Wales sets out paediatric nurse ratios for planned law extension

The Welsh government has issued interim guidance to help health boards prepare for future extension of the Nurse Staffing Levels (Wales) Act 2016.

“I would welcome your support to implement these principles over the coming two years”

Professor Jean White

Chief nursing officer for Wales, Professor Jean White, said it was “imperative” that the act was extended into a paediatric setting as a “priority” because in its current form it did not cover care of children. 

In 2016, Wales became the first country in Europe to introduce legislation around safe staffing, which currently covers adult acute medical and surgical inpatient wards.

As previously reported by Nursing Times, Professor White announced in May that there were plans for an extension in the law to cover both paediatric inpatient services and district nurse led community services.

Therefore, as an interim measure, the Welsh government has published a set of guiding principles to support the planning of nurse staffing levels in this in paediatric inpatient services. It did the same for district nurse led community services in November 2017.

Under the new interim guidance for paediatric inpatient care, it stipulates that the ratio of registered children’s nurses to patients should not fall below 1:4, which equates to providing an average of six care hours per child per day.

In addition, the principles state that professional nursing judgement should be used in determining paediatric ward establishments and that all health boards should have escalation protocols in place for instances where there are decreased staffing numbers.

It also states there should always be a minimum of two registered children’s nurses rostered, one of which will have the experience and skills to act as a team leader. This should not include a ward sister, charge nurse, or manager, which will be supernumerary under the guidance. 

In a letter to chief executives at health boards, nurse directors at health boards, directors of workforce and organisational development and directors of finance, Professor White said that it was not the government’s expectation for health boards to be fully compliant with these principals immediately.

Similarly to the model established by the adult medical and surgical interim principles and the district nursing interim principles, Professor White said she would “request returns from health boards on compliance against these paediatric workforce principles on a biannual basis”.

“To allow time for the principles to begin to affect practice, I will write to executive nurse directors later in the autumn with further details and a template for completion,” she wrote.

“I would welcome your collective support to implement these principles and work towards compliance over the coming two years as we prepare for the legislative extension of the act,” she added.

Professor White said she believed that the paediatrics inpatients setting was the “most likely area” where the law would be extended by this term of government.

Earlier this year, Nursing Times did a focus feature on safe staffing which looked at the current situation regarding legislation across the UK.