Identifying nurse-staffing requirements using the Safer Nursing Care Tool

The National Institute for Health and Care Excellence (NICE) issued guidance on setting safe nurse staffing levels for hospitals in response to reports into failures in the NHS (including the Mid Staffordshire inquiries) and research showing the importance of having the right numbers of nurses on wards to ensure safe care. NICE recommends a systematic approach to setting staffing levels. NICE endorsed a tool that estimates staff requirements by assigning patients to one of five categories, based on how ill they are and the typical time taken to care for similar patients (known as acuity/dependency). This tool is the Safer Nursing Care Tool (SNCT).

The standard approach to using the SNCT sets staffing to meet the average needs of a sample of patients. There is little evidence that shows how often this means there are enough nurses on the ward to meet patient need or whether other approaches might give better results. For example, if wards often have patients with far higher need for nursing care than average, staffing will often be too low unless the hospital can employ extra staff through an agency (which might be expensive) or move staff within the hospital from wards with excess staff. It might be more cost effective to routinely employ more staff. On the other hand, using the tool this way could mean that there are often too many nurses on some wards. It might be better to plan lower regular staffing, with extra nurses sent to a ward when needed.

Our study will examines how patients' need for nursing care, as measured by the SNCT, varies from day to day to see how often staffing shortfalls or excess occur, and explores the costs and consequences of different ways of using the tool and deploying nurses. We will collected information on ward nurse staffing, nurses' assessment of whether they have adequate staff and the SNCT measures of patient acuity/dependency in 4 hospitals every day for 1 year. We compared the daily nursing hours available for each ward to the required hours as calculated by the SNCT, and nurses' judgment of the number of staff needed. We used this information to develop computer simulation models that consider variability in patient need and availability of nurses to explore scenarios where nurse staffing is based on different approaches to using the SNCT. We will estimated the impact on patient outcomes using results from other studies showing the increased risk of poor outcomes, including death, for patients who experience low nurse staff levels in hospital.