Context

The Department of Health and NHS England asked NICE to develop evidence-based guidelines on safe staffing, with a particular focus on nursing staff, for England. This request followed the publication of the following reviews and reports.

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013)
Keogh review into the quality of care and treatment provided in 14 hospital trusts in England (Keogh 2013)
The Cavendish Review, an independent enquiry into healthcare assistants and support workers in the NHS and social care setting (Cavendish 2013)
Berwick report, A promise to learn – a commitment to act: improving the safety of patients in England. (Berwick 2013).

The need for guidelines on safe staffing, including nursing staff, was also highlighted in the following policy documents and responses:

How to ensure the right people, with the right skills, are in the right place at the right time. A guide to nursing midwifery and care staffing capacity and capability (National Quality Board 2013).
Hard truths. The journey to putting patients first (Department of Health 2013).
Compassion in practice – nursing, midwifery and care staff – our vision and strategy. (Department of Health and NHS Commissioning Board 2012).

Focus of the guideline

This is the first guideline for this NICE work programme. It makes recommendations on safe staffing for nursing in adult inpatient wards in acute hospitals, based on the best available evidence. The guideline focuses on wards that provide overnight care for adult patients in acute hospitals. It does not cover intensive care, high dependency, maternity, mental health, acute admission or assessment units or wards, or inpatient wards in community hospitals.

In this guideline, nursing staff refers to registered nurses and healthcare assistants unless otherwise specified.

The guideline identifies organisational and managerial factors that are required to support safe staffing for nursing, and indicators that should be used to provide information on whether safe nursing care is being provided in adult inpatient wards in acute hospitals. (For further information, see the scope for the guideline.)

This guideline is for NHS provider organisations and others who provide or commission services for NHS patients. It is aimed at hospital boards, hospital managers, ward managers, healthcare professionals and commissioners. It will also be of interest to regulators and the public.

Those responsible and accountable for staffing for nursing in adult inpatient wards in acute hospitals, at an organisational and a ward level, should take this guideline fully into account. However, this guideline does not override the need and importance of using professional judgement to make decisions appropriate to the circumstances.

This guideline does not cover nursing workforce planning or recruitment at regional or national levels, although its content may inform these areas.

While we acknowledge the important contribution of a multi-disciplinary approach to ensure safe nursing care, staffing requirements in relation to doctors, specialist nurses and other healthcare professionals are not addressed in this guideline. They may however be covered in future staffing guidelines.

Related documents

The National Quality Board for England considers that nursing staff capacity and capability are the main determinants of the quality of care experienced by patients, and has issued guidance about what is expected of commissioners and providers in this area (See the National Quality Board's guide on how to ensure the right people, with the right skills, are in the right place at the right time. A guide to nursing, midwifery and care staffing capacity and capability). NHS England and the Care Quality Commission also recently published joint guidance to NHS trusts on the delivery of the 'Hard Truths' commitments on publishing staffing data regarding nursing, midwifery and care staff levels. In early 2014, the Department of Health consulted on introducing fundamental standards for health and social care providers to promote care that is safe, high quality, and puts patients first (Department of Health 2014). The Department was analysing the responses at the time this guideline was published and a final version was not available. This guideline should be read alongside these documents.

Toolkits to support this guideline

The guideline will also be of interest to people involved in developing decision support toolkits and resources for assessing and determining safe nursing staff requirements. NICE offers a separate endorsement process to assess whether submitted decision support toolkits for informing nursing staff requirements comply with the guideline recommendations. Details of any tools that can help with implementing this guideline are listed alongside other resources.