About the project
Since publication of the national report on compliance with all 12 national clinical standards for neurosurgery in 2013, the MSN has audited selected criteria from individual clinical standards, choosing the standards in response to concerns or pressures within the service. Within the 12 standards there are 83 auditable criteria. This project focuses on two criteria from Standard 5 Access to Care – staffing:
5.1 Neuroscience wards will have a nursing skill mix which reflects an appropriate balance of neuroscience trained nurses, as defined by recognised workforce planning tools
5.5 Nursing staff numbers will be sufficient to allow one nurse to one bed for level 3 patients and one nurse to two beds for level 2 high dependency units.
Aims
To promote safe, person-centred care by ensuring the agreed number of appropriately trained and experienced nursing staff are available to look after neurosurgical patients in Scotland.
How do we achieve this?
This was achieved by documenting and reporting on compliance with nurse staffing establishments in neurosurgical wards and compliance with the required nurse-to-patient ratio for critical care (level 2 and 3 beds).
A snapshot audit was undertaken in each of the four centres on a given day in April 2018. The MSN Audit Facilitators met with the senior nurse in each unit to complete the nurse establishment proforma and met with the senior nurse in the critical care unit.
Outcome
We reported on the results of the audit in October 2018. In three of the four centres, there were either shortfalls in the agreed nurse establishment or in the proportion of nurses considered ‘new in post’, or both. The MSN is aware that nurse recruitment and retention is a challenge across the UK and is satisfied that the four health boards which provide the national service are addressing the issue within the constraints of the available pool of registered nurses.
In relation to nurse-to-patient ratios in critical care, the requirement to have a 1:1 nurse patient ratio for level 3 beds in critical care was achieved in all four units however the number of ‘funded’ beds is less than the overall number of beds in some critical care units. The 1:2 nurse patient ratio for level 2 beds was achieved in the three centres with neurosurgical high dependency units.
It was realised that the focus on ward and critical care nurse to patient staffing ratios excluded theatre and out-patient nurse establishments.
Documents