2 Evidence

2 Evidence

The Committee considered the following commissioned reports.

  • Evidence review 1: Griffiths P, Ball J, Drennan J, Jones J, Reccio-Saucedo A, Simon M (2014) The association between patient safety outcomes and nurse/healthcare assistant skill mix and staffing levels and factors that may influence staffing requirements. University of Southampton.

  • Evidence review 2: Simon M, Ball J, Drennan J, Jones J, Reccio-Saucedo A, Griffiths P (2014) Effectiveness of management approaches and organisational factors on nurse sensitive outcomes. University of Southampton.

  • Economic analysis: Cookson G, McGovern A (2014) The cost effectiveness of nurse staffing and skill mix on nurse sensitive outcomes. University of Surrey.

The Committee also considered the following:

  • Expert paper 1: Expert testimony presented to the Safe Staffing Advisory Committee.

  • Expert paper 2: Patient testimony presented to the Safe Staffing Advisory Committee.

  • Expert paper 3: Report from the Safe Staffing Advisory Committee sub-group meeting 11 April 2014.

  • Report on field testing of the draft guideline

The reviews, economic analysis and expert papers are available on the NICE website.

Evidence review 1 focused on ward-level activities and considered the following review questions:

  • What patient safety outcomes are associated with nurse and healthcare assistant staffing levels and skill mix?

    • Which outcomes should be used as indicators of safe staffing?

    • What outcomes are associated with tasks undertaken by registered nurses, healthcare assistants and other staff?

  • Which patient factors affect nurse and healthcare assistant staffing requirements at different times during the day? These include:

    • patient dependency and acuity assessment and grading

    • patient turnover.

  • How does the ward environment, including physical layout and diversity of clinical disciplines, affect safe staffing requirements?

Evidence review 2 focused on ward-level managerial activities and organisational level factors and considered the following review questions:

  • What management approaches affect nurse and healthcare assistant staffing requirements?

    • What nursing staff supervisory and/or team management approaches are required?

    • What approaches for identifying required nurse staffing levels and skill mix are effective, and how frequently should they be used?

  • What organisational factors influence safe staffing at a ward level? These include:

    • management structures and approaches

    • organisational culture

    • organisational policies and procedures, including staff training.

The economic analysis used the best available evidence and data from the UK to determine the relationship between nursing and skill mix and nursing sensitive outcomes. The cost effectiveness of altering staffing or skill mix was also assessed.

Expert paper 1 presented testimony from the topic specialist member on the experience of safe staffing in the New Zealand public health system.

Expert paper 2 presented testimony from the topic specialist lay member of the Committee.

Expert paper 3 presented a summary of a subgroup meeting of the Committee to explore the key patient factors and nursing needs that must be considered when calculating nursing care requirements, and aspects of nursing missed care that could be monitored as red flag nurse staffing indicators.

The Report on field testing of the draft guideline presented results of testing the use of the draft guideline with nursing staff.