Safe Staffing Unit Research: right staffing = happier staff

1 May 2014

Staff were happier and care rationing less likely to occur when staffing levels met CCDM criteria during a nursing shift, a research report released last year found.

The SSHW unit study looking at nurse and patient perceptions of care after shifts which were either understaffed or staffed according to the ward’s CCDM ‘mix and match’ staffing methodology.

Six wards at two district health boards took part in the study and data was collected from 734 shifts over six weeks – of which only 24 per cent met the full criteria of a “design-met” or appropriately staffed shift.

On the 75 per cent of shifts that failed to meet the good staffing criteria, nurses were nearly twice as likely to report care rationing, like not answering patient bells within five minutes or mobilising patients. They were also less likely to be happy (45 per cent) after the shift than if the shift was staffed appropriately (58 per cent). But patients reported little to no difference in perception of their care.

The study also found that all six wards “consistently fell short” in responding quickly to sudden surges in patient demand. The study reports that these findings, and the SSHW unit’s experience of working with DHBs “suggests that DHBs cannot expect to have a lean staffing base and a lean buffer, and expect to maintain safe production in the face of predictable and significant variance between demand and capacity”.

The study also says “further investigation will be required to determine if the recommended staffing design is ‘good enough’ as opposed to simply ‘better than’ shifts that do not meet the design level.”

A shift was regarded as “design met” when:

  • Actual nursing hours available were within 10 per cent of nursing hours required by patients
  • 80 per cent or more of skill-mix staff were RNs (during day shift)
  • At least 75 per cent of staff were from the home ward

“Here, have our Smart Fives card”

The traffic light system can see gifted nurses arriving to help out a ward in strife for an hour or two to find ward nurses too rushed off their feet to brief them.

So the Smart Fives cards – setting out jobs that can be delegated and quickly done by a borrowed nurse (or health care assistant), initially developed by Bay of Plenty DHB and adopted by CCDM – are there to allow the briefing to be streamlined and snappy.

One side of the card welcomes the helping nurse, names their ‘buddy’ ward nurse, and below has a check list of the top five or five-minute activities ticked to show what would be most helpful to the ward at that time. The other side of the card has a map of the ward, so visiting staff can find what they need, and the key codes used. Visiting nurses might be asked to do the obs in one room, or if the nurse is familiar with that service or patient type, may be asked to help their buddy with medication rounds.

Skeet says the aim of the cards is to help change the culture of nurses feeling uncomfortable about helping out in a strange ward and how they are accepted when they get there.