Emergency Department Nursing Workforce Planning Framework

210 Pages·2016·2.45 MB·English

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Emergency Department Nursing
Workforce Planning Framework
A framework to assist standardisation of workforce planning approaches
across Emergency Departments and the Emergency Care Networks in
Ireland.
EMERGENCY
MEDICINE
Clinical Strategy and Programmes Division
Acknowledgements
The development of this framework is the product of genuine
collaborative work and co-design by multiple key stakeholders across
our emergency care and wider healthcare services. The collaborative
effort by all stakeholders has ensured the development of a framework fit
for purpose to equip our emergency services in their workforce planning
endeavours not only for now, but also into the future.
A team based in the Institute of Leadership, Royal College of Surgeons in
Ireland, who were successful in the commissioning process, developed
the framework in collaboration with a dedicated Project Advisory Group
comprised of key stakeholders across the spectrum of Emergency Care
and Emergency Nursing in Ireland, the National Emergency Medicine
Programme (EMP), Health Services Executive (HSE) HR, Directors of
Nursing Acute Services, HSE Acute Hospitals Office, Irish Nurses and
Midwives Organisation, and led by the EMP Service Planner.
I wish to thank the following for their involvement in and support for the
development of this framework, which was supported by Dr. Michael
Shannon, and funded by the Office of the Nursing and Midwifery Services
Director (ONMSD), at the request of the National EMP.
___________________
Dr. Gerry McCarthy
National EMP Clinical Lead
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Emergency Department Nursing
Workforce Planning Framework
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RCSI Institute of Leadership (IL) – Project team
Ms Sibeal Carolan Programme Director and Lecturer RCSI IL
Dr. Philippa Ryan Withero Associate Faculty RCSI IL
ED Workforce Planning Framework Project Advisory Group
Susanna Byrne (chair) Emergency Medicine Programme Service Planner
Sinead O’Connor Emergency Medicine Programme Manager
Fiona McDaid Emergency Medicine Programme Nurse Lead
Sinead Lardner Emergency Medicine Programme Nurse Lead
Valerie Small Emergency Medicine Programme Advanced Nurse Practitioner Lead
Deirdre Thomas Emergency Nurse Interest Group representative from Acute Urban ED
Liz Whelan Emergency Nurse Interest Group representatives from Adult Only Urban ED
Bridget Conway, Charlotte O’Dwyer Emergency Nurse Interest Group representatives from Paediatric Only ED
& AnneMarie Dowling
Helen Hanrahan & Angela Boyle Emergency Nurse Interest Group representatives from Mixed Adult/Paediatric ED
Patricia Donovan Emergency Nurse Interest Group representative from Local Injury Unit
Aine Lynch Emergency Nurse Interest Group (education representative)
Geraldine Shaw Director of Nursing National Clinical Programmes (Replaced Joan Gallagher)
Liz Roche ONMSD / Area NMPD Director
Margaret Casey Director of Nursing representative from IADNAM
Paddy Duggan HSE HR (Replaced John Brehony)
Elizabeth Adams Irish Nursing and Midwifery Organisation (INMO).
Ciaran Browne HSE Acute Services
Participating sites
Site Link staff
Our Lady of Lourdes Hospital Drogheda, Co Louth Angela Boyle: Assistant Director of Nursing
Sinead Lardner: Clinical Nurse Manager III
National University Hospital Galway Helen Hanrahan: Assistant Director of Nursing
Our Lady’s Children’s Hospital Crumlin, Dublin 12 Bridget Conway: Clinical Nurse Manager III
St. James’ Hospital Dublin 8 Deirdre Thomas: Assistant Director of Nursing
Sean Farrell: Clinical Nurse Manager III
Sligo General Hospital Sligo Helen O’ Shea: Clinical Nurse Manager III
Project advisory group and ENIG members who participated in site data collection
Liz Roche NMPDU Area Director DML, ONMSD
Liz Whelan Assistant Director of Nursing, Mater Hospital Dublin
Charlotte O’ Dwyer Clinical Nurse Manager III, National Children’s Hospital Tallaght Dublin
Sinead Lardner Clinical Nurse Manager III, Our Lady of Lourdes Hospital Drogheda
Sean Farrell Clinical Nurse Manager III, St. James’ Hospital, Dublin
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Toolkit Test Sites
Margaret Casey Director of Nursing Portiuncula Hospital Ballinasloe
& Mary Crehan Clinical Nurse Manager 3
Berneen Laycock, Adelaide, Meath and National Children’s Hospital
& Yvonne Connaughton
Brendan Malone Tallaght, Dublin 24
Susan Watkins CNM 2 (research) University Hospital Limerick
Noreen O’Sullivan Mercy University Hospital Cork
Assistant Director of Nursing
Specialist Advisors & Contributors
Dr. Keith Hurst Independent Consultant
Ms. Michelle O’ Neill Senior Health Economist, Health Information and
Quality Authority (HIQA)
Dr. Sarah Condell Nursing & Midwifery Research & Development Lead
ONMSD
Ms. Maureen Flynn National Lead for Clinical Governance Development
Ms. Joan Gallagher Office of the Director General
Ms Carmel Cullen HSE Communications
Ms Helen Bohan Senior Administrator, Nursing and Midwifery Planning &
Development Unit, Dublin South, Kildare & Wicklow.
This framework is for use by senior ED nurse managers and their teams in the emergency setting, directors
of nursing, other senior nurse managers, human resource staff and other healthcare staff clinical or corporate,
that have a remit for workforce planning.
The framework should be read alongside the National Emergency Medicine Programme (EMP) report (HSE
2012b) and other subsequent relevant EMP publications; ANP guide (HSE 2013b), LIU guidance document
(HSE 2013a) and ED nursing role profile document (HSE 2014a) (available on emnow.ie)
Individual sections of the framework can be used separately but should be interpreted and implemented in the
context of the entire framework.
This framework is endorsed by HSE ONMSD and the EMP and HSE Leadership team. Implementation of the
framework is the responsibility of local services.
©: The ONMSD & EMP
This framework can be downloaded for use and may be reproduced for local workforce planning and not-for-
profit purposes. No reproduction for commercial purposes is allowed.
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Table of Contents Page
Executive Summary.............................................................................................6
Glossary of terms ..............................................................................................12
Part 1 - Literature Review ..................................................................................13
Part 2 - ED Workforce Planning Toolkit .............................................................49
Part 3 - Education Workshop Programme Design ...........................................133
Appendix 1 Project Methodology .....................................................................143
Appendix 2 Survey Data Collection Tool .........................................................163
Appendix 3 Participating Site Observation Analysis Data Collection Tool .......175
Appendix 4 Emergency Nursing Workforce Planning Toolkit Evaluation .........189
Appendix 5 Blank Templates ...........................................................................193
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EXECUTIVE SUMMARY
Appropriate levels of staffing are fundamental in planning at local level is critical as ideally systems
meeting patients’ needs and assuring the quality and at local level should guide and inform regional and
safety of their time spent in the emergency setting. national nurse staffing levels. Such an approach
Currently there are no national guidelines for nursing is more likely to produce intelligent and consistent
establishments in Emergency Departments (EDs) information on the nursing workforce. This demands
in Ireland, nor is there an agreed methodology for that local services and nursing management be
determining appropriate utilisation of nursing and informed and equipped with appropriate guidance
support staffing allocations in the ED. One of the on the most appropriate methods to determine
recommendations of the Emergency Medicine nurse staffing levels and skill mix, to meet the
Programme (EMP) report (HSE 2012b) is that evolving needs, not only of health service redesign
‘Standardised staffing models will be developed to and technological advances, but also service user
ensure equitable and appropriate staffing for all EDs expectations of quality care. This is evident in
and Emergency Care Networks (ECNs)’. Therefore, the recent publication of the National Institute of
in order to realise this recommendation, the Office Healthcare Excellence (NICE) guidance (2014a) on
of the Nursing and Midwifery Services Director safe staffing, which sets out recommendations on the
(ONMSD), at the request of the EMP, commissioned factors to be systematically assessed to determine
the Royal College of Surgeons in Ireland, Institute of the appropriate nurse staffing establishment.
Leadership, (RCSI IL) following a tendering process, The ED Workforce Planning Framework Project
to design and develop a Workforce Planning objectives were to
Framework to assist ED nurse managers and other u Develop a framework to serve as a guide to
relevant staff in determining the most effective and support senior ED nurse managers and their
appropriate utilisation of their existing nursing (and teams to assess and plan their nursing (and
support staff) resource in the emergency setting. support staff) workforce to meet the needs of
The primary drivers for the development of this their individual services
framework were the necessity to; u Support the standardisation of workforce
u Implement a standardised staffing model as planning approaches across EDs nationally
recommended by the EMP Strategy; u Develop the competence and confidence of
u Support and guide senior ED nurse managers senior ED nurse managers and other relevant
and their team to assess and plan their nursing staff in making informed workforce decisions
workforce; u Provide the evidence base to support informed
u Respond to the current focus of the health reform workforce decisions by senior ED nurse
agenda which sets out the necessity for greater managers in conjunction with local management.
utilisation of skills of all healthcare workers in
response to and in conjunction with the current This completed Emergency Department Workforce
reforms across the health system; Planning Framework, hereafter referred to as
u Be compliant with HIQA (2012a) standards. ‘the framework’, serves as a guide and a suite of
Standards for safer, better healthcare, Standard resources to support senior ED nurse managers and
6-Workforce. their teams in collaboration with local management
to assess and plan their nursing (and support staff)
The decision to undertake a workforce planning workforce to meet the needs of their individual
framework approach was significant; the justification services. The framework promotes a consistent,
being to facilitate ground up decisions around local standardised and evidence based approach to
workforce requirements. According to the Royal workforce planning and provides the tools and
College of Nursing (RCN 2010a), nursing workforce resources to support workforce decisions.
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Key principles of the Framework A more detailed presentation of the methodology
The following principles guided the methodology employed for the development of the framework is
used in the development of the framework: presented in Appendix 1 of the framework document.
The three key components of the final framework
u Using research to underpin the development include a robust review and presentation of relevant
u Driven by information and data national and international literature pertaining to
u Using cycles of testing, evaluating, adapting and workforce planning in the emergency setting (Part
refining to ensure fit for purpose 1) a practical and user-friendly workforce planning
u Facilitating a collaborative approach in design to toolkit comprising of six distinct sections focusing on
ensure successful development and subsequent factors to be systematically assessed to determine the
implementation appropriate nurse staffing establishment (Part 2) and an
u Supporting users to have a strategic approach implementation methodology for the framework in the
to workforce planning form of an education programme outline designed for
u Supporting a focus on quality and safe care for users of the framework (Part 3).
emergency patients
How the framework was developed
The approach taken to the development of this
ED workforce planning framework was one of a
successive staged approach. The project was
implemented in five stages (Figure 1); with each
stage a critical component to the achievement
of the specific and overall project objectives and
key outcomes. This approach ensured a robust
methodology to support development of the
framework and guided the project from initiation to
completion.
Figure 1: Five key stages of the Workforce Planning Framework development.
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
q q q q q
Liteature Review Developing and testing Toolkit design and Toolkit Evaluation Design of Education
data collection tools integration of data and Final Design Programme to support
implementation
q q q q q
1) Comprehensive 1) Development of 1) Consultation with 1) Informal evaluation 1) Design of a defined
review of national workforce analysis the project Advisory of the toolkit in educational
and international tools pertinent for Group on the further consultation with the programme to faciliate
literature on nursing use in ED setting, develpment of the ED Advisory Group development of
workforce planning incorporating the Toolkit competence in
national and 2) Formal evaluation workforce planning
2) Critical review of international evidence 2) Consultation with of the Toolkit using and analysis
ED specific models coupled with external advisory a defined evaluation
of workforce planning consultation with experts on survey by those 2) Consultation with
the project Advisory the develpment of testing the tools in Project Advisory
3) Review of the Group tools within the toolkit the ED Group on the
professional and programme
governmental 2) Testing the tools 3) Integration of the 3) Final design of the outline, delivery
evidence on the across 5 ED sites collected data using toolkit based method and
current and future incorporating data the tools, to illuminate on evaluations assessment
development of collection on case studies and
the nursing profession ED Activity, ED worked examples
Observation and ED
Role Clarification
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Part 1: Literature review The toolkit aims to:
u Introduce the core concepts of nursing workforce
The objective of this literature review was to firstly
planning;
broadly examine and assess the available literature
u Act as a guide to nurse managers and nursing
pertaining to workforce planning models and
teams in EDs to plan and/or review their nursing
approaches and secondly to examine this literature
and support staff workforce;
in the context of Emergency Departments from a
u Provide a systematic approach to the
National, European and Global perspective. The
measurement of nursing workload to inform
literature review is available as a tool in itself within
planning of the nursing workforce both currently
the framework for ED nurse managers and their
and into the future;
team to support evidence based workforce decisions
u Provide tools, practical examples, work-based
(Part 1).
activities and case studies to support informed
decisions on shaping the nursing workforce;
The key conclusions from this literature review
u Lead to informed decisions on the utilisation and
include the necessity
deployment of the nursing workforce to meet
u to monitor ongoing changes in the profession
service needs.
of nursing coupled with changes in the health
system model of delivery which may impact
on current and future planning of the nursing The ED Workforce Planning Toolkit is structured in
workforce six sub sections and is colour coded to help users
u to use a systematic method, inclusive of the navigate to their chosen section (Figure 2). The
various factors affecting the workforce capability toolkit is designed for use as a collective suite of
to delivery safe quality care, to determine the tools however it is also designed to be flexible in that
appropriate nursing workforce users can select sections that are most relevant to
u to understand the requirement to engage in their current needs. The toolkit has a practical user
ongoing monitoring and reassessment of the friendly focus and includes work-based activities and
factors affecting the capability of the workforce worksheets, tools, tips, worked examples, and case
to deliver safe quality care studies underpinned by a workforce planning model,
u to integrate professional judgment in addition to help guide practice on assessing and planning the
to systematic assessments to determine the nursing workforce by the emergency nursing team.
nursing workforce The toolkit is evidence based and a comprehensive
u to ensure methods take cognisance of and reference list is available in the literature review
measurement of patient outcomes section. In addition, to support implementation
u to factor in financial considerations to ensure at local level, samples of the templates and tools
value for money in the management of the to support workforce planning in EDs are also
workforce as well as to support effective and presented.
efficient workforce planning
The toolkit has been tested on the ground to
The information generated in this review was establish its usability, relevance and applicability in
used to inform the subsequent development of the practice.
ED Workforce Planning Toolkit (Part 2) and the
outline design education programme to support
implementation of the overall framework (Part 3).
Part 2: ED Workforce Planning Toolkit
This toolkit aspires to provide a systematic and
consistent approach to emergency nursing
workforce planning and to provide the tools to collect
the evidence to strengthen and enhance the use of
the nursing resource to its full potential.