Safe staffing for older
people’s wards
An RCN toolkit
Acknowledgements
Report prepared by Nicky Hayes, Older People’s
Adviser, RCN
The author would like to thank:
Soline Jerram, British Geriatrics Society Nurses’
Special Interest Group
Ann Farenden, National Professional Adviser,
Care Quality Commission
Jo Webber, Deputy Policy Director, NHS
Confederation
Clare Gorman, Policy Manager, NHS Confederation
Barbara Schofield, Consultant Nurse, Calderdale
& Huddersfield NHS Foundation Trust
Chris Beech, Consultant Nurse, NHS Forth Valley
Fiona Howell, Matron, University Hospital North
Staffordshire
Jayne Elias, Assistant Director of Nursing, Aneurin
Bevan Health Board
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This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers
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ROYAL COLLEGE OF NURSING
Contents
Introduction4
1. Purpose of the toolkit
4
2. Who should use the toolkit
4
3. How to use the toolkit
5
4. What to do if the recommendations are not met
5
Ward staffing review tool
6
Q1: Is workforce planning adequately reviewed for this ward?
6
Q2: Are ward sisters/senior charge nurses empowered to make decisions on staffing for their area?
8
Q3: Staffing levels and skill mix
9
Q3a: Does this area meet the RCN recommendations on overall staffing numbers?
10
Q3b: Does this area meet the RCN recommendations on skill mix?
11
Q3c: Does this area meet the RCN recommendations on additional nursing support?
13
Q3d: Does this area meet the RCN recommendations on senior clinical support?
14
Q4: Does the ward sister/senior charge nurse for this area have sufficient time to lead and
support their team?
15
Q5: Does this ward have sufficient professional staffing and support at patient meal times to
ensure that all patients that need assistance with food and drink receive it?
16
Q6: Is appropriate training in the knowledge and skills to care for older people available to all
nurses, health care assistants and assistant practitioners?
17
Q7: Do ward sisters/senior charge nurses have a determining influence in selecting staff for
their teams, and adequate administrative and human resources support for this process?
18
Summary and action plan
19
Appendix: Safe staffing for older people’s wards calculator 25
3
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Introduction
Purpose of the
toolkit
This toolkit has been developed by the Royal
College of Nursing (RCN) to help support a review
of staffing on hospital wards where older people
are cared for. It can also be used to help address
any associated leadership and workforce issues.
It is based on the RCN recommendations in Safe
staffing for older people’s wards (RCN, 2012).
These were developed with expert nurses and
a range of stakeholders, supported by a survey,
focus group and evidence from the literature.
This toolkit is designed to provide a simple,
practical way to explore nursing staff levels
on older people’s wards, or wards where the
large majority of patients are older people,
and to determine whether they meet the RCN
recommendations for safe care. It can be used for
a variety of purposes, for example:
• for review of staffing on individual wards or
groups of wards
The starting point was a recognition that older
people who are in hospital often have highly
complex needs which require skilled care and
enough time to meet their needs in a dignified
way. Nursing staff need to be able to meet
these needs now and in the future. The RCN’s
recommendations identify a range of factors that
underpin safe, dignified care:
• as part of a system-wide review of workforce
planning
• to provide information to an external review of
hospital safety and performance
• to produce evidence to inform commissioning
of hospital services.
• sufficient numbers and skill mix of nursing staff
on duty at the times when they are needed
It could be used to obtain a ‘snapshot’ of the
staffing on one or more wards within a hospital,
or as part of a more detailed review in which
staffing factors and trends are explored over
a period of time. Its outcomes can be used
to: support workforce planning and staff
development; challenge unsafe staffing levels;
provide data for the hospital’s quality indicators;
or inform risk assessment and clinical governance.
• strong leadership at ward level
• empowerment of ward sisters/senior charge
nurses for ensuring safe staffing
• proper workforce development, skills and
training
• appropriate resourcing and environment
• development of appropriate metrics and
measures of patient experience and outcome
of compassionate care giving.
Who should use
the toolkit
Some factors are specific to individual wards,
for example, the numbers of staff rostered for a
shift, while others take in broader support and
infrastructure issues within the hospital. The
RCN recommendations recognise that hospital
teams are multidisciplinary – team members from
all disciplines contribute to care provision and
influence whether it is safe or not.
Hospital-based nurses, managers, board
members and governors, commissioners of
hospital services, or any person or agency that
has an interest in safe, dignified care for older
people in hospital. It is recommended that the
most effective approach is one that is recognised
and supported at as many levels within the
organisation as possible. Outcomes can then be
jointly discussed and can inform ward and
organisational planning. Therefore, the toolkit
should be used as part of a co-ordinated and
transparent review process, in conjunction with
the ward sister/senior charge nurse and their
team, and with upward organisational feedback to
board level via the executive nurse director.
The RCN recognises that there is no universal
or simple solution to staffing issues. Ultimately,
a local decision must be made as to what is
needed for good, safe care. There are also some
differences in health policy and workload planning
approaches across the four countries of the UK,
as identified in the Safe staffing for older people’s
wards (RCN, 2012) recommendations and full
report. Therefore, this toolkit should be applied in
the context of local factors to inform planning for
safe staffing.
4
ROYAL COLLEGE OF NURSING
How to use the
toolkit
to whether the staffing levels are unsafe and may
result in compromised care and, if so, whether
immediate action needs to be taken to ensure
that the problem is appropriately addressed. This
should be progressed using clinical governance
mechanisms and involving hospital management
at the appropriate level. The action plan should be
further escalated, up to board level if necessary,
until any patient safety issues are satisfactorily
resolved. This is to ensure hospital boards and
health boards are aware of any significant safety
issues within the organisation.
The toolkit can be applied to one or more hospital
wards. It is self-contained but should be used
with reference to the recommendations made
in Safe staffing for older people’s wards (RCN,
2012 b,c). The toolkit follows the sequence of the
RCN recommendations, and presents a series of
questions and checkpoints derived from them.
The questions can be completed in any order,
then summarised and transferred to the action
plan. They are framed around the point of care
delivery, for example, at ward level. This is so an
accurate picture can be obtained and any variance
between wards can be clearly identified and
addressed. Evidence should be gathered from the
ward sister/senior charge nurse and their team
and from patients and/or their representatives
where appropriate. Therefore, it is essential that
their permission and co-operation is sought if the
review is to be led at a different organisational
level, or externally. Patient confidentiality must be
respected at all times.
It is important to note that simply calling for
more staff does not guarantee safe care will be
achieved. As many factors as possible should
be taken into account and there should not
be reliance on numbers alone. Efficient ward
management, patient flow, appropriate skill mix,
a safe and therapeutic physical environment and
a positive, person-centred culture are all part of
the mix.
References
Royal College of Nursing (2012a) Safe staffing for
older people’s wards calculator, London: RCN.
Publication code: 004 302.
The Safe staffing for older people’s ward calculator
is featured as an appendix in this toolkit. It is also
available as a standalone resource.
Royal College of Nursing (2012b) Safe staffing
for older people’s wards: full report and
recommendations, London: RCN. Publication code:
004 301.
What to do if the
recommendations
are not met
Royal College of Nursing (2012c) Safe staffing for
older people’s wards: summary of key guidance
and recommendations, London: RCN. Publication
code: 004 234.
Application of this toolkit may highlight
issues, risks and potential actions at various
organisational levels. The toolkit provides
guidance on developing an action plan that
will identify how, and to whom, actions should
be addressed. There must be reasonable
interpretation of the implications of short staffing
and the degree of urgency with which it should
be addressed. Timescales for action could be
immediate, medium or long term. For example,
on some wards even a one-off shortage may be
unacceptable; on others a single occurrence may
be manageable.
If a review identifies that the staffing level
or skill mix on a ward falls below the RCN
recommendations, a decision must be made as
5
Ward staffing review tool
Checkpoint
Evidence to look for
Is a systematic
approach to
workforce
planning used?
The ward sister/senior charge nurse
can describe the approach to workforce
planning that is applied to their ward,
eg application of a workload tool and/or
professional judgement on a regular basis.
6
The approach to workforce planning takes
into account both the quality and quantity
of care needed by older people, ie time
needed to give dignified, person-centred
care that meets the needs of people with
dementia, sensory loss, special needs
at mealtimes, complex discharge needs
or family/carer support. This might be
evidenced by low levels of complaints
about quality of care and high levels of
positive patient feedback, as well as
quality indicators such as falls, pressure
sores, nutritional indicators and
discharge delays.
Were staff
involved in the
process of the last
review and aware
of the outcomes?
The ward sister/senior charge nurse states
that they are aware of a review having been
carried out and report that they, and their
team, were involved.
Is a triangulation
approach used?
The ward sister/senior charge nurse is
aware that a combination of approaches
is used to review staffing, eg any workload
tools that are used are complemented
with professional judgement by the ward
sister/senior charge nurse and benchmark
data from other wards.
Yes/no/partial/
not applicable
Comments/rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Question 1: Is workforce planning adequately reviewed for this ward?
Is a 25%* uplift
applied?
The number of staff needed to cover all
shifts* has been determined and an extra
allowance of 25% added to cover absence
*RCN 2010
of all kinds in order to give the total staffing
recommendations,
establishment, or there is evidence that
but 22.5% agreed
regionally or locally negotiated uplift
in Scotland (Royal
is adequate to cover leave/absence
College of Nursing
according to local need. The ward sister/
(2010) Guidance
senior charge nurse is aware of the impact
on safe staffing
of ‘incremental’ drift on budgets and
levels in the UK.
establishments and revisits this regularly
London: RCN.
with the budget holder to ensure that
Publication code
adequate resources remain available.
003 860)
A range of outcome measures are used
on this ward that are likely to reflect the
quality and quantity of staffing, eg adverse
incident reports, patient satisfaction/
complaints, staff satisfaction, sickness/
absence rates.
Is staffing
regularly
reviewed?
The ward sister/senior charge nurse is
aware that staffing has been reviewed
within the last two to three years.
7
Is there evidence
that the adequacy
of staffing has
been evaluated?
Overall
Achieved/
partially
achieved/
not achieved
ROYAL COLLEGE OF NURSING
Question 2: Are ward sisters/senior charge nurses empowered to make decisions on staffing for
their area?
Evidence to look for
Ward sisters/
senior charge
nurses are able
to use their
professional
judgement to
ensure safe and
realistic day-today workload
planning
The ward sister/senior charge nurse states that their
professional judgement is used to ensure safe and realistic
day-to-day workload planning. This includes considering the:
Yes/no/partial/
not applicable
• environment of care, including its geography and its
appropriateness for caring for older people, particularly for
people with dementia and people at risk of falls
• additional need for one-to-one care, or other additional
support for patients arising from delirium, acute confusion,
wandering, falls or other high risks
• time required to support relatives and lay carers and to
involve them appropriately in care
• time and skills required to manage complex discharges
8
• time needed to communicate with older patients who may
have sensory or cognitive impairment
• skills and competence of the staff available in caring for
older people*
*see also Question 6
• time needed to provide essential care in a compassionate
and person-centred way
• time needed to supervise and support health care
assistants, assistant practitioners and other support worker
roles, to ensure that care is person-centred rather than
task-driven, and that support workers maintain and develop
appropriate skills in the care of older people
• time needed to supervise and support student nurses and
other learners who are on clinical placement on the ward.
Overall
Achieved/partially
achieved/
not achieved
Comments/rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Checkpoint
Question 3: Staffing levels and skill mix
a) Does this area meet the RCN recommendations on overall staffing
numbers?
b) Does this area meet the RCN recommendations on skill mix?
c) Does this area meet the RCN recommendations on additional
nursing support?
d) Does this area meet the RCN recommendations on senior clinical
support?
9
To address this question, you should determine how many beds are
typically occupied at any one time. The ward off-duty rota should then
be reviewed to identify a typical recent daytime shift. The ward sister/
senior charge nurse should verify that this reflects the actual number
of staff on duty for that shift, not just the establishment. You should
then use the calculator and Table 1 below to work out whether the skill
mix and total staff numbers are safe for the number of beds occupied,
and then go to the checkpoint box at the end of this section to enter
your conclusions. The calculation should exclude any additional staff,
students or volunteers, or staff deployed for one-to-one care. If the ward
sister/senior charge nurse has supervisory status they should also be
excluded from the calculation. NB The recommendations for both skill
mix and total staffing numbers must be met in order to confirm that
staffing levels are safe.
Table 1: Summary RCN recommendations
Staff: patient ratio Number of RNs
Total staff on duty
1:9
1: 4.6
3
6
Basically safe care 1:7
1: 3.3 – 3.8
≥4
≥8
Ideal, good quality 1:5 - 1:7
care
1: 3.3 – 3.8
4-6
≥8
Unsafe
ROYAL COLLEGE OF NURSING
Registered nurse
(RN) patient ratio
Question 3a: Does this area meet the RCN recommendations on overall staffing numbers?
Overall staffing numbers calculator
Step 2: Identify the total staff numbers (RNs plus HCAs) on a typical day shift
and highlight this on the calculator against the bed occupancy.
Step 3: Look across to column 3 to identify whether the staffing numbers
You may wish to consider whether the staff available are from the permanent
ward team, or whether a proportion are bank/agency staff. If bank/agency
are included, you may wish to take into account whether a full contribution to
care activities was made, and if not, whether you wish to exclude these staff
from the calculation.
1
2
3
Number
of beds
occupied
Total number of staff actually on duty on a
typical day shift (RNs plus HCAs), excluding
the ward sister/senior charge nurse if they are
designated supernumerary, and also excluding
staff who are deployed for one-to-one care
Total number of staff needed on duty (RNs plus HCAs), excluding the ward sister/senior charge
nurse and staff deployed for one-to-one care, to meet recommended staff : patient ratio of 1:
3.3 – 3.8
NB: if staffing falls below these levels, it may be unsafe. Greater acuity on the ward is likely to
mean that more staff are needed
10
30
≥8
29
≥8
28
≥8
27
≥8
26
≥7
25
≥7
24
≥7
23
≥6
22
≥6
21
≥6
20
≥6
19
≥5
18
≥5
17
≥5
16
≥5
15
≥4
14
≥4
13
≥4
12
≥4
Comments/rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Step 1: Identify the actual bed occupancy on a typical day shift, and circle it
on the calculator below.
meet the recommended level and enter this in the summary box for question
3 that follows the calculator.
Question 3b: Does this area meet the RCN recommendations on skill mix?
Skill mix calculator
Step 1: Identify the actual bed occupancy on a typical day shift, and
circle it on the calculator below.
Step 3: Look across to columns 3 and 4 to identify whether the RN
numbers meet the recommended level for this number of beds and
enter this in the summary box for question 3b below.
Step 2: Identify the number of RNs on duty on a typical day shift and fill
this in on the calculator against the bed occupancy.
Number of beds
occupied
Number of RNs on duty per
number of beds occupied
Total number of RNs needed on duty as part of the total staff
Basically safe care
Ideal care
(RN: patient ratio 1:7
(RN: patient ratio 1:5 - 1:7
11
skill mix 65: 35)
≥4
4-6
29
≥4
4-6
28
≥4
4-6
27
≥4
4-6
26
≥4
4-6
25
≥4
4-5
24
≥4
4-5
23
≥3
4-5
22
≥3
4-5
21
≥3
4-5
20
≥3
3-4
19
≥3
3-4
18
≥3
3-4
17
≥3
3-4
16
≥3
3-4
15
≥2
2-3
14
≥2
2-3
13
≥2
2-3
12
≥2
2-3
ROYAL COLLEGE OF NURSING
skill mix 50: 50)
30
Summary box: Does this area meet the RCN recommendations on skill mix?
Evidence to look for
Yes
No
Is the skill mix adequate for See calculator. At least half
basically safe care?
the staff on duty should be
registered nurses
(50: 50 ratio).
Is the skill mix adequate for See calculator. There should
ideal, good quality care?
be at least a 65:35 RN: HCA
ratio on duty on a day shift.
Overall
Achieved/partially
achieved/
not achieved
Comments/rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Checkpoint
12
Question 3c: Does this area meet the RCN recommendations on additional nursing support?
Checkpoint
Evidence to look for
Availability of
additional staff
Does the ward
sister/senior
charge nurse have
rapid access to
additional nursing
resources during
periods of high
patient acuity,
dependency and
risk?
The ward sister/senior charge nurse states
that an additional member of staff can be
rapidly accessed to support one-to-one care
when needed, eg for the supervision and
support of patients at high risk of harm, such
as patients with disturbed behaviour, who
wander, or who are at very high risk of falls.
Immediately
Patients and/or visitors state that staffing
appears to be adequate to cope at times of
high acuity, dependency and risk.
Yes/no/partial/
not applicable
Comments/rationale
By the end of
the shift
Later
13
Never
Ward sister/senior charge nurse states that a
budget is available for additional staff during
periods of high patient acuity, dependency
and risk.
Staff that are
allocated for oneto-one support for
high-risk patients
are appropriately
skilled to care for
them
Ward sister/senior charge nurse states that
additional staffing is used appropriately, eg a
member of the ward team who is appropriately
skilled is allocated to ‘special’ the patient, or
an additional staff member who is brought in
does have the skills needed.
Overall
Patients who have received one-to-one support,
or their relatives/representatives state that
support was sufficient and of the right quality.
Achieved/
partially
achieved/
not achieved
ROYAL COLLEGE OF NURSING
Resources for
funding the
additional staff
are budgeted
Checkpoint
Evidence to look for
Ward sisters,
senior charge
nurses and their
teams should have
access to senior
clinical support
and leadership
from nurses who
are expert in
the care of older
people (such as
consultant nurses)
The hospital/trust/health board has at least
one individual in post who is supernumerary
and holds one of these roles: consultant
nurse for older people; clinical nurse
specialist for older people.
Yes/no/partial/
not applicable
The ward sister/senior charge nurse and their
team state that this individual is available
within a reasonable timescale to provide
advice regarding care for older people.
14
The ward sister/senior charge nurse and
their team state that these senior clinical
support roles demonstrate clinical and
service development skills, providing direct
care as well as championing older people’s
care across the organisation and nurturing
innovation and improvement at ward level.
The ward sister/senior charge nurse is
aware that the hospital/trust/health board
has access to at least one individual who
is supernumerary and holds one of these
roles: psychiatric liaison nurse; clinical nurse
specialist in dementia.
This individual is available within a
reasonable timescale to provide advice to
the ward sister/senior charge nurse and their
team regarding care for older people.
Overall
Achieved/
partially
achieved/
not achieved
Comments/rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Question 3d: Does this area meet the RCN recommendations on senior clinical support?
Question 4: Does the ward sister/senior charge nurse for this area have sufficient time to lead
and support their team?
15
Checkpoint
Evidence to look for
Is there a nurse
in charge every
shift?
The ward sister/senior charge nurse can demonstrate
that the off-duty rota identifies a nurse in charge for
every shift.
Is the ward
sister/senior
charge nurse
supervisory?
The ward sister/senior charge nurse confirms that they
have adequate supervisory status to enable them to lead
the ward and support their staff effectively, including
time to recruit, appraise and develop their team.
Is there evidence
that the Executive
Nurse Director/
Director of Nursing
of the hospital/
trust/health board
provides strong
leadership and
support to ward
sister/senior
charge nurses and
their teams?
The ward sister/senior charge nurse confirm that
their executive nurse director/director of nursing
demonstrates that they:
Yes/no/partial/not
applicable
Comments/rationale
• champion the needs of older people at board level
• recognise the key role of the ward sister in achieving
high standards in the care and culture on their ward
• empower their ward sisters/senior charge nurses to
deploy these recommendations
• support development of metrics that identify the
nursing contribution and champion this at board level
• ensure that systems are in place to assure the quality
of care for older people across the organisation
ROYAL COLLEGE OF NURSING
• identify budgets for safe staffing and flexible additional
resources
• regularly review staffing establishments with their ward
leaders.
Overall
Achieved/partially
achieved/
not achieved
Checkpoint
Evidence to look for
On a typical shift,
all patients who
need assistance
with food and
drink receive it
The ward sister/senior charge nurse confirms
that there are sufficient staff/support to meet
patient needs at mealtimes:
Yes/no/partial/
not applicable
• nursing staff numbers are sufficient to help
all patients who need it
• multidisciplinary team (MDT) members
contribute to patient assistance if needed
16
• ward team has access to additional support
at mealtimes to enable everyone to be
assisted who needs it, eg nutritional support
workers, volunteers, family carers.
Additional support from volunteers, family
etc, (used to support patients with less
complex needs) does not replace NHS staff,
but performs additional activities for patient
comfort, social and psychological support,
preparation and non-complex support with
eating and drinking.
Older patients can confirm that they receive
help to prepare for mealtimes, to wash their
hands or to open containers.
Overall
Achieved/
partially
achieved/
not achieved
Comments/rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Question 5: Does this ward have sufficient professional staffing and support at patient meal
times to ensure that all patients who need assistance with food and drink receive it
Question 6: Is appropriate training in the knowledge and skills to care for older people available
to all nurses, health care assistants and assistant practitioners?
Checkpoint
Evidence to look for
Training in the knowledge
and skills to care for older
people is available at a level
that is appropriate to role and
band, to all nurses, health
care assistants and assistant
practitioners
RNs on this ward state that they have accessed appropriate training
for their role and band.
Yes/no/partial/not
applicable
Comments/rationale
HCAs and assistant practitioners on this ward state that they have
accessed appropriate training for their role and band.
Ward staff confirm that their training typically included the
following (appropriate to role):
• delivering dignified, person-centred care for older people and
understanding the patient experience
17
• human rights, mental capacity issues and safeguarding
vulnerable older people
• understanding the ageing process and how this impacts on health
and wellbeing
• recognition and management of cognitive impairment, dementia,
delirium and depression
• identifying frailty and co-morbidity and the impact on health need
• communication with people who have cognitive and sensory
impairment
ROYAL COLLEGE OF NURSING
• identifying and meeting psycho-social needs in later life
• meeting carers’ needs
• continence promotion and management of incontinence
• nutritional needs in later life and support with eating and drinking
• prevention and management of falls.
Staff can demonstrate/describe what impact this training has had
on patient care.
Overall
Achieved/partially
achieved/
not achieved
Checkpoint
Evidence to look for
Ward sisters/
senior charge
nurses have a
determining
influence in
selecting staff for
their teams
The ward sister/senior charge nurse for the
ward states that they have a determining
influence in:
Yes/no/partial/
not applicable
• recruitment and selection of nursing staff
that have the right knowledge and skills to
care for older people
• ensuring recruitment processes include a
focus on values and attitudes that support
compassionate care
18
• recruitment processes that identify
individuals who have the right qualities to
care for older people
• the support, development and appraisal
of staff, with a focus on performance in this
area.
Ward sisters/
senior charge
nurses have
adequate
administrative and
human resources
support for this
process
Overall
There is an identified administrative support
(part time or full time) that is allocated
specifically to the ward’s sister/senior charge
nurse. The ward sister/senior charge nurse
states that this resource is adequate.
The ward sister/senior charge nurse states
that they have adequate support from human
resources.
Achieved/
partially
achieved/
not achieved
Comments/rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Question 7: Do ward sisters/senior charge nurses have a determining influence in selecting staff
for their teams, and adequate administrative and human resources support for this process?
Summary and action plan
19
Use the table overleaf to assess whether the RCN safe staffing
recommendations are being met. Enter the outcomes of each
checkpoint into the grid, indicating which are met or not met. The
next step is the action plan.
It is essential that workforce issues are addressed systematically and
in the context of the full range of factors that support safe staffing.
Therefore, action planning is likely to include some input from one or
more of the following:
The action plan should include the priorities and timescales for action.
However, it is crucial that any issues that might compromise safety on
the ward are addressed as a matter of urgency. These urgent issues
should be escalated appropriately via clinical governance processes
within the hospital. For ward-based staff, this means that unsafe
staffing levels that compromise essential care should be immediately
reported and addressed using clinical incident reporting mechanisms.
• senior nurses
It is important that the action plan is championed by an individual
or team who are empowered to make change happen. It is therefore
essential that this person (or team) is clearly identified and their lead
and responsibility is recognised by senior management within the
hospital. If you have led the review but are not sure who can champion
the necessary change, take advice from your manager or, if you are
from a commissioning group or regulator, this should be discussed
with the director of nursing.
• patient experience leads
• education providers
• hospital board members
• the ward-based MDT
• patient representatives
• human resources department
• local union representatives
• volunteer organisers
• administrative and housekeeping staff.
ROYAL COLLEGE OF NURSING
There are many factors and people within an organisation that need
to be considered when forming an action plan. Action planning
should include input from the ward multdisciplinary team (MDT) so
that workload factors can be discussed in the context of all staff
roles, and patient outcomes appropriately considered. Additional
evidence such as patient stories, feedback or case studies can
be included in this section to support the issues raised or actions
proposed. The view of the ward sister/senior charge nurse should
also be included as supporting evidence.
• hospital-based clinical practice facilitators
RCN summary table and action plan
1. Is workforce planning adequately reviewed for this
ward?
2. Are ward sisters/senior charge nurses empowered to
make decisions on staffing for their area?
20
3. Staffing numbers and skill mix
a) Does this area meet the RCN recommendations on
skill mix?
b) Does this area meet the RCN recommendations on
overall staffing numbers?
NB both staffing numbers and skill mix must meet the
recommended levels for staffing levels to be safe.
c) Does this area meet the RCN recommendations on
additional nursing support?
d) Does this area meet the RCN recommendations on
senior clinical support?
Yes No Partially
Action
required
Who should
take action
Timescale for action
to be completed
Date actioned
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Recommendation/ question number
Recommendation/ question number
Yes No Partially
Action
required
Who should
take action
Timescale for action
to be completed
Date actioned
4. Does the ward sister/senior charge nurse for this area
have sufficient time to lead and support their team?
5. Does this ward have sufficient professional staffing
and support at patient meal times to ensure that all
patients who need assistance with food and drink
receive it?
21
6. Is appropriate training in the knowledge and skills
to care for older people available to all nurses at both
pre- and post-registration levels, and to health care
assistants and assistant practitioners?
ROYAL COLLEGE OF NURSING
7. Do ward sisters/senior charge nurses have a
determining influence in selecting staff for their teams,
and adequate administrative and human resources
support for this process?
Supporting evidence from ward sister/senior charge nurse
At this point, the ward sister/senior charge nurse should contribute their personal view of the staffing on their ward, what appropriate action is needed (if
any) and whether this is covered in the action plan
Rationale
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Personal view of ward sister/senior charge nurse
22
Additional supporting evidence
Please add any additional evidence that illustrates the impact of staffing issues arising from this review; both positive and negative evidence can be added,
to support any call for action. Evidence can be drawn from:
• patient stories
• patient feedback
• case studies
• any other source of evidence.
Additional evidence
Rationale: how this evidence supports or adds to Source of evidence and date
the issues raised/action plan
23
ROYAL COLLEGE OF NURSING
Action planning: review
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Outcome
Lead reviewer
Review date
24
Total number or staff needed on duty (RNs and HCAs) to meet
recommended staff : patient ratio
25
safe
staffing
levels
unsafe
staffing
levels
7
6
5
4
12
14
16
18
Number of beds occupied
20
22
24
26
28
ROYAL COLLEGE OF NURSING
Total number of staff on duty
8
Appendix
Safe staffing for older
people’s wards calculator
Skill mix: number of registered nurses (RNs) needed on duty
l
skil
5
3
65:
6
mix
ideal care
and above
Number of RNs on duty
26
5
x
kill mi
s
0
5
:
50
4
3
2
12
14
16
18
Number of beds occupied
20
22
24
26
28
basically
safe –
ideal care
unsafe
care
SAFE STAFFING FOR OLDER PEOPLE’S WARDS - AN RCN TOOLKIT
Safe staffing for older
people’s wards calculator
ROYAL COLLEGE OF NURSING
Notes
27
The RCN represents nurses and nursing, promotes
excellence in practice and shapes health policies
October 2012
Published by the Royal College of Nursing
20 Cavendish Square
London
W1G 0RN
020 7409 3333
RCN Online
www.rcn.org.uk
RCN Direct
www.rcn.org.uk/direct
0345 772 6100
Publication code: 004 301
ISBN: 978-1-908782-18-2
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