Nursing Workforce Planning and Development WP

1
Nursing Workforce Planning and Development (WPD)

• Hospital Phase
• Keith Hurst
• Nuffield Centre for Health and Social Care
• k.hurst_at_leeds.ac.uk, 44(0)113 3436985

2
Presentation Objectives

• Briefly explain the background projects.
• Explain how hospital managers adopted the Modern
  Matron project method and findings.
• Describe the acuity-quality WPD method in
  detail.
• Discuss clinical, educational and financial
  findings and implications arising from the
  expanded acuity-quality database.

3
Introduction and Background

• Modern Matron Report
• Five WPD approaches offered (used)
• i. Professional judgment, i.e., Telford (16)
• ii. Nurse per occupied bed, e.g., Dr Foster
  (17)
• iii. Acuity-quality, e.g., Criteria for Care
  (48)
• iv. Timed-task, e.g., GRASP (7)
• v. Regression, e.g., Teamwork (3)
• 2. Strong triangulation.

4
Intro and Background cont

• Acuity-quality WPD database
• 500 wards in 14 care groups.
• 31.4k patients classified as Dep.1 to 4 turnover
  measured as PatWTEs (0.5PatWTE).
• 530k nursing activities (a) direct (b)
  indirect (c) associated work and (d) personal,
  recorded over 16,500 hours.
• Around 1000 workload sensitive nursing standards
  measured in each ward.
• Actual nurses per occupied bed by grade.

5
Intro and Background - cont

• Main outputs were the acuity-quality report,
  annotated bibliography and software
• www.nuffield.leeds.ac.uk/content/research/workfor
  ce_
• planning.asp
• Softwares purpose
• 2. Estimating staffing by grade based on
  acuities drawn from best-practice wards.
• 3. Wards summarised using 80 variables and placed
  in a league table from best (98) to worst (47)
  quality.
• 4. Flexible database.

6
Best and Worst Wards Quality
7
Best and Worst Wards Dependency
8
Best and Worst Wards Acuity
9
Best and Worst Wards Activity
10
Best and Worst Wards NPOB (WTEs)
11
Best and Worst Wards WTEs Costs
12
So What Explains Lower Quality?

• Significant differences in low quality wards
• Ward leaders spend less time with patients and
  less time supervising juniors, which rubs-off.
• Time-out is higher (23.3 v 21.9), but a
  caveat!
• Rely on agency, bank and overtime, and learners.
• Include nurses with more down time.
• Fluctuating workloads.
• Evidence that staff are burned out.

13
Explaining Lower Quality cont

• Lower quality wards
• Cleaner.
• Doing the care is good but nurses fail to
  assess, plan and evaluate patients medico-legal
  and accreditation implications!
• Grade-mix dilute and cheaper false economy?
• Structurally complex.

14
Whats Next?

• Update the Nuffield Centre website.
• Compare PFI and Foundation Hospitals with
  traditional hospitals.
• Analyse wards with more temporary staff.
• Compare care pathway and Kardex wards.
• Explore the impact of education and training on
  workload and quality.
• Compare Nightingale, Nucleus and Bay wards.
• Compare and contrast Irish and British wards!
• Build a primary and community care equivalent.