Transformation of Urgent and Emergency Care Services

The Role of Emergency Nursing in

Providing the Highest Standards of Care

Mary Hutchinson RN, BSc (Hons), MSc, FFEN

Tackling the systemic problem of understaffing that is undermining the quality of care received by patients

Using evidence-based workforce planning tools to ensure safe staffing levels

Assisting individual nurses to reach their potential during their emergency care career by ensuring regular workforce development programmes

Enabling all emergency nurses to contribute to the development of emergency and urgent care

Tackling the systemic problemof understaffing that is undermining

the quality of care received by patients

Tackling the systemic problem of understaffing that is undermining the quality of care received by patients

Systemic problem or system problem?

Tackling the systemic problem of understaffing that is undermining the quality of care received by patients

Systemic problem or system problem?

Key Facts - National Audit Office - Emergency admissions to hospital: managing the demand (2013)

Tackling the systemic problem of understaffing that is undermining the quality of care received by patients

Tackling the systemic problem of understaffing that is undermining the quality of care received by patients

Tackling the systemic problem of understaffing that is undermining the quality of care received by patients

Tackling the systemic problem of understaffing that is undermining the quality of care received by patients

Using evidence-based workforceplanning tools to ensure safe staffing levels

Using evidence-based workforce planning tools to ensure safe staffing levels

Using evidence-based workforce planning tools to ensure safe staffing levels

“An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%, and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7%.

These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients”.

AIKEN et al (2014) Nurse staffing and education and hospital mortality in nine European countries:a retrospective observational study. The Lancet. Volume 383 Number 9931 p1781-1860

Using evidence-based workforce planning tools to ensure safe staffing levels

The dependency tool is used to evaluate patients’ needsin six areas:

Communication

Airway

Breathing and circulation

Mobility

Eating, drinking, elimination and personal care

Environmental safety, health and social needs plus Triage

Using evidence-based workforce planning tools to ensure safe staffing levels

Jones Dependency ScoreThe dependency score is therefore between6 and 18, where scores from:

• 6 to 7 = low dependency

• 8 to 12 = moderate dependency

• 13 to 15 = high dependency

• 16 to 18 = total dependency

Using evidence-based workforce planning tools to ensure safe staffing levels

• 6 to 7 = low dependency

• 8 to 12 = moderate dependency

• 13 to 15 = high dependency

• 16 to 18 = total dependency

1 nurse to 3.5 patients

1 nurse to 2 patients

1 nurse to 1 patient

2 nurses to 1 patient

Jones Dependency Tool Baseline Emergency Staffing Tool

Using evidence-based workforce planning tools to ensure safe staffing levels

Using evidence-based workforce planning tools to ensure safe staffing levels

Using evidence-based workforce planning tools to ensure safe staffing levels

Assisting individual nurses to reachtheir potential during their emergency

care career by ensuring regularworkforce development programmes

Assisting individual nurses to reach their potential during their emergencycare career by ensuring regular workforce development programmes

Assisting individual nurses to reach their potential during their emergencycare career by ensuring regular workforce development programmes

http://www.fen.uk.com/

Assisting individual nurses to reach their potential during their emergencycare career by ensuring regular workforce development programmes

Assisting individual nurses to reach their potential during their emergencycare career by ensuring regular workforce development programmes

Assisting individual nurses to reach their potential during their emergencycare career by ensuring regular workforce development programmes

Enabling all emergency nursesto contribute to the development

of emergency and urgent care

Enabling all emergency nurses to contribute to the development of emergency and urgent care

Enabling all emergency nurses to contribute to the development of emergency and urgent care

Enabling all emergency nurses to contribute to the development of emergency and urgent care

References

• AIKEN, L. et al (2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet. Volume 383 Number 9931 p1781-1860.

• Campbell, D. and Syal, R. (2015) Lack of GP appointments driving one million a year to A&E Units. The Guardian. Photograph: Aldama/Demotix/Corbis [online](http://www.theguardian.com/society/2015/jan/09/gp-appointments-ae-units-hospitals-emergencies-patients) (Accessed 15/5/16)

• Drennan, J., Recio-Saucedo, A., Pope, C., Crouch, R., Jones, J., Dall’Ora, C., and Griffiths, P. (2014) Safe Staffing for Nursing in Accident and Emergency Departments –Evidence Review. NICE.

• LAND, L. and MEREDITH, N. (2013) An evaluation of the reasons why patients attend a hospital Emergency Department . International Emergency Nursing (21), 35–41.

• Monitor (2014) Walk-in Centre Review: Final Report and Recommendations. (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283778/WalkInCentreFinalReportFeb14.pd) (Accessed 15/5/16)

• National Audit Office (2013) Report by the Comptroller and Auditor General. DH - Emergency admissions to hospital: managing the demand. HC 739 SESSION 2013-14 31 (https://www.nao.org.uk/wp-content/uploads/2013/10/10288-001-Emergency-admissions.pdf) (Accessed 15/5/16)

• NHS Choices (2015) The History of the NHS. The NHS in the 2000s – the new millennium. (http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory2000s.aspx) Accessed 15/5/16)

• NHS Information (2014) NHS Hospital and Community Health Services: Qualified nursing, midwifery and health visiting staff and support to doctors and nursing staff working in Accident & Emergency area of work as at 31 May 2014. (http://www.hscic.gov.uk/article/2021/Website-Search?q=Nursing+workforce&go=Go&area=both)

(Accessed 14/5/16)

• Office of the Nursing and Midwifery Services Director - Ireland (2016) Emergency Department Nursing Workforce Planning Framework . Dublin.

• Weber, S. (2010). Impacts of Clinical Decision Support Technology on Nursing and Medical Practice in U.S. Critical Care. CJNI: Canadian Journal of Nursing Informatics, 5 (4), Article Three. http://cjni.net/journal/?p=1094 (Accessed 15/5/16)

• NHS England: Building and Strengthening Leadership - Leading with Compassion November 2014