School of Nursing & Midwifery Annual Report 2018

Catherine McAuley School of Nursing and Midwifery, UCC

Programme of Research on Safe Nurse Staffing and Skill Mix Research funded by the Health Research Board and the Department of Health

The Story: Determining safe and appropriate nurse staffing levels, that is ensuring that the right nurse is in the right place at the right time, can be challenging and, for many years, decisions on nurse staffing in the Irish healthcare system were based on historical need and legacy issues rather than using a systematic, evidence based approach. Previous research has identified that failings in care and poor nurse staffing can result in adverse patient outcomes including mortality and failure to rescue as well as outcomes affecting nursing staff such as increased staff turnover, burnout and decreased job satisfaction. To address these issues, the Department of Health published the Draft Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Adult Hospitals in Ireland (Department of Health 2016). This report set out for the first time in Ireland an evidenced based approach to determining safe nurse staffing and skill mix levels across general and specialist medical and surgical in-patient care settings in acute hospitals. The recommendations in the Framework included: the Clinical Nurse Manager (CNM) - grade 2 role is fully 100% supervisory (that is, they carry no patient caseload), and that a ‘systematic...evidence based approach to determine nurse staffing and skill mix requirements is applied’ (Department of Health 2016: 9). The research team are testing the implementation of this evidence based approach to safe nurse staffing in medical and surgical wards and acute floor settings (emergency departments, local injury units, acute medical assessment units). To date the results from pilot sites have demonstrated that the implementation of the Framework in medical and surgical settings has resulted in a number of positive outcomes including a reduction in adverse patient events, a reduction in missed care, a reduction in

agency use, an increase in staff levels of job satisfaction and an increase in staff perceptions that wards are adequately staffed and resourced. The research has now been expanded and data continues to be collected in medical and surgical settings; results from the research in emergency departments will be published later this year. The results from the research team at UCC were central to the publication of a major policy document by the Department of Health, a Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland 2018. This outlines for the first time in Ireland the process to ensure that wards are safely staffed to meet patient need and to ensure their safety. Co-applicants: Professor Anne Scott (NUIG); Professor John Browne (UCC); Professor Christine; Duffield (University of Technology Sydney); Dr Aileen Murphy (UCC); Professor Peter Griffiths (University of Southampton). Collaborators: Professor Eileen Savage (UCC); Professor Josephine Hegarty (UCC); Professor Jane Ball (University of Southampton); Professor Cathy Pope (University of Southampton). Research Team (UCC): Dr Noeleen Brady (Post-doctoral Researcher); Dr Ashling Murphy (Post-doctoral Researcher); David Gilligan (PhD student); Ms Clare Fitzgerald (Research Assistant); Ms Grainne McKenna (Research Assistant); Ms Shauna Rogerson (Research Assistant). The Team: Programme Lead: Professor Jonathan Drennan (UCC).

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