Healthcare Workforce is a research group, established to test the implementation of the “Framework for Safe Nurse Staffing and Skill-Mix in acute adult medical and surgical wards”. The Department of Health recently published this document and made a number of recommendations to ensure that the staffing of hospitals was safe and effective; that is to ensure the right number of nurses are in the right place at the right time and with the right skills to deliver care. This research intends to measure the extent to which the recommendations in this report impacts on patients and staff in hospitals and emergency departments (EDs). The research also examines how much the recommendations cost to implement. We measure a number of factors that we know are related to nurse staffing. These include missed care, which is looking at work that nurses may not have had time to complete, as well as how satisfied patients are with their care. We will look at whether changes in staffing will impact on the experience of patients in EDs, such as the length of time waiting for care. Based on our findings, we will make a number of recommendations to improve the staffing of wards and emergency departments in Ireland.
Aims & Objectives
This is an interventional study using a pre-post-test design. There are four aims of the study:
- Measure the impact of implementing the pilot of the Framework (specifically Nursing Hours per Patient Day (NHPPD)) on nurse sensitive patient outcomes measures, staff outcome measures and organisational factors.
- Measure the economic impact of implementing the Framework using appropriate economic evaluation techniques.
- Using implementation science, provide an evidence-based assessment of the adoption and implementation of the Framework in practice to guide future national rollout decisions.
- Determine the extent to which the Framework delivered on its intended outcomes, including: stability of the nursing workforce and appropriate staffing and skill-mix to meet patient need.
Programme Of Research on Safe Nurse Staffing and Skill Mix
Research funded by the Health Research Board and the Department of Health
Determining safe and appropriate nurse staffing levels, that is ensuring that the right nurse is in the right place at the right time, can be challenging and, for many years, decisions on nurse staffing in the Irish healthcare system were based on historical need and legacy issues rather than using a systematic, evidence based approach. Previous research has identified that failings in care and poor nurse staffing can result in adverse patient outcomes including mortality and failure to rescue as well as outcomes affecting nursing staff such as increased staff turnover, burnout and decreased job satisfaction. To address these issues, the Department of Health published the Draft Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Adult Hospitals in Ireland (Department of Health 2016). This report set out for the first time in Ireland an evidenced based approach to determining safe nurse staffing and skill mix levels across general and specialist medical and surgical in-patient care settings in acute hospitals. The recommendations in the Framework included: the Clinical Nurse Manager (CNM) - grade 2 role is fully 100% supervisory (that is, they carry no patient caseload), and that a ‘systematic...evidence based approach to determine nurse staffing and skill mix requirements is applied’ (Department of Health 2016: 9). The research team are testing the implementation of this evidence based approach to safe nurse staffing in medical and surgical wards and acute floor settings (emergency departments, local injury units, acute medical assessment units). To date the results from pilot sites have demonstrated that the implementation of the Framework in medical and surgical settings has resulted in a number of positive outcomes including a reduction in adverse patient events, a reduction in missed care, a reduction in agency use, an increase in staff levels of job satisfaction and an increase in staff perceptions that wards are adequately staffed and resourced. The research has now been expanded and data continues to be collected in medical and surgical settings; results from the research in emergency departments will be published later this year. The results from the research team at UCC were central to the publication of a major policy document by the Department of Health, a Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland 2018. This outlines for the first time in Ireland the process to ensure that wards are safely staffed to meet patient need and to ensure their safety.
The research report and the Framework can be accessed here:
The research team has developed its own website which will be updated with information on the project, the people involved, research outputs, and news and upcoming events. The website can be accessed here: https://www.ucc.ie/en/safenursestaffing/
Programme Lead: Professor Jonathan Drennan (UCC)
Co-applicants: Professor Anne Scott (NUIG); Professor John Browne (UCC); Professor Christine; Duffield (University of Technology Sydney); Dr Aileen Murphy (UCC); Professor Peter Griffiths (University of Southampton)
Collaborators: Professor Eileen Savage (UCC); Professor Josephine Hegarty (UCC); Professor Jane Ball (University of Southampton); Professor Cathy Pope (University of Southampton).
Research Team (UCC): Dr Noeleen Brady (Post-doctoral Researcher); Dr Ashling Murphy (Post-doctoral Researcher); Ms Clare Fitzgerald (Research Assistant); Ms Grainne McKenna (Research Assistant); Ms Shauna Rogerson (Research Assistant).