination of safe nurse staffing and skill mix, Phase I focused on general and specialist medical and surgical care settings in adult hospitals in Ireland. Phase II focused on Emergency Care settings (being launched today).
Due to the unpredictable nature of patient presentations, determining safe nurse staffing levels in emergency settings has always been a challenge. In Ireland, as in other developed countries, there is high patient demand for these emergency services.
Prior to the Covid-19 pandemic, there were 1,506,343 emergency presentations from January 2019 to December 2019, an increase of 2.6% from the previous year (HSE, 2019). People in the 65 and older age group represent an increasing proportion of ED discharges each year, rising from 36.5% of discharges in 2012 to 41.3% in 2018 (Department of Health, 2019). It is projected that activity in EDs will increase by between 16% and 26% over the next decade (Wren et al. 2017).
Pilot results:
A pilot study was undertaken in three Emergency departments and one Injury Unit to develop, implement and test an approach to determine safe staff nurse staffing levels in these settings. This approach was unique in that it brought together clinical experts, policy makers and a research team to develop and test the Framework.
This approach led to the development of a systematic approach to determine nurse staffing levels based on patients’ triage score, ensuring that the clinical nurse manager in charge was in a completely supervisory role and that the skill-mix (proportion of care provided by registered nurses and healthcare assistants) reflected patient need (in emergency settings 85% of staffing is by registered nurses with 15% provide by healthcare assistants).
The implementation of this approach resulted in a number of positive outcomes for patients, staff and the organisation as well as resulting in financial savings in emergency settings.
Patient Outcomes as a Result of the Framework:
• Time to Triage: All EDs, following the introduction of the Framework, demonstrated a reduction in time to triage for patients. Overall, time to triage decreased from an average of 0.31 hours prior to the introduction of the Framework to 0.20 hours following the introduction of the Framework, an overall percentage decrease of 35.4% in time to triage.
• Time from Triage to Be Seen: There was an overall percentage decrease of 43.2% in Time from Triage to be Seen by a key decision maker.
• Leaving Without Being Seen: The proportion of patients who left without being seen decreased overall following the introduction of the Framework, with a 52.3% percentage decrease in patients who left without being seen.
Financial Efficiencies as a Result of the Framework:
• Significant decrease in agency spend - There was a substantial decrease agency spend with an overall 22% decrease in agency spend as a result of the implementation of the Framework for safe Nurse Staffing and Skill-Mix in Emergency Settings.
Staff Outcomes as a Result of the Framework:
• Job Satisfaction: Overall job satisfaction of nursing staff increased from 54.4% of staff reporting being either satisfied or very satisfied with their current job at baseline to 80.0% being either satisfied or very satisfied following the introduction of the Framework in emergency settings.
• Nursing staff reports of burnout decreased following the introduction of the Framework in emergency settings.
Organisational Outcomes:
• Staff perceptions of the organisational working environment improved following the introduction of the Framework for Safe Staffing in Emergency Settings. Overall, there were increases in nurses’ participation in hospital affairs, as well as increases in staff perceptions of the quality of care delivered, enhanced nurse manager leadership and improved nurse doctor relations. In particular, there was a significant increase in RNs’ positive rating of staffing and resource adequacy.
Next Steps/the way forward:
• The next step is to commence a phased implementation of the Framework for Safe Nurse Staffing and Skill-Mix across Emergency Departments in Ireland.