Getting staffing levels right

Do you remember the days when staff rosters were drawn up by a ward sister or nursing officer armed with nothing more than a clipboard and pen? Probably not if you’re a more recent recruit to nursing. But once upon a time, allocating staff to shifts was a knotty but fairly mundane task whose purpose was simply to ensure gaps were plugged and shifts allocated equitably.

With the advent of e-rostering, which hands the number-crunching over to computer software, the whole business has become a lot more dynamic. Acuity, patient dependency, activity patterns, staff requests and a host of other variables can all be fed in. And emerging at the other end is improved safety, lower costs, new ways of working and, in some cases, better retention of nursing staff.

RCN member Liz Rix, Chief Nurse at University Hospitals of North Midlands NHS Trust, says: “When I used to do off-duty, it would be on a Sunday afternoon, sitting at the kitchen table, and it was a chore.”

The trust has now used e-rostering software for over a decade, but in that time the technology has evolved from being simply a tool to ease the load on sisters and charge nurses into something more sophisticated, she says. Various add-ons to the original system have given much more scope.

“So now, not only have we got the electronic roster, which is all linked up with our electronic staff record and the nursing bank, but three times a day we use an acuity and dependency tool to score patients in our beds across the whole trust. It means I can sit in my office and see every ward and how its staffing is meeting the needs of its patients.”

Predicting periods of high demand

Over time, Liz says, what the system offers is a level of predictability about patterns of activity. Various benefits flow from that, including a tighter focus on care needs and a reduction in spending on agency nursing as periods of high demand can be better predicted and managed. The composition of some care teams has also been reshaped as a result – for example, through the introduction of therapy technicians on the stroke ward.

“We don’t have problems recruiting and our retention rate is higher than the national average, and I think all of that is because we’ve got the right people with the right skills to care within a team,” Liz says.

In terms of fairness and transparency, there is a lot of data that can be pulled from e-rostering software to support nursing staff. A report published last year by an expert group and supported by Allocate Software said one trust had saved more than £140,000 in agency staff costs over just one quarter thanks to the introduction of e-rostering. 

The report highlights the many benefits of such “workforce optimisation technology” but says good practice needs to become more consistent and widespread.

It calls on trusts to consider greater personalisation of e-rostering to meet the demands of individual staff members, “striking a balance between flexibility and predictability."  

It adds: “Importantly, this should focus on both substantive and temporary staff deployment.”