Each clinical team or service that provides nursing care will have a registered nurse lead.
a) Any service which has nurses working within it must have a registered nurse as part of the leadership team. This individual will have the authority and the responsibility to identify the nursing workforce required to meet the clinical need. They will identify mitigating action when real time and recurrent risks are identified. If risk mitigation such as reducing caseloads or bed closures cannot be achieved, risk escalation must take place and be responded to. This individual’s reporting line will feed into the executive nurse. If there is no executive nurse in the organisation they should report to an identified member of the board or senior management team.
b) Where nurses practise within a wider multi-disciplinary team and have a direct line manager who is not a registered nurse, a clear professional line to clinical nursing leadership must be available.
A registered nurse lead must receive sufficient dedicated time and resources to undertake activities to ensure the delivery of safe and effective care.
a) In the majority of large organisations this registered nurse lead will be supervisory and not rostered as part of the nursing workforce allocation. If there is exception to this, clear rationale must be documented, agreed by the board and highlighted to commissioners / regulators.
b) Resources and time are required for:
- leading and management of the team
- improving and monitoring the quality of care experienced by people who use a service
- workforce planning, monitoring and associated activity
- budget management
- clinical audit and regulatory audit
- initiating quality improvement programmes
- clinical supervision and staff development
- monitoring health and safety data for adverse incidents involving staff and people who use services.
c) Their role in the leadership team must be reflected and incorporated into job descriptions to ensure the additional workload and time management are included.
The time needed for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team.
a) Practice development encompasses clinical supervision, assessment, supervision and teaching, Continuing Professional Development (CPD), revalidation and lifelong learning. Practice development must align to the needs of people who use services.
b) Comprehensive workforce planning should be undertaken and include a workforce learning needs analysis, commissioning and provision of training and education. Facilities for regular professional reflection and clinical supervision should also be in place to support ongoing learning and best practice development.
c) As a minimum, all inductions must include explanation of the governance structure within the team and organisation, and the routes of escalation of nursing issues such as nursing workload, nursing workforce and safety concerns.
When calculating the nursing workforce Whole-Time Equivalent (WTE) an uplift will be applied that allows for the management of planned and unplanned leave and absence.
a) Realistic uplift enables recognition of planned and unplanned leave. Underestimation of either or both planned and unplanned leave will result in an establishment that cannot meet day to day staffing requirements, and over reliance on supplementary staffing such as bank and agency staff, will impact on overall costs and quality of care. The uplift percentage agreed should not compromise service delivery, safety and quality of care.
b) Approved nursing workforce establishment tools are recommended when calculating uplift which must consider each of the following:
- annual leave
- sickness / absence – derived from organisational monitoring of sick leave
- study leave – this must meet or exceed the statutory requirements for registrants
- leave for parents
- other leave – this includes carers leave, compassionate leave etc.
c) Professional judgement considerations for nursing workforce establishment / uplift should include:
- Environmental issues, for example, single rooms
- Geographical issues, for example, travel requirements for community-based staff
- shift patterns / working day
- flexible working
- acuity, complexity and dependency
- professional regulatory requirements
- time required to support/mentor learners in the workplace.
If the substantive nursing workforce falls below 80% for a department/team this should be an exception and should be escalated and reported to the board / senior management.
a) Bank and agency work provides both services and nursing staff with flexibility on both an individual and an organisational level. Over reliance on a temporary workforce such as bank or agency staff:
- has an effect on care provision in the range of activities temporary staff are able to undertake, accountability and delegation and continuity of care for people who use services
- is associated with increased clinical risks due to factors such as variable clinical ability, limited relevant experience and unfamiliarity with the specialty and/or the local geography / population
- is associated with financial risk for the service / organisation.
b) When using nursing staff from bank or agency, the service must be assured that they are competent to work in the role or setting to which they are allocated. Staff skill should be matched to acuity and dependency of people who use services, within approved guidelines. The bank or agency must follow approved employment practices and clearance.
c) All staff from bank / agency will be provided with orientation and local induction which must include incident reporting and how to escalate concerns.
Registered nurses and nursing support workers must be appropriately prepared and work within their scope of practice for the people who use the services, their families and the population they are working with.
a) This includes access to CPD, education, support and development to ensure the nursing workforce has the knowledge, skills and competencies required to deliver evidence based, safe, person-centred care that is of high-quality. As a minimum this needs to include:
- mental capacity
- record keeping
- basic life support
- competency frameworks specific to the area of specialty
- the principles of accountability and delegation
- raising concerns
- health and safety related training including moving and handling, infection prevention and control and fire training.
b) The registered nurse lead will ensure that:
- individuals appointed to the nursing workforce, including those in management roles, are allocated a period of supernumerary induction /preceptorship
- individuals with no previous experience should have a preceptorship period which includes structured induction and close supervision until specialty competence and confidence are achieved
- for more senior/experienced staff taking on additional or different roles, a preceptorship period is still needed until competence and confidence are achieved.
c) For staff who are lone workers, there must be clear access to advice, supervision and support at all times as well as compliance with necessary health and safety requirements.
d) Fostering leadership capability is integral to all members of the nursing workforce throughout their career to embed a psychologically safe culture and strengthen the nursing voice.
Workforce Standards case studies
The Nursing Workforce Standards are being used by RCN reps to support members working in a range of health care settings across the UK.Find out more