Framework for Safe Nurse Staffing and Skill-Mix

The RN4Cast was a large study examining the staffing levels of 12 countries in Europe. In response to these findings, the Department of Health in Ireland developed a “Framework for Safe Nurse Staffing and Skill-Mix in acute adult medical and surgical wards”. The Framework is based on the best available national and international evidence and sets out the assumptions upon which staffing should be determined. There are three main recommendations of the Framework:

1. Staffing levels should be determined based on nursing hours per patient day and based on patient acuity and dependency, i.e. “the number of productive hours worked by nursing staff with direct patient care responsibilities per patient day for each in-patient unit” (National Quality Forum 2013: 5).
2. They also recommend a rich skill-mix with 80% of the proportion of hours of care provided by RNs.
3. The CNM2 (ward leader) role to be converted to 100% supervisory.

Therefore, these recommendations may result in an uplift of staff to the required hours of care, along with an adjustment of skill-mix and the CNM2 role, all conducted at ward level.