THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NURSING AND MIDWIFERY STAFFING LEVELS MONTHLY EXCEPTION REPORT NOVEMBER 2014 Agenda item A5(v) EXECUTIVE SUMMARY This report is the regular Nursing and Midwifery staffing monthly Board report detailing planned and actual figures which have been published on NHS Choices. This monthly report includes the following Nursing and Midwifery staffing data: a. Planned and actual staffing and average fill rates for all inpatient areas within the Trust, with the numbers broken down between hours of Registered Nursing/Midwifery and Care staff, and between day and night shift. b. Information regarding the one week summary of the Safer Nursing Care Tool (SNCT) data collection, which is undertaken each month within the Trust. c. Discussion of staffing indicators including: turnover rates, and vacancies. d. Identification of and discussion about any trends and development of levels and tolerance. RECOMMENDATION To i) receive the briefing and note the content and ii) comment accordingly. Helen Lamont Nursing and Patient Services Director Elizabeth Harris Head of Nursing (RVI) Karen Coles Nurse Staffing Project Lead 19 th November 2014
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NURSING AND MIDWIFERY STAFFING LEVELS MONTHLY EXCEPTION REPORT NOVEMBER 2014 1. INTRODUCTION / BACKGROUND This monthly Board paper provides more detail to support the planned and actual staffing information which is published on the Trust Internet and NHS Choices web pages. Appendix 1 provides a summary of the fill rates for each of the Wards in the Trust. Trend information is developing and this will help us to identify areas requiring support more clearly, as well as monitor patterns and trends The long term goal is to have a real time monitoring system in place. 2. NURSE STAFFING Nurse staffing continues to have a high priority within the Trust. Phase Two of the Nurse Staffing Review (NSR) is in progress, with Day Units, Critical Care, Theatres, Out Patients and Community being reviewed currently. All reports and recommendations should be complete by the end of January 2015 and will subsequently be reported to the Board. The Trust continues to be committed to providing safe and effective staffing levels within Nursing and Midwifery, and this is challenging in the context of an increasing national shortage of Registered Nurses and Midwives. The Trust s Nursing and Midwifery Recruitment and Retention group has developed an Action Plan to operationalise the ideas and suggestions to improve recruitment processes to minimise risk. To aid achievement of the Action Plan goals, a Matron has been seconded to work in the Recruitment Team within Human Resources. The focus of this is to: streamline the recruitment process, improve the information to attract staff (e.g. via the Trust web site), improve the Band 5 interview process, and to define and agree monitoring metrics to develop understanding of recruitment and attrition patterns and trends. An International Recruitment project has been supported by the Trust. A detailed project plan is being written with the aim of establishing a recruitment team to go to the Philippines in January 2015 to recruit approximately 50 to 60 Nurses. The Steering Group responsible for the reporting and monitoring of Nurse Staffing continues to collaborate to ensure the Trust meets the National Quality Board and NICE guidance with regard to Nurse staffing. This includes how Red Flag events are monitored; Datix reports are validated and development of a real time monitoring system. 1
3. NURSE STAFFING REPORT (i) Planned and Actual Staffing Nursing and Midwifery staffing continues to be a complex and challenging issue and many co- and inter-dependencies exist. Staffing is constantly under review day by day, shift by shift, and a robust professional leadership framework is in place. Areas which look unusual, are being validated and commented upon by the relevant Matron and corroborated against any documented escalation processes. The development of a web-based application by the IT Department has assisted the data collection of planned and actual Nurse staffing hours. The Matrons validate this information and comment regarding variations. In analysing the October data, it is clear that wards are continuing to prioritise cover for Night Duty when there are fewer staff available which is good practice, an example of this is Ward 20 FH. Some areas show greater than 100% fill rate, which occurs where one group of staff are increased to cover short fall in the other, for example Ward 10 FH. Some wards have higher fill rates, this happens when there is an increased requirement for monitoring/observation or supervision of a particular patient or group of patients. We use the term specials for this short term requirement and an example of this is FH Ward 18. It is important to recognise that Nurse staffing requirements can change very quickly. Where there is a low percentage fill rate, it can be due to staff absences i.e. vacancies or sickness where it has not been possible to cover the shift or, it may be that the actual required staffing was lower than anticipated, for example Ward 41, RVI. Matron has reported this is due to sickness, staff being sent to help on other wards and Bank shifts not filled, as the Ward s workload was less than expected. The data demonstrates that in some Neurosciences, Medical and Care of the Elderly Wards continue to have a higher number of actual staff than that which was planned. This has been to provide specials for patients at risk and this is being monitored by the Senior Nursing Team. In Maternity, staff are moved from postnatal and antenatal areas to cover absences in high-risk areas such as Delivery Suite; this is reflected in the actual staffing figures. (ii) Staff Turnover Streamlining the recruitment process is a key target as part of the Recruitment and Retention Action Plan in order to minimise the period of time post remains vacant. A new electronic system in Human Resources is to be launched in November with an electronic RCG (Recruitment Control Group) form. (iii) Vacancy Rate Nationally there continues to be a shortage of Registered Nurses but despite this, the Trust s Band 5 vacancy rate reduced in September by a small margin. 2
Hopefully, this will further improve during the following months with the employment of newly qualified Registered Nurses taking up posts in October 2014. (iv) Safer Nursing Care Tool (SNCT) The SNCT is used to assess the dependency or acuity of a patient on an inpatient ward, and is used for monitoring purposes, one week each month. Variance is expected, some Wards SNCT results are lower than their funded establishment some higher from month to month. The results are used to triangulate information alongside professional judgment when reviewing establishments. The results are building trend information for each area regarding the acuity and dependency of patients which will be very useful in validating other data, e.g. RVI Ward 15 has an increased number of patients requiring specials, and this is reflected in an increase in their SNCT results and a higher percentage of actual staff against planned. There are some Wards where the SNCT result has been higher than the funded establishment for the past few months, which will require close monitoring: these Wards are mainly within NCCC (Northern Centre for Cancer Care), Medicine and Care of the Elderly and Neuro. In NCCC, this is mainly due to an increase in the acuity of patients, whereas the others are due to the dependency of patients, many requiring specials. Midwifery do not use the SNCT but have recently used Birth-rate plus to review staffing and are preparing a separate Board paper regarding these results. (v) Datix Matrons manage and monitor staffing within their areas on a daily basis. The Datix system, which is the Trust s incident reporting system, is used to report staffing concerns and complements the Matron s role. Any incidents related to Nurse staffing that have been reported are investigated by Matron, with action plans developed where necessary. There has been a slight increase in the number of incidents reported over the last few months as emphasis on the use of Datix in this way is strengthened, and all reports appear to be appropriate. The Datix reports are identifying common themes which can be used to review practice. The key points of the Nurse Staffing Strategy, especially regarding escalation, have been addressed at the Nursing and Midwifery Forums. Work is underway with the Matron for Patient Services to improve the process for Matrons to communicate staffing issues to the Patient Services Coordinators, which is a key issue during out of hours periods. 4. RISKS AND RISK MITIGATION The publication of Nursing and Midwifery guidance has been positive in raising the profile of this important issue. However, staffing data should not be viewed in isolation, as it does not take into account experience of staff, patient dependency/acuity or the workload of the Ward. The use of the incident reporting 3
system Datix assists in the triangulation of information, as does the monitoring via SNCT. 5. SUMMARY This paper brings together information related to Nursing and Midwifery staffing and includes planned and actual staffing data, which the Trust is now required to publish. Further work is underway to develop a more robust reporting template which will allow the Trust Board to review trend information monthly, will support regular establishment reviews, and will ensure transparency with the public who will have access to this data. 6. RECOMMENDATION To i) receive the briefing and note the contents and ii) comment accordingly. Helen Lamont Nursing and Patient Services Director Elizabeth Harris Head of Nursing (RVI) Karen Coles Nurse Staffing Project Lead 19 th November 2014 4