Nursing and Midwifery Workload and Workforce Planning Project: A Good Practice Guide in the Use of Supplementary Staffing

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1 Nursing and Midwifery Workload and Workforce Planning Project: A Good Practice Guide in the Use of Supplementary Staffing

2 Nursing and Midwifery Workload and Workforce Planning Project: A Good Practice Guide in the Use of Supplementary Staffing The Scottish Government, November 2007

3 Crown copyright 2007 ISBN: The Scottish Government St Andrew s House Edinburgh EH1 3DG Produced for the Scottish Government by RR Donnelley B /07 Published by the Scottish Government, December, 2007 Further copies are available from Blackwell s Bookshop 53 South Bridge Edinburgh EH1 1YS The text pages of this document are printed on recycled paper and are 100% recyclable

4 Contents Foreword by the Chief Nursing Officer iv Introduction 2 1. The Bigger Picture 3 2. Getting the best from the Nurse Bank 7 3. Getting the best from the Bank Nurse 11 iii

5 Foreword by the Chief Nursing Officer Ensuring that there are sufficient numbers of nursing staff with the right skills and competencies to deliver the high quality of care people in Scotland demand of their NHS is part and parcel of the day-to-day life of operational managers and nurse leaders throughout the country. Their primary resource in meeting this demand is the nurses employed within the substantive workforce of NHS boards. When short- or longerterm deficiencies in supply of nurses from the substantive workforce occur, they turn to what is termed supplementary staffing resources nurses employed through the nurse bank. Nurse banks consist of groups of nurses employed to work on a flexible as-and-when-required basis to cover for planned and unplanned shortfalls in the nurse staffing establishment. Bank nurses can work across all the clinical services provided by NHS boards in hospital and community settings, depending on their skills, competencies and experience. The Nationally Co-ordinated Nurse Bank Arrangements report, published in 2005, analysed the pattern of usage of bank nurses in NHSScotland at that time. While the report found much to be admired in the way supplementary staffing was being handled within the NHS, it also highlighted areas in which a different approach would provide better standards of care for service users and better value for money for the service. It is fair to say that the management and deployment of supplementary staff in NHS boards in Scotland has come a long way since that time, with significant improvements in appropriate use of bank nurses rather than more expensive options. But nurse bank managers across Scotland feel there is still more that can be done to improve the situation. Nurse bank managers have been putting forward a clear message that they can help their local NHS boards to manage the supply of supplementary staffing, but that their sphere of influence does not extend to managing the demand for supplementary staff a responsibility that lies with managers in direct care settings. As a result, nurse bank managers across Scotland have developed this Good Practice Guide for frontline staff and managers. It is a practical guide that will help them review and improve their role and responsibilities in the management of nurse staffing and which sets out the qualities substantive staff can expect to see in bank nurses. It also provides helpful support to nurse bank managers in the running of nurse banks by setting out what works well (and why it works well) from the perspectives of people who have significant experience in managing a supplementary staffing service. The Guide also helps to promote the importance of nurse banks to nurses professional development. Providing services via a nurse bank is becoming increasingly recognised as an important point in a nurse s career. It is not the end-point of that career a winding down towards retirement but is a stage in a career development profile that fits with individuals lifestyles and in which nurses can gain excellent experience that will position them well to attain substantive posts in the NHS when the time is right for them. iv

6 But the most important thing is to emphasise the ultimate end-point of a nurse bank service - the delivery of a high quality service for patients and clients. Bank nurses make a significant contribution to frontline services in the NHS, and the better trained, developed and supported they are, the higher the quality of care they will deliver to patients and clients. This Good Practice Guide will, I believe, help managers and frontline staff in NHSScotland put together the diverse elements that make up an excellent nurse bank service, resulting in significant clinical benefits for patients and clients, significant professional benefits for bank nurses, and significant cost savings for the NHS. Paul Martin Chief Nursing Officer 1

7 Introduction In 2005, the Scottish Executive charged NHS boards in Scotland with addressing the recommendations of the report Nationally Co-ordinated Nurse Bank Arrangements. 1 This was followed by a second report in with further detail on methodology and fuller results of the original project. The reports were produced to support NHS employers to maximise the contribution of nursing staff employed in nurse banks, consequently reducing reliance on agency nursing staff. National spend on nurse agency at the time was unacceptably high. The main ways of implementing the recommendations of the reports were through: improving the management of nurse banks; consolidating the management of nurse banks to NHS board level; ensuring effective information technology was in place to support nurse bank management; and introducing a national contract for nurse agency use in NHSScotland. Nurse bank managers across Scotland have been networking and developing best practice as part of the process of implementation. Their aim is to ensure that nurse banks are run as effectively and efficiently as possible, and that nurse banks are promoted as an option to help substantive staff manage their demand for bank or agency staff. The Good Practice Guide highlights the organisational policies and responsibilities of those who manage the nurse staffing resource through, for example, staff rostering, use of workload tools, managing sickness and absence and annual leave, providing both the rationale and a means of assessing the ward, care setting or organisational position. It has three main sections: The bigger picture Getting the best from the nurse bank Getting the best from the bank nurse (Figure 1). Figure 1. Shape of the Good Practice Guide. Getting the Best From the Bank Nurse The Bigger Picture Effectively Managing The Nursing and Midwifery Resource Getting the Best From the Nurse Bank The Good Practice Guide will be supplemented by an education programme developed by the national Nursing and Midwifery Workload and Workforce Programme to provide support in the management of staff and financial resource. 1 Scottish Executive (2005) Nationally Co-ordinated Nurse Bank Arrangements. Edinburgh: Scottish Executive. 2 Scottish Executive (2006) Background Methodology and Results of Nationally Co-ordinated Nurse Bank Arrangements Project. Edinburgh: Scottish Executive. 2

8 1. The Bigger Picture

9 Recommended practice Rationale Measures of success 1.1 The overall ethos of the organisation should be reflected in a range of policies to reduce use of agency staff and manage the use of bank within a locally agreed limit. 1.2 A consolidated NHS board nurse bank should be in place. 1.3 The NHS board Workforce Planning Strategy should set out a target for supplementary staff as a percentage of the total nurse staffing establishment. Reduction in use of bank and agency spend enables re-investment in substantive staff. A consolidated board-level bank allows use of bank staff in the most effective way and prevents duplication across multiple banks in, for example, provision of mandatory training. It allows for easier checking of deployment of bank staff. It provides for more effective use of dedicated clerical staff, releasing clinical staff time. Having a target allows for monitoring of performance against the target over time, identifying areas for specific action. It drives actions to reduce or eliminate the use of agency staff. Complying with the target ensures the majority of care is provided by substantive staff. It enables bank staff to be used to manage short-term staffing shortfalls, rather than long-term vacancies. It must be recognised, however, that the percentage may have to change in unusual or exceptional circumstances. There is a reduction in spend on supplementary staff, particularly agency, with the aim of zero spend on agency staff and agreed investment in bank and substantive staff. A consolidated board bank is in place, not necessarily on one site, but under a single management structure. A senior nurse is responsible for management of the bank and provides ongoing support to the bank. There is a clear accountability line to a board executive director who reports progress to the NHS board on bank and agency use. Most administrative duties are performed by clerical staff. A target has been set within the strategy that reflects local aspirations for the workforce. Senior managers are monitoring target performance and taking appropriate action to address anomalies. Senior Charge Nurses are monitoring performance against the target to identify what proportion of care is delivered by substantive staff and what proportion by supplementary staff and ensuring they take relevant action to address anomalies, if appropriate. 4

10 Recommended practice Rationale Measures of success 1.4 A process should be in place for setting and reviewing the nurse establishment and agreeing budgets, using nationally agreed workforce tools defined by the National Nursing and Midwifery Workload and Workforce Planning Programme and in line with national policy. 1.5 A staff vacancy management process should be in place. 1.6 A range of policies designed to promote flexible working and attendance at work should be in place, in accordance with PIN policies. This process enables the right number of staff to be in the right places to deliver effective services. It allows review of the overall establishment against the needs of particular care settings, creating flexibility in workforce deployment. Vacancies that need to be filled are not left unfilled for prolonged periods, reducing the need for bank or agency cover. A review of vacancies allows changes in service delivery and workload to be taken into account. If these policies work well, the demand for bank and agency is reduced. Establishments and budgets for each care setting are agreed across the organisation. The vacancy management process is ensuring that long-term placements for bank staff are flagged up to local managers, linking the vacancy management process to managing supplementary staffing use. Reviewing the overall workload picture that takes vacancy and predicted absence levels into account is reducing demands for supplementary staffing. Senior Charge Nurses have a suite of indicators generated by the Review of the Senior Charge Nurse in Scotland that allow them to monitor the effectiveness of the policies. Senior Charge Nurses are taking advantage of the opportunities for flexibility the policies give in their recruitment practice, staff rostering, management of annual leave and promoting attendance at work. 5

11 Recommended practice Rationale Measures of success 1.7 There must be complete compliance with HDL (2006) 39, 3 which mandates the use of nationally contracted agency suppliers. 1.8 Strategies that prevent manipulation of the nurse staffing market should be in place. 1.9 The organisation should agree the most appropriate forum to performance manage all of the above, with appropriate representation across partnership organisations, human resources, finance, nursing and the bank. Compliance with this HDL is mandatory in NHSScotland; failure to do so breaches European procurement law. Appropriate strategies will protect NHS funds and ensure the service gets best value for money from spend on supplementary staffing. This will put in place the mechanisms to ensure organisational accountability for good financial management, staff, corporate and clinical governance and good patient care. It will also identify areas for specific action. Contract compliance is monitored on a quarterly basis at a national level. Individual NHS boards are measuring and reacting to their own data on contract compliance. No current member of staff is engaged to work in the service on a regional basis through an agency. An identified forum within the organisation is undertaking ongoing review of performance against board policy and putting mechanisms in place to deal with problems. Reports on performance are prepared and presented to the board for scrutiny. 3 For more on HDL (2006) 39, see: 6

12 2. Getting the best from the Nurse Bank

13 Recommended practice Rationale Measures of success 2.1 There should be adequate office space and resource and facilities to enable effective functioning of the bank. 2.2 The bank should use one of the two accredited software systems for managing nurse banks in Scotland. 2.3 The same pre-employment checks used in the recruitment of nurses to the substantive workforce should be used for recruiting bank nurses. 2.4 There should be adequate capacity within NHS boards to ensure that bank nurses have access to mandatory training opportunities as appropriate. The bank requires accommodation and resource commensurate with its importance to the organisation. Complex information systems in nurse banks require adequate IT provision. Using an accredited system ensures the software meets the Scottish Government s prescribed specification for nurse bank IT systems. There is consistency in capability of accredited software systems. This helps to ensure consistency in recruitment practice across the nursing workforce. The message that bank nurses are considered equal employees is promoted. Supplying appropriate mandatory training opportunities for staff is a requirement of all NHS boards and is an essential element in ensuring patient, public and staff safety. There are recognisable nurse bank premises with good facilities within the organisation, on single or multiple sites. An accredited software system with appropriate staff training programmes to optimise use is in place. The bank is supported by a nationally accredited IT system. There is equality in the recruitment processes used for recruiting nurses to the substantive and bank workforce. Capacity and systems are in place within NHS boards to ensure that mandatory training requirements of bank nurses are recognised, supplied, recorded and regularly monitored. Findings are managed through a planned programme of development. 8

14 Recommended practice Rationale Measures of success 2.5 A variety of methods should be employed to communicate with nurse bank staff. 2.6 A clear written process of authorisation for use of supplementary staff should be in place across all care settings in the organisation. 2.7 A process should be in place to allow authorised personnel to identify their budget for covering shortfalls. 2.8 Systems should be in place to enable the nurse bank to capture reasons for the use of supplementary staff and feed this information back to managers. Using a variety of methods supported efforts to communicate with bank staff in the shortest possible time, with associated savings in clinical staff time. Scrutiny ensures that the total staffing picture at any given time is taken into account before booking supplementary staff and that all options for covering shortfalls, including extra hours, bank and overtime, are explored before the last resort of agency. Services have to manage within their resources. This kind of activity enables trends in shortfalls to be identified and actioned. The organisation is using and reviewing the effectiveness of systems such as intranet, , texting, telephoning and faxing to communicate with bank staff. Individual personnel are identified as having authority to sanction the use of supplementary staff, in accordance with an agreed hierarchy of options. There is wide understanding among staff of the reasons that make an authorisation process necessary, such as the cost variances of each supplementary staffing option. A process for agency sign-off is in place. Authorised personnel are enabled quickly to access information regarding the available budget for supplementary staff. The nurse bank is reporting regularly to nurse managers on trends in staffing shortfalls. 9

15 Recommended practice Rationale Measures of success 2.9 Systems of regular audit and surveillance of service users views of the deployment of supplementary staff, including monitoring levels of complaints, should be in place Clinical managers should identify and plan for anticipated staffing shortfalls Staff rostering should ensure the most efficient use of the workforce resource Systems are in place to detect fraudulent invoices, travel claims and timesheets from supplementary staff. This is part of the process of ensuring the service meets the needs of service users. Prior notice of an anticipated shortfall increases the likelihood of filling from the nurse bank, rather than having to pursue more expensive options. The aim is to optimise use of substantive staff and minimise use of supplementary staff. Staff rosters employ a variety of mechanisms to ensure optimum cover for all shifts. The potential for individuals to claim remuneration for services not provided exists this risk must be minimised to protect public resources. The nurse bank service actively seeks service users views of the service it provides on a regular basis and modifies and develops its processes and systems accordingly. The percentage of short-notice shifts (that is, 12 hours notice or less) being presented to the nurse bank is reducing. Advance block booking is reducing. Parameters for rostering schedules are clear for all staff. Systems are in place to prevent and detect fraudulent claims for remuneration from supplementary staff. Agreed audit procedures are carried out on a regular basis in conjunction with internal audit staff. 10

16 3. Getting the best from the Bank Nurse

17 Recommended practice Rationale Measures of success 3.1 Induction processes with associated recording systems should be in place for all newly-employed bank nurses. 3.2 Bank nurses should have adequate preparation and education relevant to the clinical area in which they may be deployed. Access to appropriate induction is not only essential in preparing newly-employed bank nurses for work within the organisation, but is also a key element of the Staff Governance Standard. 4 It is essential to patient and public protection that bank nurses possess the requisite knowledge and skills to practise effectively in clinical areas. A variety of induction processes, including supernumerary clinical working, are in place to ensure newly-employed bank nurses develop a basic awareness of the ethos, policies and procedures of the organisation and gain an understanding of their own capabilities and limitations with respect to how they can contribute to the services the organisation provides. Accurate records of induction training offered and received are being maintained. Systems are in place to prevent bank nurses from practising in areas for which they have had inadequate preparation. The accredited IT nurse bank system in use enables identification of the skills, experience and expertise of individual bank nurses and their suitability for working in specific clinical areas. 4 Scottish Executive (2002) Staff Governance Standard for NHSScotland Employees. Edinburgh: Scottish Executive. For more on the Staff Governance Standard, see: 12

18 Recommended practice Rationale Measures of success 3.3 Core bank nurses should have professional development plans, developed in partnership with their line manager. 3.4 NHS boards should have policies in place which reflect the Balanced Working Lives 5 approach to employing nurses and midwives. Bank nurses are as accountable for their practise as any member of the substantive nursing staff and require mechanisms to be in place to allow them to identify their strengths and areas in which further development work is required. It is essential that bank nurses have access to professional development opportunities to allow them to meet the range of Knowledge and Skills Framework (KSF) elements they are required to meet. This is necessary not only for their own career development, but also for protection of patients and the public. Flexible options within the workplace will enable bank nurses to apply for substantive posts. Bank nurses have professional development plans, planned and agreed with their line manager. Bank nurses have recognised KSF profiles to describe their roles. There is a variety of different contractual arrangements for nurses in the workforce, reflecting their diverse needs. These are enabling bank nurses to feel confident to apply for substantive posts. 5 For more on the Balanced Working Lives approach, see: 13

19 Recommended practice Rationale Measures of success 3.5 A process should be in place to enable clinical staff to provide ongoing feedback on individual bank nurses performance in clinical areas. Feedback from clinical areas on the performance of individual bank nurses can be used as a lever to: keep bank nurses appraised of their perceived performance; develop and improve individual performance; identify training needs; act as a quality indicator of the level of service provided by the nursing bank as a whole. Systems are in place to enable staff from clinical areas to provide regular feedback, both positive and negative, to the nurse bank on the performance of individual bank nurses. Feedback is collated by bank nurse managers, who take action as appropriate. Bank nurses are receiving regular feedback from bank nurse managers on their perceived performance, with appropriate plans for future action linked to their personal development plans. A system-wide approach is in place to enable collation of generic data from feedback to provide an overview of the perceived quality of the nursing bank from within the service. 14

20 Further reading

21 Scottish Executive (2003) Good Practice Guidelines for Establishing Contact Centres. Edinburgh: Scottish Executive. Scottish Executive (2005) Nationally Co-ordinated Nurse Bank Arrangements: Report and Action Plan. Edinburgh: Scottish Executive. Scottish Executive (2006) Background Methodology and Results of Nationally Co-ordinated Nurse Bank Arrangements Project, NHSScotland. Edinburgh: Scottish Executive. National Procurement: Use of National Contracts For Agency Labour Purchase and Review of Procurement in Scotland. HDL (2006) 39, July Implementation of Nursing and Midwifery Workload and Workforce Planning Tools and Methodologies. CEL (6) 2007, August Audit Scotland (2007) Planning Ward Nursing Legacy or Design? A follow-up report. Edinburgh: Audit Scotland. 16

22 Crown copyright 2007 RR Donnelley B /07 Further copies are available from Blackwell's Bookshop 53 South Bridge Edinburgh EH1 1YS Telephone orders and enquiries or Fax orders orders w w w. s c o t l a n d. g o v. u k

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