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Nursing & Midwifery: Workload & Workforce: Planning Project
Executive summary
Introduction
The successful delivery of healthcare services in Scotland relies critically on the shape and extent of the nursing and midwifery workforce. There is therefore a need for more effective planning of nursing and midwifery workforce development systems within NHSScotland, in partnership with other professional groups.
Audit Scotland's report into nursing workforce planning at ward level,
Planning Ward Nursing - Legacy or Design? (Audit Scotland, 2002), raised important questions on how nursing and midwifery workforce development was being taken forward.
The
Facing the Future group commissioned a project to examine the current situation in nursing workload and workforce planning in Scotland, commencing July 2003. The aim of the project, which was overseen by a steering group and run by a project manager, was to develop a national picture of all key areas of nursing and midwifery workload and workforce planning activity. This report describes the outcomes of the project.
Project design
The project was based on a survey of most parts of NHSScotland where nursing and midwifery services are delivered:
The survey questionnaires focused on key issues relevant to nursing and midwifery workload and workforce planning, such as:
workforce planning systems currently in use
current funded establishments
'protected time' from clinical work for senior charge nurses or other professional groups
predictable absence allowances within establishments
flexible working
examples of best practice.
Follow-up interviews with key contact personnel in each NHS Board area (as they were configured in September 2003) were then carried out.
Following a pilot in four sites, 102 questionnaires were issued in August 2003, with a 100% response rate being achieved. Visits to NHS Board areas were conducted in September and October 2003.
Key findings and outcomes
Principles to govern nursing and midwifery workload and workforce planning
NHS Board action plans should spell out how continuity of care can be improved through reducing use of agency staff (where used) and increasing permanent nursing and midwifery resources.
Data from individual NHS Boards should be collated, leading to the creation of a national dataset on nursing and midwifery workload and workforce planning. This process should be reflected through the Performance Assessment Framework and accountability review.
Innovative and effective approaches to the use of flexible working are essential, particularly to maximise recruitment and retention of nursing and midwifery staff.
Systematic approaches to nursing and midwifery workload and workforce planning should be applicable across the whole of NHSScotland, taking into consideration national workforce influences and having the capacity to reflect local needs.
Nursing and midwifery workload and workforce planning tools used in NHSScotland should be capable of taking account of the impact of developments in health technologies, shorter hospital stays and increased patient acuity, and should reflect emerging workload issues. Where necessary, tools should be adapted to ensure these factors are reflected. It is important to ensure that the benefits of using the tools are not negated by inadequate resources being made available.
Education and development
Better training in use of nursing and midwifery workload and workforce planning tools is likely to improve users' competence. Education and training is also needed to ensure that people involved in determining nursing and midwifery establishments, budgets and resources are equipped with basic underpinning knowledge and competencies.
The current local and national education, training and development initiatives focusing on clinical leadership should be continued and developed.
Nursing and midwifery workload and workforce planning systems
Professional judgement, explicit in the wide use of a 'Telford'-type method, is the current bedrock of nursing and midwifery workload and workforce planning. 'Telford' (or any single tool) should not, however, be used as a stand-alone system. A combination of tools should be used, with all services using a nationally agreed 'Telford'-type approach as a minimum. A standardised 'Telford' system should be refined at national level and made available throughout NHSScotland in electronic format.
The survey showed ambiguities in how respondents interpreted 'quality systems', 'quality tools' and 'quality rating scales'. Until such times as work on quality measures being carried out by NHS Quality Improvement Scotland is reported, nationally recognised quality measures relevant to individual areas of practice should be used in conjunction with a workforce planning tool and patient dependency measure.
Systems for workforce planning currently being used should be tested to identify which best meet the needs of NHSScotland.
Currently used National Recommendations on nurse staffing levels and ratios in specialty areas need to be examined, monitored and reviewed to ensure their validity.
Allowances
The survey highlighted variability throughout Scotland in 'protected time allowance' for senior charge nurses. This variation should be addressed through the development of a national standard protected-time allowance.
A national standard for predictable absence allowance should be established. The impact of
Agenda for Change will also need to be factored into the allowance.
Further research
Research and evaluation work is required in some specialty areas (paediatrics, psychiatry and primary care teams) to obtain a clear picture of the current situation with regard to nursing and midwifery workload and workforce planning and to work towards developing tools appropriate to these specialties.
Further work on workload implications of managing of 'Level 1' patients (or equivalent) is also necessary.
Moving forward
The recommendations lay the foundation for the development of a more systematic and standardised approach to nursing and midwifery workload and workforce planning to succeed the current
ad hoc situation. NHS Boards should have in place, no later than four months after publication of this report, an agreed action plan for taking forward the recommendations emerging from the project.
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