Bristol Children’s Hospital’s emergency department (ED) is “significantly” understaffed and needs to almost double its number of permanent health workers, bosses have warned. The hospital’s Seahorse intensive care unit and Weston General Hospital A&E are also in need of more registered nurses, nursing assistants and healthcare support workers, a meeting of University Hospitals Bristol & Weston NHS Trust’s (UHBW’s) board was told.
UHBW insists employee levels at the three departments are safe and that it is using agency staff to fill the gap on a temporary basis. A biannual report called “Safe Staffing for nursing, midwifery and allied health professionals” said the trust had assessed how many of each permanent role it should have in all wards, using a nationally approved method called the safer nursing care tool (SNCT).
It said: “The SNCT results for children’s ED demonstrated significant staffing gaps across the department. This was supported by the consistent level of low staffing incidents reported for this area.
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“November and December were exceptionally challenging for the ED, with record numbers of children attending.” The report called for an extra 18 registered nurses, 11 nurse associates and 11 healthcare support workers, with recruitment phased over three years.
The department currently has 43 nurses and about 11 healthcare support workers, plus supervisory staff. The report said the requirement to ensure full staffing of the 18 beds in the children’s intensive care unit was roughly eight more nurses and four practice education facilitators (PEFs), who give staff professional and pastoral support and guide junior workers, on top of the existing 95 registered children’s nurses, three Band 4 nurses and four PEFs.
It said Weston’s emergency department needed an additional 10 nurses and 10 healthcare support workers to join the 53 staff currently there “to provide safe cover across the whole 24-hour period as patients are cared for in ED overnight”. UHBW chief nurse and midwife Deirdre Fowler told the meeting on Thursday, January 15: “The reviews primarily have told us that across our adult in-patient wards, in the main our nurse staffing is fit for purpose.”
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She said it would cost about £2.5million to employ the extra staff, and the board approved her request to begin the funding and recruitment process. The trust's annual operating expenditure budget is just over £1billion, of which £649million is spent on employees.
Professor Fowler told the meeting: “We have looked right across the organisation in-depth in every ward and there aren’t any areas where we are overstaffed where we can redeploy elsewhere.” After the meeting she said: “We are committed to the highest quality patient care and continue to maintain safe nurse staffing levels across the trust to support this.
“We introduced the ‘safer nursing care tool’ in July 2022 to determine optimal nurse staffing levels and are responding to the tool’s insights to plan for a more sustainable, permanent nurse staffing structure, including using fewer agency staff. It is positive that for the first time since the Covid-19 pandemic we are now starting to see staffing levels similar to those pre-pandemic.
“In fact, over 95 per cent of required nurse shifts have been filled in the nursing workforce across the trust. We continue to see our nursing vacancy rate go down, largely due to international colleagues who have joined UHBW and brought with them a wealth of experience.
“We are also seeing a continued reduction in our nursing turnover rate, largely due to the extensive work we are undertaking on staff wellbeing. However, we cannot rely solely on international recruitment and are investing in developing our brilliant Band 3 and Band 4 nurses into registered nurses, as well as continuing to develop our current nurses, midwives and allied health professionals, to ensure staff have the correct skills to safely care for patients.
“In addition, a one-year bespoke funded nursing recruitment and retention plan was approved earlier this year which includes further international recruitment, a fully funded pathway including trainee nurse associate and registered nurse degree apprenticeships, funding for continuing professional development, additional trust-wide practice educator roles, training support staff and funding for victim support officers.
“The trust scrutinises staffing levels on a continuous basis and undertakes formal reviews of nursing, midwifery and allied health professionals requirements annually to ensure we maintain a sustainable professional workforce.”
