Kathryn Halford, Chief Nurse, Barking, Havering and Redbridge University Hospitals NHS Trust and Jan Stevens, Interim Chief Nurse, Barts Health NHS Trust will discuss the issue of the length of nursing shifts in their organisations.
Minutes:
The Chief Nurse at BHRUT explained that nurses at the Trust worked a variety of shifts and a system of long days with 12.5 hour shifts was available. This included one hour of breaks, split throughout the day. Around 20% of nurses sometimes worked this shift pattern but there was a mixed model available to staff.
Staff were only allowed to work two long days or four long nights in succession and the Chief Nurse felt this was a safe level. Two successive days off were required to be taken each week and staff got at least one weekend in every four off work.
Family commitments meant that some staff often preferred to work 2-3 long days each week and this could also reduce costs of childcare and commuting. Full-time employees at BHRUT worked 37.5 hours per week and were not permitted to work in excess of 48 hours per week unless they had signed a special opt out clause. These cases were also monitored by the Trust.
The Barts Health Interim Chief Nurse explained that offering a variety of shifts was the recognised norm across the NHS. The large numbers of nursing vacancies was also a challenge. The Trust was also aware of the risks of staff making mistakes if they were too tired and had similar controls in place to prevent people working excessive hours. Approximately 20-25% of staff at BHRUT had signed to work in excess of 48 hours per week although no staff were permitted to work more than 56 hours at the Trust in one week.
Both Trusts used e-rostering systems which ensured that staff had the required breaks of at least 11 hours built in. Continuity of care needed to be established across shifts and it was felt that this was the responsibility of the Sister in charge of the ward and how they built the nursing team. Officers agreed that it was important that the handover between shifts was robust enough to ensure that all key information was shared. Ward teams comprised 35-50 people and it was felt the availability of longer shifts encouraged the recruitment and retention of permanent staff and hence better continuity of care.
It was confirmed that the shift patterns were available to all grades of ward staff. Clinical nurse specialist working in clinics were likely to work more of a Monday – Friday, 9 am to 5 pm pattern. Senior nurses above Sister level tended to work a longer shift pattern.
It had been proposed by the Secretary of State to remove bursaries from nurses entering training although this had not been finally agreed as yet and would not impact on the two Trusts until at least 2017. Both Trusts had their own schemes to support nurses to train. The Royal College of Nursing had recently launched its own consultation on this issue and officers would obtain further details. It was noted that universities had in fact supported the ending of bursaries as there were 5-10 applications for each nursing place. Officers agreed however that proper discussion was needed before any changes were made. The BHRUT Chief Executive added that he would welcome further discussion on this issue and suggested this be considered by the Trust’s Local Representative Panel.
The Portuguese nurses recruited to BHRUT had been settling in well and further recruitment exercises in Europe were planned by the Trust. Recruitment from the Philippines was also being considered. Barts Health had also recruited a lot of international nurses for whom there was dedicated support available. BHRUT held interviews face to face (in English) and insisted that nurses recruited could both speak and understand English. Barts Health also required nurses to sit an exam in English. Support at both Trusts was given to foreign nurses not just in understanding medical terminology and general orientation but also in practical issues such as opening a bank account.
All newly qualified nurses underwent an 18 month induction programme at Barts Health and spent two weeks on training and development before being counted as part of the ward staff. New staff were also supported by the Ward Sister and via a buddy system.
The option of long shifts was also available in training and a balance of experience was sought on ward rosters. There were not specific figures kept of the ratio of trained to training nurses on wards. The number of nurses and Health Care Assistants on wards was however monitored twice a year and this information was published on the NHS Choices website. These audits looked at professional judgements of what constituted an appropriate nursing level and had recently led to an agreement to recruit 500 further nurses across Barts Health. Daily Safety Huddle meetings also allowed for a response if staffing levels were down.
The number of nursing training places had already gone up following a national review of workforce planning. The rising age of the nursing workforce was also an issue and it was noted that a new grade of Associate Nurse (above Health Care Assistant) was also being introduced.
It was suggested that if Members had further concerns re the number of training places, representation could be made on this matter to Health Education England. A Member added that she could raise this matter with colleagues on the Community Wellbeing Board of the Local Government Association.
The Committee NOTED the presentations and thanked officers for their input to the meeting.