Commentary on Sections Section 25C Nurse staffing levels: method of calculation
29.Section 25C sets out the approach that a designated person must take when calculating the nurse staffing level and provides details as to how this may be used. This method of calculation is commonly known as the “triangulated approach” in the NHS in Wales, because it involves taking into account three different types of information (set out in (1)(a) and (b)).
30.The first of these is information that, in the professional judgment of the person adopting the approach, is relevant to the nurse staffing level. This would include things such as the skills, qualifications and experience of the staff, how sick the patients on the ward are and how much care they each need.
31.The second is an estimated appropriate ratio of nurses to patients that has been generated using an evidence-based workforce planning tool. Various evidence-based workforce planning tools are available. An acuity tool is one type, which records changes in levels of patients’ acuity and dependency (see glossary) over a defined period of time. It is designed to establish an average staffing requirement over time, in order to help Local Health Boards and NHS Trusts with long-term workforce planning; specifically, to help determine how many posts there should be on a ward.
32.The third type is nurse-sensitive indicators, which are used to measure the extent to which patients’ well-being is known to be particularly sensitive to the provision of care by a nurse. They include factors such as the number of falls resulting in harm that have occurred on a ward, patients’ developing pressure ulcers whilst in hospital and errors resulting in harm when administering medicine to patients on a ward.
33.Subsection 25C(2) allows the designated person to calculate different nurse staffing levels for different times and depending on the conditions in which care is provided. This allows for a designated person to calculate a nurse staffing level that takes into consideration the actual number of patients on the ward and the type and level of care that those patients require.
34.In arriving at the nurse staffing level, the designated person can take account of the number of healthcare support workers who are providing care to patients under the supervision of a nurse or who are discharging duties delegated to them by a nurse. This is possible as subsection (6)(a) of Section 25A provides that in sections 25A to 25E inclusive, “references to a nurse providing care for patients include the provision of care by a person other than a nurse acting under the supervision of, or discharging duties delegated to the person by, a nurse”.