An International Comparison of Nursing Workforce Planning to Achieve Optimal Nursing Levels Related to Patient Outcomes.
Aim: To examine nurse workforce planning in cities with different nurse staffing models and the relationship between nursing workload and nurse sensitive indicators at unit level in care of older people’s wards.
Background: The demand on the NHS increasing at a time when the number of available nurses in decline. There is currently a supply and demand gap for nursing locally and this is set to remain for the next five years. This has led to organisations recruiting overseas in order to find sufficient nursing staff. This may have implications for quality of care as literature suggests there is a relationship between nursing workload and nurse sensitive indicators at a macro level. There are different staffing models in some cities around the world, including nurse staffing levels that are legislated for, mandated and indicative.
Methodology: Literature was reviewed from 2008 to date using CINAHL. Nurse leaders in San Francisco, Melbourne and Perth were interviewed in 2014 around the current situation and challenges for nursing workforce planning in their cities. Unit level data for care of older people’s wards was requested from one hospital each in San Francisco, Melbourne and Perth for financial year 2013-2014 and included: ratio of the number of patients to registered nurses, number of beds in each ward and data relating to falls, pressure ulcers and MRSA levels. The relationship between nursing workload and these nurse sensitive indicators was examined.
Results: There is evidence of workforce planning at a macro level in all cities visited. All cities were reliant on workforce planning methodologies that looked at supply and demand, but didn’t examine progression through the career pathways. There are differing arrangements for the commissioning of student nurse training in the three countries. There is no supply and demand gap for nurses in San Francisco, Perth or Melbourne. When analysing unit level data, a significant inverse correlation was found between nursing workload and falls. The care of older peoples wards at Whittington were found to be outliers for nursing workload (higher number of patients per nurse) and falls (lower number of falls) in comparison with wards based in the other cities. There were found to be statistically significant differences between wards in the numbers of falls and pressure ulcers, with the lowest values being at Whittington Health.
Conclusion and Recommendations for Practice: There are a number of initiatives in the cities visited that warrant further scoping and exploration in the UK. The need to train more student nurses in the UK is clear and a central local, regional and/or national system for placements would enable more efficient use of these resources. Mandatory submission and standardisation of unit level data relating to workload and nurse sensitive indicators should be explored so that unit level comparisons can be made. Further research should be conducted on the contribution of support staff in providing safe care on care of older people’s wards. Also, the inclusion of time spent by nurses caring for families and carers of patients should be considered when reviewing the numbers of nurses required in an establishment.