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Safety First: Professor Gillian Leng writes about the NICE Safe Staffing Guideline

June 11, 2014

Advising the NHS on how to work out the number of nurses to have on each ward at any given time was never going to be an easy job.

Just six months ago NHS England and the Department of Health asked NICE to develop evidence-based advice on safe nurse staffing. Our safe staffing advisory committee has risen to the challenge – they have delivered the first draft guideline for adult inpatient wards in acute hospitals.

The committee followed the rigorous NICE process and developed a well-considered guideline that outlines the factors which need to be assessed when planning nurse staffing.

Our safe staffing advisory committee is a carefully selected group of well-regarded professionals currently making staffing decisions including chief nurses and senior board managers. They have been joined by lay members who bring real-life experience of using NHS services. This is a highly experienced and knowledgeable committee.

The committee looked at all the available evidence that could be applied to the adult inpatient setting, including systematic literature reviews, an economic analysis report and expert reports. Published evidence was supplemented by an analysis of data from trusts, plus field testing of the draft recommendations on almost 100 wards in 15 trusts. In the absence of any data or published research used we relied on – as is standard NICE practice – the experience and expertise of the committee.

All the evidence reviewed is available on the NICE website.

The draft guideline puts patient needs at the forefront when planning nurse staffing. The guideline describes ‘red flag events’, such as patients not getting medication on time or their vital signs not being assessed. All of which call for an immediate response to adjust nursing numbers.

These red flags relate to fundamental aspects of patient care that must be met regardless of financial or recruitment issues. The evidence is clear that these fundamental aspects of care are missed when wards are understaffed.

Also described are ‘safe nursing indicators’ which evidence has shown relates to the number of available nursing staff and the skills mix. These indicators include staff missing breaks or working overtime and patient safety incidents such as falls and pressure ulcers.

The committee was clear that safe staffing for nursing is not simply about having a single “right” number of staff available. Safe staffing needs to be about providing adequate numbers of nursing staff to ensure patients get safe care, regardless of their needs.

With the very practical nature of the draft guideline we recognise that successful implementation requires access to the right toolkits. The guideline therefore provides specifications to help developers produce toolkits in the most user friendly and convenient format.

We will apply a new endorsement process to assess the content of published staffing toolkits and the NICE seal of approval will be given to those that are consistent with our recommendations. Work has already begun with the Safer Nursing Care Tool. Once the final guideline is available we will consider other toolkits, as submitted by the developers.

We want to make sure we get this guideline right and this is why our open consultation is so important. Being able to get the views from nurses on the ground is invaluable. Everything we hear will be considered by the committee to help inform and further shape the final guideline.

We actively sought feedback from hospital trusts, doctors, nurses and other healthcare professionals, as well as members of the public, to ensure the views of all relevant stakeholders are reflected in the final guideline.

This draft guideline is an important step forward in ensuring safe staffing for nursing within the NHS.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, kindly authored this article in response to my earlier posts A Silk Purse from a Sow’s Ear and Your Flexible Friend, both of which are viewable on this website.

  1. Elaine Maxwell permalink

    Useful description of NICE process, however it is unfortunate that they took a ‘Safety1’ approach- that is care is OK if no observed harm. This denies the therapeutic benefits of good nursing which can also be measured via reduced Length of Stay and low re admission rates among many others metrics. Indeed these are exactly the benefits that the NHS needs to harness to meet the financial benefits as well as the improvements for patients.
    Sadly NICE appear to be stuck in an old school mindset on safety and benefit

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