PNAE – staffing survey PNAE – staffing survey findingsfindings

Fiona SmithFiona SmithAdviser in Children’s & Young People’s Adviser in Children’s & Young People’s

Nursing, Royal College of Nursing, United Nursing, Royal College of Nursing, United KingdomKingdom

The voice of nursing in the UKThe voice of nursing in the UK

Developing a positionDeveloping a position Survey undertaken Spring 2007Survey undertaken Spring 2007

1616 Countries respondedCountries responded

Summary of overall findings:Summary of overall findings: Established guidance/ Established guidance/ ‘paediatric’‘paediatric’ recommendations recommendations

in 5 countriesin 5 countries

Variations in numbers of paediatric nurses, Variations in numbers of paediatric nurses, registered nurses and support staff in clinical areas registered nurses and support staff in clinical areas …..but some similarities particularly in neonates and …..but some similarities particularly in neonates and paediatric intensive carepaediatric intensive care

Ratio of registered paediatric nurses to unregistered Ratio of registered paediatric nurses to unregistered nursing support staff ….level of consistencynursing support staff ….level of consistency

FindingsFindings Nationally agreed minimum staffing levelsNationally agreed minimum staffing levels

- Belgium, Croatia, Holland, Malta & UK- Belgium, Croatia, Holland, Malta & UK

Paediatric agreed minimum staffing levelsPaediatric agreed minimum staffing levels- Belgium, Holland, Hungary, Malta & UK- Belgium, Holland, Hungary, Malta & UK

Minimum of 2 registered paediatric nurses on Minimum of 2 registered paediatric nurses on duty at all times throughout the 24 hour period duty at all times throughout the 24 hour period in General paediatric wards and departments in General paediatric wards and departments - Belgium, Croatia, Greece, Holland, Hungary, Iceland, Italy & - Belgium, Croatia, Greece, Holland, Hungary, Iceland, Italy & UKUK[Children’s Hospitals in Estonia also achieve, Switzerland [Children’s Hospitals in Estonia also achieve, Switzerland advise 1-2 per shift, variable in Norway, Malta advises advise 1-2 per shift, variable in Norway, Malta advises registered nurses but not paediatric nurses]registered nurses but not paediatric nurses]

Findings: Ward Nurse Findings: Ward Nurse staffingstaffing

Minimum ratio of registered paediatric nurses Minimum ratio of registered paediatric nurses to children/young people might be: to children/young people might be: Under 2 yearsUnder 2 years 1 registered nurse to 3 children 1 registered nurse to 3 children - Croatia, Switzerland and UK- Croatia, Switzerland and UK

Variation: 1 nurse to 4; 1: 5; 1: 5-6; 1: 1-7Variation: 1 nurse to 4; 1: 5; 1: 5-6; 1: 1-7

For children over 2 years of ageFor children over 2 years of ageDuring the dayDuring the day 1 registered nurse to 4 children 1 registered nurse to 4 children

- Croatia, Estonia, Switzerland and UK- Croatia, Estonia, Switzerland and UK

Variation: 1 nurse to 4; 1: 5; 1: 6-8; 1: 6-10; 1: 7-8; 1: 1-Variation: 1 nurse to 4; 1: 5; 1: 6-8; 1: 6-10; 1: 7-8; 1: 1-77

During the nightDuring the night 1 registered nurse to 5 children1 registered nurse to 5 children- Croatia, Estonia and UK- Croatia, Estonia and UK

Variation: 1 nurse to 5; 1: 6-8; 1: 7-8; 1: 8-10; 1: 15Variation: 1 nurse to 5; 1: 6-8; 1: 7-8; 1: 8-10; 1: 15

FindingsFindings

The ratio of registered paediatric The ratio of registered paediatric nurses to unregistered nursing support nurses to unregistered nursing support staff in general paediatric nursing staff in general paediatric nursing wards is above the minimum 70 wards is above the minimum 70 percent registered paediatric nurses to percent registered paediatric nurses to 30 percent unregistered nursing 30 percent unregistered nursing support staffsupport staff

- Belgium, Croatia, Estonia, Greece, Holland, Hungary, - Belgium, Croatia, Estonia, Greece, Holland, Hungary, Switzerland & UKSwitzerland & UK

Iceland during the day but not in the evening or nightIceland during the day but not in the evening or night

Findings: Neonatal Findings: Neonatal ServicesServices

Special careSpecial care 1 registered nurse to 4 babies requiring 1 registered nurse to 4 babies requiring this level of carethis level of care

- Estonia, Holland, Iceland, Switzerland & UK- Estonia, Holland, Iceland, Switzerland & UKVariation: 1 nurse to 4-6 babies; 1: 5; 1: 5-6Variation: 1 nurse to 4-6 babies; 1: 5; 1: 5-6

High dependencyHigh dependency 1 registered nurse to 2 babies 1 registered nurse to 2 babies requiring this level of carerequiring this level of care

- Holland, Iceland, Malta, Switzerland & UK- Holland, Iceland, Malta, Switzerland & UKVariation: 1 nurse to 2-3 babies; 1: 4; 1: 3-5Variation: 1 nurse to 2-3 babies; 1: 4; 1: 3-5

Intensive careIntensive care 1 registered nurse to 1 baby requiring this 1 registered nurse to 1 baby requiring this level of carelevel of care

- Holland, Iceland, Malta, Switzerland & UK- Holland, Iceland, Malta, Switzerland & UKVariation: 1 nurse to 2 babies; 1: 2-3Variation: 1 nurse to 2 babies; 1: 2-3

Findings: Paediatric Intensive Findings: Paediatric Intensive CareCare

Level 1:Level 1: This describes care provided to a child who This describes care provided to a child who may require closer observation and monitoring than is may require closer observation and monitoring than is usually available on an ordinary paediatric ward, usually available on an ordinary paediatric ward, although much of this care is already provided, with although much of this care is already provided, with higher staffing levels than usual, in such locations. For higher staffing levels than usual, in such locations. For example the child may need continuous monitoring of example the child may need continuous monitoring of the heart rate, non-invasive blood-pressure the heart rate, non-invasive blood-pressure monitoring, or single organ support (but not monitoring, or single organ support (but not respiratory support). The child may, for example, be respiratory support). The child may, for example, be suffering from moderately severe croup, suspected suffering from moderately severe croup, suspected intestinal obstruction or suspected poisoningintestinal obstruction or suspected poisoning

1 registered nurse to 2 children requiring this 1 registered nurse to 2 children requiring this level of carelevel of care- Holland, Iceland, Switzerland & UK- Holland, Iceland, Switzerland & UK

Variation: 1 nurse to 4 children; 1: 5 ….some countries Variation: 1 nurse to 4 children; 1: 5 ….some countries not surenot sure

Findings: Paediatric Intensive Findings: Paediatric Intensive CareCare

Level 2:Level 2: These children will always need continuous These children will always need continuous nursing supervision. They may need ventilatory nursing supervision. They may need ventilatory support, or support for two or more organ systems. support, or support for two or more organ systems. Sometimes the child will have one organ system Sometimes the child will have one organ system needing support and one other suffering from chronic needing support and one other suffering from chronic failure. Usually children receiving level 2 care are failure. Usually children receiving level 2 care are intubated to assist breathing.intubated to assist breathing.

1 registered nurse to 1 child requiring this 1 registered nurse to 1 child requiring this level of carelevel of care- Holland, Iceland, Malta, Switzerland & UK- Holland, Iceland, Malta, Switzerland & UK

Variation: 1 nurse to 2 children; 1: 3; 1:3-4 ….some Variation: 1 nurse to 2 children; 1: 3; 1:3-4 ….some countries not surecountries not sure

Findings: Paediatric Intensive Findings: Paediatric Intensive CareCare

Level 3:Level 3: Children with two or more organ systems Children with two or more organ systems needing technological support, including advanced needing technological support, including advanced respiratory support, will need intensive nursing respiratory support, will need intensive nursing supervision at all times and will be undergoing complex supervision at all times and will be undergoing complex monitoring and/or therapeutic procedures. They would, monitoring and/or therapeutic procedures. They would, for example, include ventilated children undergoing for example, include ventilated children undergoing advanced renal support, those who have suffered advanced renal support, those who have suffered multiple trauma in major road accidents, or those who multiple trauma in major road accidents, or those who have undergone very complex major surgery.have undergone very complex major surgery.

2 registered nurses to 1 child requiring this level of care2 registered nurses to 1 child requiring this level of care- Holland, Iceland, Malta, Switzerland & UK- Holland, Iceland, Malta, Switzerland & UK

Variation: 1.5 nurse to 1 child; 1 nurse to 2 children; 1: Variation: 1.5 nurse to 1 child; 1 nurse to 2 children; 1: 2-3; 1:3-4 ….some countries not sure2-3; 1:3-4 ….some countries not sure

Drafting a position Drafting a position

……introduction to ……introduction to includeinclude

Nursing is…….Nursing is…….

`The use of clinical judgement in the `The use of clinical judgement in the provision of care to enable people to provision of care to enable people to improve, maintain, or recover health, improve, maintain, or recover health, to cope with health problems, and to to cope with health problems, and to achieve the best possible quality of achieve the best possible quality of life, whatever their disease or life, whatever their disease or disability, until death’disability, until death’

Royal College of Nursing, 2003Royal College of Nursing, 2003

…………. and link to PNAE ‘Definition of Paediatric Nurse’ and other . and link to PNAE ‘Definition of Paediatric Nurse’ and other PNAE position statements reinforcing the need for PNAE position statements reinforcing the need for

specifically educated paediatric nurses to ensure safe care specifically educated paediatric nurses to ensure safe care for babies, children and young peoplefor babies, children and young people

Something about the Something about the difference a registered difference a registered nurse makes?nurse makes?Higher number and proportion of registered Higher number and proportion of registered

nurses:nurses: Patient mortalityPatient mortality Incidence of respiratory, wound and UTI’sIncidence of respiratory, wound and UTI’s Incidence of pressure soresIncidence of pressure sores Medication errorsMedication errors

From the patient’s perspective:From the patient’s perspective: Patient functional independencePatient functional independence Patient experience and perception of health carePatient experience and perception of health care

Aitken et al 2002, McKenna 1995, Hewitt et al 2003, , Buchan & Dal Poz Aitken et al 2002, McKenna 1995, Hewitt et al 2003, , Buchan & Dal Poz 2002, Carr Hill et al 20032002, Carr Hill et al 2003

Drafting a position ….to Drafting a position ….to discussdiscuss

Minimum …..at least two Registered Minimum …..at least two Registered Paediatric Nurse on duty in all areas Paediatric Nurse on duty in all areas where children and young people receive where children and young people receive carecare

Include levels for Neonates i.e. SCBU, Include levels for Neonates i.e. SCBU, HDU and Intensive Care and Paediatric HDU and Intensive Care and Paediatric Intensive Care as depicted by the majorityIntensive Care as depicted by the majority

Ratio registered nurse to unregistered Ratio registered nurse to unregistered nursing support staff nursing support staff

Recommend Recommend

Each country to then look to Each country to then look to establish safe staffing level establish safe staffing level recommendations and guidance recommendations and guidance for service providers and to for service providers and to consider issues such as age based consider issues such as age based criteria and patient care criteria and patient care dependency when establishing dependency when establishing recommendations recommendations

Other?Other?