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  • The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study (March 2020)

    • UK
    • Data, research and analysis
    • Pre-existing
    • Creative Commons
    • No
    • Griffiths P. et al.
    • 01/05/20
    • Health and care staff, Patient safety leads, Researchers/academics


    The Safer Nursing Care Tool is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). It is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing the staffing levels needed for safe and quality patient care.

    The objective of this study, published in Health Services and Delivery Research, was to determine whether or not the Safer Nursing Care Tool corresponds to professional judgement, to assess a range of options for using the Safer Nursing Care Tool and to model the costs and consequences of various ward staffing policies based on Safer Nursing Care Tool acuity/dependency measure.

    Authors conclude that employing more permanent staff than recommended by the Safer Nursing Care Tool guidelines, meeting demand most days, could be cost-effective. Apparent cost savings from ‘flexible (low)’ establishments are achieved largely by below-adequate staffing. Cost savings are eroded under the conditions of high temporary staff availability that are required to make such policies function.

    The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study (March 2020) https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr08160/?utm_campaign=1407895_Research%20and%20Innovation%20newsletter%20Vol%2011%20Issue%2010%20(06-05-2020)&utm_medium=email&utm_source=dotdigital&dm_i=4JL6,U6C7,41L8UL,3O5RU,1#/abstract
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    The SNCT tool has a number of benefits and limitations as identified by the study. The authors report that the actual and required staffing levels varied considerably between the hospital trusts, between wards within trusts and also within wards, which we also identify using Establishment Genie across all settings of care (and is one of the reasons we created the Genie).

    The levels of variation don't always make sense even when professional judgement is applied, and are often more to do with subjective judgements on acuity and dependency based on experience, risk aversion, or other environmental or organisational factors. The SNCT tool measures 'on the day' and so planning an establishment for a new model of care or service is not possible, and every day we are seeing necessary changes in the delivery of care through increased access and use of technology, changed roles and responsibilities, and different working practices.

    Safety of our patients and our staff should be paramount in establishment setting. An 'on the day' tool used for 30 consecutive days to review the establishment is a good start and temperature check, but should not be used in isolation. Triangulating with other tools, peer review, benchmarking, and most importantly measuring and tracking patient and staff outcomes is the best way to design and measure an appropriate establishment to ensure we are able to deliver safe care.

    However, we must also make sure that we do not close our eyes to new ‘untested’ models of care, and we learn to embrace and adapt to new possibilities as the health and care landscape continues to change. Traditional workforce models are unsustainable based on current demand and capacity, and unless we try something different our system will become so rationalised that care from cradle to grave will be a forgotten dream rather than a celebrated reality.

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