Many years ago a world-renowned nurse leader said to me: “Ros, if we get the workforce right we get everything right.” A statement of the blindingly obvious you might think. I preferred then, as I do now, to see it as an enduring truth, forgotten at our peril. These words have never felt more pertinent as I consider the tremendous impact the shift towards prevention and community-led management of health and care will have on our registered community nurses.
Terms like workforce planning and workload analysis can be a turn-off for nurses embroiled in the day-to-day reality of practice. But these are not just abstract processes; they are about real people and their working lives and assuring the quality of care they can provide - which is more reason, not less, to have a rational system in place to ensure that we listen to our community staff and ensure staffing levels are evidence-based.
In 2010, the Royal College of Nursing (RCN) recognised that NHS Scotland was unique in being the only country within the UK to follow an integrated approach to workforce planning. This allows for a consistent approach in determining nursing and midwifery workforce numbers across all NHS boards in the country.
The Nursing and Midwifery Workload and Workforce Planning Project Report was set up by the Scottish Executive in 2004. It identified that tools and systems needed to be adapted at national level to take account of emerging patient acuity and workload issues for nursing and midwifery, using a systematic process to ensure valid and reliable outcomes.
After extensive research, a systematic national approach to nursing and midwifery workload and workforce planning was recommended. Subsequently workload tools have been developed which in turn identify the workforce required.
Since then, the programme has developed a suite of evidence-based and statistically robust workload tools which provide information and data upon which decisions about staffing establishments can be made. The workload-specific tool, however, is only one of several methods applied. In Scotland we recommend a triangulated approach which incorporates professional judgement and quality measures, and we have gone further to advise that funded and actual staffing establishments should be taken into consideration as well as local context. We describe local context as the labour market, capacity and capability, local interpretations of ward housekeeper, ward assistant roles etc.
One of the latest developments is the community nursing workload tool, which incorporates district nurses, community staff nurses, health care assistants, health visitors and school nurses. In the most recent version we have incorporated questions about caseload specifically geared towards our public health/health visitor cohort. The reports we will get from these workload tools highlight workload and give a workload index. They also report on interventions and their complexity. This in itself, following interpretation, will enable us to make better decisions regarding future workforce requirements, and in conjunction with other information sources it will inform educational requirements.
Work is about to take place to develop calculators that will provide teams with a suggested whole time equivalent number to undertake the workload measured.
The use of workload tools irrespective of specialty area should be used as part of a further triangulation – that of service, financial and workforce planning. This year the workload tools in NHS Scotland were mandated as part of the guidance issued centrally to NHS boards when determining their nursing and midwifery workforce projections. It provides an evidence-based, statistically robust recommendation for staffing numbers, based on actual workload. An effective and efficient way of determining staffing numbers.
Back to that enduring truth - getting the workforce right is important to quality care but it’s also about getting it right for the workforce as well. That’s why I remain absolutely committed to continuing this work so that our workforce can embrace the challenges ahead.
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