Pilot nursing skill mix project extended

The Framework for Safe Nurse Staffing and Skill Mix, which had been operating on a pilot basis in six hospital wards, was showing real results in the retention of nurses, the reduction of agency staff and positive outcomes for patients, according to Health Minister, Mr. Simon Harris.

Simon Harris T.D.
Simon Harris T.D.

Minister Harris said “This is an exciting and innovative project which approaches safe nurse staffing and skill mix by matching the nursing resource to the type and number of patients on the ward and their particular needs. I am delighted to extend it to a further 10 wards, within the three current pilot hospitals. I am also pleased to announce the award of a three year programme of research focusing on the impact of the Framework to the team based at UCC, led by Professor Jonathan Drennan.

The Minister said “The extension of the pilot, coupled with the research programme will provide, for the first time in Ireland, a detailed examination of the nursing workforce and its important contribution to patient care. This Framework is about developing safe nurse staffing, which provides safe patient care and outcomes, along with a healthy work environment that attracts and retains our vital nursing staff.

“The report on the work so far shows that agency use has dropped considerably in some of our pilot wards. For example, one ward saw a decrease from agency use of twenty eight per cent before the pilot to nine per cent agency use after. Meanwhile on the pilot sites, job satisfaction has improved, as has intention to stay. These are all important factors in the retention of nursing staff. The report on the pilots also outlines how the occurrence of Nurse Sensitive Patient Outcomes Measures, such as hospital acquired pneumonia or sepsis, has begun to decrease and patients’ experiences of the health service are improving.”

The Minister concluded, “This project is a welcome demonstration of collaborative work between the Office of the Chief Nursing Officer within the Department of Health, the Health Research Board, and University College Cork led by Professor Jonathan Drennan. I am delighted to witness the positive outcomes so far and look forward to extending this pilot further in the future.”

The €2 million pilot project took place in three hospitals ranging in size from small-scale to large scale and incorporated a total of six wards. The pilot consisted of two phases- pre intervention phase and the post intervention phase. Some of the interventions required included an uplift of either nursing staff or Healthcare Assistants.

This study, led by Professor Jonathan Drennan and supported by a research team from the School of Nursing and Midwifery, University College Cork, measured a number of outcomes associated with the introduction of an evidenced based approach to determining safe nurse staffing and skill mix levels in wards in three pilot hospitals. Data collection included both administrative data as well as the collection of data from patients and nursing staff. An economic evaluation of the cost implications of the programme and the resources required to deliver a national rollout was also undertaken.

The Framework for Staffing and Skill Mix for Nursing identifies four core assumptions which should be used in calculating the number and type of nurses to be deployed on any given ward:

  • Individual patient need should be measured to identify the actual demand for nursing care through acuity and dependency measurement for example;
  • The skill mix within the nursing team as a whole in addition to the nursing hours required to meet patient need should be assessed to determine the optimum skill mix and number to provide safe, effective and efficient care;
  • Monitoring the ward and organisational culture are important indicators of effective leadership that can influence the ward and organisational climate and delivery of safe, effective and efficient care and staff experience;
  • The monitoring of patient outcomes of quality and safety including: patient experience, pressure ulcers and falls, along with day to day measurement of safety triggers such as nursing care left undone, can provide a mechanism for both the necessary immediate response and recognition of patient safety concerns in addition to their medium to longer term management across hospitals.