Giving nursing associates small caseloads praised as ‘effective staffing’

The new tool by the Care Quality Commission (CQC) provides examples of organisations across the country that are utilising staff “to their greatest effect” amid nationwide shortages and rising patient demand.

“There are some things we can do now to use the staff we have available to their greatest effect”

Professor Ted Baker

The resouce, which was launched this week, highlights providers that are managing workforce challenges by focusing on the overall safety of patient care, as opposed to “rigid staffing ratios”, said the CQC. 

Among the “effective staffing case studies” promoted by the CQC was Cheshire and Wirral Partnership NHS Foundation Trust, which outlined how it approached the deployment of its new nursing associates.

In the online resource, Cheshire and Wirral provided a list of considerations that it took into account before deploying its new nursing associates.

The trust explained how it considered where the new starters would be safe, where they would add most value, and where they would be able to use their range of skills to deliver person-centred care.

In addition, the trust said it looked at where the current gaps and opportunities were in the provision and considered what supervision and delegation arrangements should be in place.

Once it was decided where the new starters would be deployed, the trust then worked with teams to raise awareness and understanding of the nursing associate role.

Heather Dutton, clinical facilitator in the trust’s Chester adult mental health team, said the nursing associate who had joined the team had proved to be a “valuable asset” and had created “increased capacity for nurses to further develop in other areas of their roles”.

“She also has a small caseload for whom she is primary worker for, provides feedback in multidisciplinary team meetings and is a keen enthusiastic member of the team,” added Ms Dutton. 

In addition, Rachel Jarmain, team manager at the trust’s adult mental health service at Ellesmere Port and Neston, gave examples of how the new nursing associate working there had helped to free up registered nurses’ time.

Ms Jarmain said: “She has enabled patients to attend physical health appointments, to ensure their physical health needs are being addressed; something we did not have capacity to offer within the team before.

“She has also been able to provide depot injections for people who require more assertive engagement, and she is carrying a caseload of clients who present with reduced complexity,” Ms Jarmain added.

The CQC hopes that its new resource will give providers more information on how different sectors have come together to “maximise capacity” and “provide more integrated care”.

“She is carrying a caseload of clients who present with reduced complexity”

Rachel Jarmain

Its resource also offers examples of how services have adapted their existing staffing model to help prevent unnecessary hospital admission.

For example, the resource showcases the work of nurses in Buckinghamshire, who are taking the lead in care for over 75s as part of a community nursing project.

The team has so far cut accident and emergency attendances by 54% and has helped to reduce the average length of hospital stays.

According to information given in the CQC resource, the community project involves delivering appropriate care interventions before a patient hits crisis.

Commenting on the launch of its new tool, the CQC’s chief inspector of hospitals, Professor Ted Baker, said: “Health and care providers are facing increasing pressure from rising demand, and this is exacerbated by workforce shortages.

Ted Baker

edward ted baker

Ted Baker

“While the interim NHS People Plan sets out a welcome vision to better support our NHS staff to deliver care in the future, the case studies we have published show there are some things we can do now to use the staff we have available to their greatest effect,” he said.

“Safe, effective staffing is about having enough staff with the right skills, in the right place, at the right time,” said Mr Baker. “It is about team work, not silo working, and developing staff so they can support each other to ensure that patients have the smoothest possible journey on their care pathway.

“I hope these examples of collaborative and innovative working will encourage others to make the best use of the range of skills they have available to improve patient experience,” he added.