Importance of Safe Staffing Levels

Discuss about the Nursing for The High Quality Health Care?

The present assignment defines the safe level of staffing and gives an explanation of the reason staffing level comes up as an issue. The assignment also puts up a discussion on the extent to which the concerned organisations and government are successful in handling the matter of staffing levels. It also has a focus on the belief in the National Health Service (NHS) and further takes into account the policy delivered by other institutions. Nurses’ role in developing and formulating polices and their impact on the safety of patients is also discussed. In the end, policy evaluation is undertaken along with the analysis of Francis report and the influence on patients as a result of policy implementation. 

Safe staffing level refers to the practice where the level is sufficient for handling the environment of huge health burden, and patients are delivered care by certified nurses. According to the Nursing and Midwifery Council appropriate staffing level is required for the best possible health care services. The importance of safe staffing lies in that it has the potential of making an impact on the safety of the patients as nursing staffing gives care for these people in a suitable manner. Insufficient staffing has, therefore, a negative impact on patient (RCN, 2010). As per the Francis Report, failure recorded in Mid Staffordshire NHS Foundation Trust can be attributed to chronic nursing staffing shortage, having a negative influence on the care delivered to the patients admitted to the health care setting. Griffiths (2014) emphasised that ensuring the presence of adequate staffing in health care settings has a direct effect on the reduction of medication and medical errors, a decrease of falls, mortality rate, infections and increase of patient satisfaction. This is in alignment with what the American Nurses Association (2014) states in this relation. According to the association, the decrease in nurse fatigue, improvement of nurse retention, the decrease in nurse burnout, enhancement of job satisfaction are all related to the prevalence of sufficient nursing staffing. In the context of all the discussion above, the problem of insufficient nursing staffing was addressed by the government to construct policies like the NICE guidelines (2014), Hard Truths (2014) and the Berwick Keogh (2013). All these made a desirable response to the Francis Report Enquiry on the poor quality of care delivered at the Mid Staffs and hed out a helping hand for tackling the issue of staffing levels for improving provisions of healthcare (Department of Health, 2013).

Policy Implementation and Evaluation

Buse et als (2012) states that Royal College of Nursing (RCN) is a policy driver that had the aim of providing a strong and supportive framework in order to fulfil the targets of productivity and achieve efficiency for intended improvement of care quality and reduction of health costs in a suitable manner (Royal College of Nursing, 2013). Moreover, the report from RCN (2013) provides support to the recommendations regarding improvement of nursing staffing levels by responding to 290 Robert Francis recommendations and mentioning that a separate sector must be present for ensuring that no such failures are repeated in the future like the incidence of Mid Staffordshire (Royal College of Nursing, 2013).

RCN (2013) adds to the subject by suggesting that the NHS must out the focus on care that is solely patient-centered. The burden of having a promising health cares service is therefore on the NHS employers for giving nursing staff the suitable support, resources and time or delivering the care worth mentioning with good ambition. On the contrary to Francis Report, 2013, David Cameron, the Prime Minister consulted a lead healthcare expert Professor Don Berwick to look into the matter of enlisting out the needs of the health care system that would reduce the harm to the patients to zero (NHS Employers, 2013). It was emphasised that NHS must take an initiative for making health care more safe to the patients and enabling a culture oriented care system that has full dedication on carrying out learning and improvement and strives in a continuous manner to reduce harm made to the patients that can be easily avoided. This was contradicted by RCN (2012) and Thungjaroenkul (2007) who said that there are instances of failures showed by NHS where the patients were not given safe care practices due to the fact that a minority of the NHS organisations could not be financially sustainable and, therefore, had to compromise on nursing staffing. The result was unsafe care quality and insufficient provisions of health care. Keogh (2013) mentioned that the NHS Director had the responsibility of giving justifications for the failings of the 14 trusts in England accountable for around 13000 additional deaths in the last ten years.

As per the report of the The Sunday Telegraph (2007), a section of the patients having access to NHS are no longer having the faith they used to have on NHS and are choosing to go abroad for health care services. The reason for discriminating out NHS is long waiting lists and increased risk of infection. However, people not being able to afford to travel abroad for health care or not willing to do so remain on the long waiting list of the NHS in the United Kingdom.  Jeremy Hunt, the Health Secretary, has ordered tightening up on NHS spending as an initiative to control the finances in order to reduce wastage. He was recorded stating that cut down of costs can be achieved by not recruiting agency staff while bringing improvements in frontline patient care. This step ensures to spiral down the staff bill that has the costing of 3.3 billion pounds per year. Moreover, new rules will make sure that agencies not present on the authorised framework are not used and will control the total spending for each trust functioning under NHS in cases of financial difficulties (DH, 2015 Kleebauer, 2015). In addition, the functioning of agency staff has witnessed rise to 3.3 billion pounds from a mere 1.8 billion pounds in three years in order to help out in nursing staffing. This drives the government to bring changes in the recruitment of the hospitals by recruiting more permanent staffs on the basis that there are evidence on better staffing refining the patient care (DH, 2015 Kleebauer, 2015).

Recommendations by National Institute of Health NICE

The main priority of the formulation of policies in the Francis Report was laid upon working together with the aim of ensuring that patients are kept first in the priority list while taking any decisions in professional conduct. Jeremy Hunt from ‘Hard Truths’ supports that patient must come before all other aspects taken up by NHS professionals. This takes into account staffs, patients, their families, carers, professionals and communities outside and inside the NHS. Needs of the patients and the community also comes before the boundaries of the health care organisation (Department of Health, 2014).

On the contrary, Thungjaroenkul et al. (2007) reports that nine out of ten health care settings are not succeeding in meeting the set targets of delivering safe levels of patient care by nurses, the reason accountable to nursing. The author also reports that nurses are under immense pressure for caring for their patients in various adverse situations that have a negative impact on the overall care. It implies that increase in a number of nurses increases the satisfaction of the patients that can conversely translate to imply that decrease in nurse number reduces patient satisfaction. In matters of patient care, the Francis Inquiry recommends that NHS must take initiatives for improving care. It also states that the case of Mid Staffordshire was a result of insufficient staffing leading to patient negligence, falls, high rate of mortality.

The guidelines put forward by National Institute of Health NICE (2014) has a section on the significance of safe staffing in wards with the aim of ensuring that all get the care they are worthy of. It is mentioned in the guideline that there is no particular ratio of nurses and patient that is applicable to the health care setting across the globe. This implies that each unit must address the safety of the patients by determining the requirements of the patients. Keogh (2014) agrees that patient safety is breached when there are insufficient nursing staffing and improper training of the professionals to deliver care.

Nurses must not be considered as archetypical leaders (George et al 2014). However, they are pivotal in the health care delivery. This draws a conclusion that nurses must be given constant support and encouragement to have a major role in bringing about clinical innovation and changes. Nurses experiencing the greater extent of empowerments have more chances of engaging in the innovative behaviour (DH, 2008). The Productive Ward (PW) programme is a strategy put in place for empowering nurses with information and skills for governing care (NHSI, 2011; White et al. 2014). The module-based program is for enabling nursing staff to give more time to direct patient care by bringing improvements in processes and environment. This is in congruency with enhancing staff and developing the quality of care (Armitage et al. 2011, Lennard, 2012). For fulfilling the aim, the program requires to meet the QIPP challenge and align the interventions with clinically driven decisions (DH, 2008).

Conclusion

Safe Staffing Alliance has stated that ration of nurses to the patient must be not more than one is to eight in order to maintain the safe level. This is the minimum acceptable level as nurses taking care of more than eight patients at a time increases risk of death and unsafe incidences (Safe Staffing Alliance, 2013; Hughes, 2014). Gregory (2013) and Patterson (2011) reported that nurses were working in settings where there is a nursing shortage suffer from job dissatisfaction and has high patient caseloads and experience more burnout. Moreover, nurse disillusion leads to compromise in values and standards. Both Keogh (2013) and Patterson (2011) concluded that nursing staffing shortfall makes it tough for professionals to practice excellent care delivery. Keogh (2013) agreed with the above writer and elaborated that understaffing leads to a decline of presentism, thereby leaving few staff ready to work. This results in pressure on the nurses and they are forced to leave the jobs that lead to their exhaustion and burnout. The valuable experience they have are lost from the system, and this results in a skill gap that is difficult to fulfil. Service impairment is the ultimate result. Unison (2013) gives an opinion in this regard that effective skill mix has a pivotal role in addition to safe levels of staffing. Thus, health care organisations must have the suitable balance of nursing staff for proper care delivery (Unison, 2013).

Improper staffing within the NHS has a deep impact on the safety of patients as complexities of nursing staffing is the main factor. Eleven hospitals were taken under consideration for special measures since most of them failed to deliver patient care and Jeremy Hunt, the Health Secretary, said that after the analysis of the 14 trusts, high death were reported. The problems entrenched in the health care system and gave rise to tough actions being taken up. The problems identified by Jeremy encompassed the fact that patients are constantly being neglected due to poor leadership and staffing issues (Tingle, 2013; Keogh, 2014).

It was supported by Tingle (2013) and Keogh (2014)  reporting on a nation wide Unison survey undertaken on 3000 nurses that 65% nurses think patient care is being neglected as the result of the situation where nurses do not get adequate time to take care of a patient. This lack of time was confirmed from the same study when 45% of the participants stated that they had to give care to more than eight patients at a time in spite of the recommendation to have a nurse and patient ratio of 1:4. The response of Unison was that they had the knowledge about nurses feeling the priority of minimum staffing and felt that the aspect is fundamental to care quality and patient safety. It also emphasised that it aims to ensure nurses have the opportunity to deliver compassionate and safe care to the best of their ability and contribute to care provision that is valued by all (Unison 2015).

The Francis Report (2013)  has being empowering nurses to react when they are facing issues in nursing staffing. If such reports are not made, there are risks of having poor quality care and the result might be high mortality rate. Nurses, in any case, want to deliver best possible care and want others to do the same too. However, there lies a concern that nurses are speaking out their views may be harried and face bullying. The Guardian highlighted that a section of the staff raise concerns about the unsafe level of staffing but actions were nor taken up. The Francis report identified that safe staffing issues are addressed by the government and they are trying to ensure that issues are sorted out fast so that reduction of patient harm can be reduced (Campbell, 2013).

NICE (2014) put forward new guidelines and in that it has stated that patients have the right to receive the best possible care regardless of the day time, week and type of clinical need. Ford (2014) and Keogh (2014) highlighted that there is a necessity to have ‘red flag’ events. A red flag means that a system for management of critical staffing levels is initiated. Definition of such events can be put in place locally. However, there would be setbacks like users of services not allocated with significant aspects of supervision. The red flags would highlight the presence of danger in the wards in relation to insufficient staffing. Nurses would be alerted to take actions and ensure that care is not compromised. Moreover, the red flags help in ensuring that efficient and safe levels of staffing are present for rendering services. This response on patient care comes as the aftermath of Mid Staff scandal (Nice, 2014; Hughes, 2014).

Unison (2013) states that measures are to be taken for introducing patient safety measures. This is a paramount aspect in health care settings. This brings the need of staffs in the healthcare setting to flag up situations they feel are danger for patient safety, and the organisations must provide constant support to these staffs. This can be done by forcing them to maintain good guidelines for practice and lead to maintenance of quality services. However, the nurses may be forced to cut corners. For example, nurses under pressure and having no time to record patient information in a correct manner can give the delegate tasks to other nurses who have the proper training (Unison, 2015).

Unison (2015) expected that the results of 2015 survey would be more positive and have more significant improvements since the government claims that it has brought the increase in nursing numbers as per the guidance of safe staffing levels of NICE. The Francis Report and Berwick recommendations state to improve staffing levels. However, when Unison puts forward a comparison fo the surveys of the previous years, it is evident that no improvements have been made in relation to safe staffing as many nurses till continue to care for more than eight patients at a time. This leads to harm to the patients. Unison, therefore, states that it wants staffing levels to be improved and minimum patient to nurse ration to be identified. There is also the necessity to have red flag events raised by the nurses as per the NICE guidelines. This also puts forward the need of reviewing the guidelines of NICE. This review would assess the compliance with effectiveness and recommendations of red flag events (Unison, 2015).

The Royal College of Nursing has been accepting a number of suggestions in the Francis Report. The reaction of the government is that developments are to be made for improving staffing levels by the strengthening the staff planning and regulatory processes. The development of appliances and staffing-level standards is a chance to ensure that evidence-based practice is undertaken. The CQC’s standards are to be abided by in this regard, and this would manage the health care system. Moreover, this must have a clear picture of both the public and the contributors on what the scenario of staffing levels are, skill mix and patient and nurse ratio. The RCN puts composition of many personal organising resources in a strong position that aids in the invention of the nursing appliances (RCN, 2013).

As per the policy statement, the foundation for bringing changes has been kept along the recommendations of Robert Francis. The observations of the CQC would be established on a more simple position, and this brings the necessity to take up durable actions to address inadequate staffing level and reduction in quality of care (Tinlge, 2013). Moreover, the CQC observations would make an appeal to the providers and would consolidate the basic qualities that will be prosecutable and will reflect the vital requirements of a central quality service.

In conclusion, the present writing is an attempt to explore policy drivers and influence of nursing staffing levels on care quality within the NHS. It has established the facts that negative influence is associated with improper staffing levels on the experiences of the patient and nurses. In relation with impact on patient care, it has been shown that nurses have a tendency to work under pressure because of having to take care of eight patients at a time. Insufficient staffing levels lead to stressed nurses, burnouts, medication errors, high staff turnover and loss of interest. In relation to patient safety, it has been stated that inadequate staffing levels result in negligence of patients and poor quality of care. Such incidences of patient care are evidenced by the scandal of Mid Staffordshire NHS Foundation Trust identified by the Francis Report (2013). The report drove the government to set out policies for staffing levels. The care given to Mid Staffordshire was not up to the standard, and it led to high mortality rate, pressure scores, falls and infections. As mentioned that policies have been ensuring patient care, productive methods are to be used for empowering the nurses. The assignment also states that patient has lost faith in the NHS. The government needs to ensure that staffing levels are maintained in all NHS hospitals for delivering the high quality health care.