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Nursing Workforce Standards for Type 1 Emergency Departments

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Nursing Workforce Standards for Type 1 Emergency Departments Nursing Workforce Standards for Type 1 Emergency Departments October 2020 Contents Foreword Foreword 3 Patients depend on acute care delivered in our Emergency Departments (EDs). We Scope 4are the frontline of the NHS. An appropriate Glossary of Nursing Roles in the Emergency Department 5 ED workforce is the most important factor for providing safe, effective, high quality Nursing Workforce Standards for emergency care in a timely, cost-effective Type 1 Emergency Departments 7and sustainable manner. This requires a balanced team of nurses, doctors, allied Converting the nursing workforce model health professionals and support staff, with into a Whole Time Equivalent (WTE) number 14 appropriate knowledge and skills. Determining the financial cost of the total WTE nursing workforce 15 Over time a number of organisations have endeavoured to make recommendations References 16 regarding the nursing workforce in EDs [1,2]. However, specific standards have Professor Dame Donna Kinnair Appendix - Approaches that may be used Chief Executive and General Secretary never previously been established. of the Royal College of Nursing to determine the nursing workforce 17 Authors and acknowledgments 18 Therefore, in the collective interests of patient safety and quality of care, the Royal College of Nursing (RCN) Emergency Care Association (ECA) and the Royal College of Emergency Medicine (RCEM) have collaborated to define, for the first time, the nursing workforce standards for Type 1 EDs. This collaboration represents something greater than just a workforce standard – it represents a recognition that the ED team is truly multidisciplinary. Dr Katherine Henderson President of the Royal College of Emergency Medicine 2 3 Scope Glossary of Nursing Roles in the Emergency Department Adapted from the RCN ECA National Foundation Staff Nurse: A Registered Nurse who This document details the nursing These standards are not intended for use Curriculum and Competency Framework is either newly qualified, or new to emergency workforce standards for Type 1 EDs. in areas such as clinical decision units or for Emergency Nursing [3]. Where level of nursing; has not yet acquired the competencies of an Emergency Nurse. These nurses require It is designed to be used by those observation wards that may fall under competency is stated it is this framework supervision in practice, ranging from direct responsible for planning, commissioning the governance of EDs, which should be which is referred to. supervision in their initial weeks, to indirect and implementing nursing workforce staffed according to ward models. supervision as they near the accomplishment of models, whilst supporting the delivery Where pay scale bandings are stated, an Emergency Nurse. They should be working to of the RCN ECA National Curriculum Emergency Nurse Practitioners (ENPs), they refer to the NHS Agenda for Change complete the Level 1 competencies. Typically and Competency Framework for Advanced Nurse Practitioners (ANP), pay bandings. they are Band 5. Emergency Nursing [3]. Advanced Clinical Practitioners (ACPs) and others working as clinical decision Clinical Support Worker / Healthcare Assistant: Emergency Nurse: A Registered Nurse who has completed preceptorship, and has achieved The nursing workforce refers to makers such as liaison mental health A non-registered care worker working under the Level 1 competencies. They are able Registered Nurses, Nursing Associates practitioners are also excluded from the supervision of a Registered Nurse, who is accountable for the care delivered. They are to work with individual patients, or groups and non-registered care workers, such these standards. invaluable members of the team in supporting of patients, without direct supervision in the as Healthcare Assistants and Clinical direct care to patients, particularly in relation emergency care setting. This includes initial Support Workers, unless otherwise to the essential provision of hydration, hygiene assessment and the provision of treatment specified. (See Glossary for description and elimination needs. Clinical support workers, (but not diagnosis) for patients. In EDs, this is of Nursing Roles). with additional training, may also undertake likely to include working with patients in the clinical observation of vital signs, or undertake resuscitation room, those with major illness or investigations such as urinalysis or ECG injury and those with minor presentations. They recording. Furthermore they may complete should be working to complete the Level 2 prescribed treatments for patients such as competencies. Typically they are Band 5 or 6. application of casts, and wound dressings according to local protocols. They do not Emergency Charge Nurse: An Emergency Nurse administer medications. Typically they are who has completed level 2 competencies, Band 2 or 3. is a clinical expert and proactively develops themselves and others. They lead and supervise Associate Practitioner / Nursing Associate the clinical work of others and can manage the (England only): Work within defined local emergency care setting as a whole; managing policies and are accountable for their practice. patient flow and delegating care accordingly. They have a required level of knowledge and In EDs they should work in close partnership skill beyond that of the traditional support with the Emergency Medicine Consultant worker, and are able to undertake clinical work and clinical decision makers to ensure safety in domains that were previously the remit of of patients and best use of resources. They registered professionals, such as advanced should focus on leadership, educational and/ wound closure. Their remit is comprehensive or research competencies. Typically they are and extended, working under unsupervised Band 6 or 7. guidance from Registered Nurses. They contribute to the core work of nursing, freeing up Registered Nurses to focus on more complex clinical care. Typically they are Band 4. 4 5 Scope Nursing Workforce Standards for Type 1 Emergency Departments Practice Educator: This is an Emergency Nurse Lead Nurse Manager: This is an Emergency who has completed Level 2 competencies Nurse who has completed Level 2 Standard Additional rationale / consideration and facilitates educational opportunities in competencies and is responsible for the the ED. They provide supervision in practice, day-to-day operational management of the 1 The ED nursing workforce will be reviewed ED nursing workforce reviews will take deliver training sessions and assessment of ED, including workforce management and on at least an annual basis. into account significant seasonal competencies. They often teach on nationally implementation of local policy and clinical variation in nursing workload. recognised courses (for example, Advanced guidelines. Typically they are Band 7 or 8a. Life Support). They should be working towards 2 The ED nursing workforce will be Professional judgement will take into education-specific competencies and/or Matron (England and Wales) / Senior Lead determined by triangulating: account nursing roles, local workstreams qualifications. Typically they are Band 6 or 7, Nurse (Scotland and Northern Ireland): This is / models of care and local ED / hospital depending on the leadership responsibilities of an Emergency Nurse who has completed Level • professional judgement - Telford geography. the role. 2 competencies and is responsible for quality Model [4] (see Appendix) The ED nursing workload will inform the assurance and quality improvement in the ED; • nursing workload, calculated using shift patterns and skill mix for the nursing Practice Development Lead: This is an including responding to patient feedback and the RCN ECA Baseline Emergency workforce. Emergency Nurse who has completed Level ensuring clinical incidents are investigated, and Staffing Tool (BEST) [5] (see Appendix) 2 competencies and leads the education any recommendations actioned. Typically they or other appropriate ED nursing strategy for the ED. They provide supervision are Band 8a. workload tool in practice and deliver some training sessions, whilst establishing the training requirements Emergency Nurse Consultant: A clinical expert • benchmarked with appropriately to ensure the necessary workforce skill mix. in emergency nursing with responsibility for selected and comparable peers [2]. They will link the education strategy for the emergency care leadership; including strategic ED with the overall strategy for education in development of policy and practice, research, 3 Each ED will have a Lead Nurse Manager See Glossary for role summary. the organisation. They will work closely with education and advanced clinical practice. (Band 7 / 8a). the Lead Nurse Manager and/or Matron / Typically they are Band 8b or 8c. Senior Lead Nurse, the Clinical Director, and 4 Each ED will have a Matron / Senior Lead See Glossary for role summary. other education providers, including Higher Nurse (Band 8a). Education Institutes (HEIs). Typically they are In Trusts with more than one ED, the Band 7 or 8a. Matron / Senior Lead Nurse may work across more than one site, supported by a Lead Nurse Manager on each site. 5 Each ED will have at least one See Glossary for role summary. Emergency Nurse Consultant In Trusts with more than one ED, the (Band 8b / 8c). Emergency Nurse Consultant may work across more than one site. EDs may require more than one Emergency Nurse Consultant to lead on specific sub-specialty clinical domains. 6 Each ED will have a WTE dedicated See
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