The Framework for Safe Nurse Staffing and Skill Mix is a systematic, triangulated, evidence-based approach to determine nurse staffing (including both the nurse and healthcare assistant roles) and skill mix, based on patient acuity and dependency. The Framework has been applied consistently across a range of care settings nationally. It continues to develop and is currently on its third phase of development.
The Framework on Safe Nurse Staffing and Skill Mix is based on four assumptions:
Patient Elements – underpinned by the belief and evidence that all patients are not the same and therefore their care needs are different. Thus, the elements influencing the determination of safe nurse staffing and skill mix are those directly related to the patient. Included in this assumption are acuity and dependency measurements, enhanced care needs and professional judgement.
Nurse Staffing - underpinned by the belief and the evidence that the size, educational levels, and skill mix of the nursing care team is important to delivering high-quality, safe care to patients. The elements influencing the determination of nurse staffing and skill mix are those directly related to staffing profiles, skill mix (nurse to healthcare assistant ratio), education, recruitment, planned and unplanned absences and tipping points.
Organisational Factors – underpinned by the belief and the evidence that features of the organisational environment do impact nursing number and skill mix. The elements influencing the determination of nurse staffing and skill mix are those directly related to the culture and climate of care setting, along with system factors such as organisational care processes, nurse leadership, capacity, and geographical layout.
Outcomes – underpinned by the belief and the evidence that the nurse staffing and skill mix resource has a direct impact on patient and staff outcomes. Monitoring nurse sensitive patient outcomes is necessary to determine if the nurse staffing and skill mix resource is at a safe level and is capable of adequately meeting patients’ needs. Included in this assumption are nurse sensitive Key Performance Indicators, staff and patient experiences and Safety CLUEs (Care Left Undone Events).
The Framework has been applied and developed over three phases.
Phase 1 applies to general and specialist medical and surgical care settings in adult hospitals.
Phase 2 applies adult emergency care settings.
Phase 3 applies to general non-acute care setting.
Phase 3 given the range and breath of the non-acute setting will include three different stages:
- Phase 3(i) applies to long-term residential care settings (LTRCs) for older persons
- Phase 3(ii) applies to general community care settings
- Phase 3(iii) applies to step down and rehabilitation care settings