PNAE – staffing survey findings Fiona Smith Adviser in Children’s & Young People’s Nursing, Royal College of Nursing, United Kingdom The voice of nursing in the UK

Developing a position  Survey undertaken Spring 2007  16 Countries responded Summary of overall findings:  Established guidance/ ‘paediatric’ recommendations in 5 countries  Variations in numbers of paediatric nurses, registered nurses and support staff in clinical areas …..but some similarities particularly in neonates and paediatric intensive care  Ratio of registered paediatric nurses to unregistered nursing support staff ….level of consistency

Findings  Nationally agreed minimum staffing levels - Belgium, Croatia, Holland, Malta & UK  Paediatric agreed minimum staffing levels - Belgium, Holland, Hungary, Malta & UK  Minimum of 2 registered paediatric nurses on duty at all times throughout the 24 hour period in General paediatric wards and departments - Belgium, Croatia, Greece, Holland, Hungary, Iceland, Italy & UK [Children’s Hospitals in Estonia also achieve, Switzerland advise 1-2 per shift, variable in Norway, Malta advises registered nurses but not paediatric nurses]

Findings: Ward Nurse staffing Minimum ratio of registered paediatric nurses to children/young people might be: Under 2 years1 registered nurse to 3 children - Croatia, Switzerland and UK Variation: 1 nurse to 4; 1: 5; 1: 5-6; 1: 1-7 For children over 2 years of age During the day1 registered nurse to 4 children - Croatia, Estonia, Switzerland and UK Variation: 1 nurse to 4; 1: 5; 1: 6-8; 1: 6-10; 1: 7-8; 1: 1-7 During the night1 registered nurse to 5 children - Croatia, Estonia and UK Variation: 1 nurse to 5; 1: 6-8; 1: 7-8; 1: 8-10; 1: 15

Findings The ratio of registered paediatric nurses to unregistered nursing support staff in general paediatric nursing wards is above the minimum 70 percent registered paediatric nurses to 30 percent unregistered nursing support staff - Belgium, Croatia, Estonia, Greece, Holland, Hungary, Switzerland & UK Iceland during the day but not in the evening or night Iceland during the day but not in the evening or night

Findings: Neonatal Services Special care1 registered nurse to 4 babies requiring this level of care - Estonia, Holland, Iceland, Switzerland & UK Variation: 1 nurse to 4-6 babies; 1: 5; 1: 5-6 High dependency1 registered nurse to 2 babies requiring this level of care - Holland, Iceland, Malta, Switzerland & UK Variation: 1 nurse to 2-3 babies; 1: 4; 1: 3-5 Intensive care 1 registered nurse to 1 baby requiring this level of care - Holland, Iceland, Malta, Switzerland & UK Variation: 1 nurse to 2 babies; 1: 2-3

Findings: Paediatric Intensive Care Level 1: This describes care provided to a child who may require closer observation and monitoring than is usually available on an ordinary paediatric ward, although much of this care is already provided, with higher staffing levels than usual, in such locations. For example the child may need continuous monitoring of the heart rate, non-invasive blood- pressure monitoring, or single organ support (but not respiratory support). The child may, for example, be suffering from moderately severe croup, suspected intestinal obstruction or suspected poisoning 1 registered nurse to 2 children requiring this level of care - Holland, Iceland, Switzerland & UK Variation: 1 nurse to 4 children; 1: 5 ….some countries not sure

Findings: Paediatric Intensive Care Level 2: These children will always need continuous nursing supervision. They may need ventilatory support, or support for two or more organ systems. Sometimes the child will have one organ system needing support and one other suffering from chronic failure. Usually children receiving level 2 care are intubated to assist breathing. 1 registered nurse to 1 child requiring this level of care - Holland, Iceland, Malta, Switzerland & UK Variation: 1 nurse to 2 children; 1: 3; 1:3-4 ….some countries not sure

Findings: Paediatric Intensive Care Level 3: Children with two or more organ systems needing technological support, including advanced respiratory support, will need intensive nursing supervision at all times and will be undergoing complex monitoring and/or therapeutic procedures. They would, for example, include ventilated children undergoing advanced renal support, those who have suffered multiple trauma in major road accidents, or those who have undergone very complex major surgery. 2 registered nurses to 1 child requiring this level of care - Holland, Iceland, Malta, Switzerland & UK Variation: 1.5 nurse to 1 child; 1 nurse to 2 children; 1: 2-3; 1:3-4 ….some countries not sure

Drafting a position ……introduction to include

Nursing is……. `The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death’ Royal College of Nursing, 2003 ……. and link to PNAE ‘Definition of Paediatric Nurse’ and other PNAE position statements reinforcing the need for specifically educated paediatric nurses to ensure safe care for babies, children and young people

Something about the difference a registered nurse makes? Higher number and proportion of registered nurses:  Patient mortality  Incidence of respiratory, wound and UTI’s  Incidence of pressure sores  Medication errors From the patient’s perspective:  Patient functional independence  Patient experience and perception of health care Aitken et al 2002, McKenna 1995, Hewitt et al 2003,, Buchan & Dal Poz 2002, Carr Hill et al 2003

Drafting a position ….to discuss  Minimum …..at least two Registered Paediatric Nurse on duty in all areas where children and young people receive care  Include levels for Neonates i.e. SCBU, HDU and Intensive Care and Paediatric Intensive Care as depicted by the majority  Ratio registered nurse to unregistered nursing support staff

Recommend  Each country to then look to establish safe staffing level recommendations and guidance for service providers and to consider issues such as age based criteria and patient care dependency when establishing recommendations

Other?