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Safer staffing

Nurses in corridor

There are many factors that impact on the quality of care delivered to patients.

One of these factors is making sure that the numbers of registered nurses, registered midwives and care assistants in our inpatient areas, where patients stay overnight, are at the right levels.

Factors that impact on patient safety, the levels of effectiveness of care delivery and the overall patient's experience include:

  • The numbers of patients, service users, carers and their families that need care and support.
  • The level of need of each patient (otherwise known as "patient dependency", "care complexity" or "acuity").
  • The numbers of other clinical staff that are available as part of the overall clinical team to deliver  the required levels of care, including doctors, physiotherapists, occupational therapists, speech and language therapists, specialist nurses / midwives.

As part of its response to the findings from 'The Mid Staffordshire NHS Foundation Trust Public Inquiry', the National Quality Board published guidance to support providers and commissioners of NHS care to make the right decisions about nursing, midwifery and care staffing capacity and capability.

CLICK HERE to download this guidance from the NHS England website.

This webpage provides information on how we address and monitor these matters at County Durham and Darlington NHS Foundation Trust.

This includes:

  • The Board receives a report every six months on staffing capacity and capability.  (Available to download in the list of links on this page.)
  • The Trust makes regular "Safer Staffing" returns to NHS England (Available to download in the list of links on this page.)
  • The Trust clearly displays information about the nurses, midwives and care staff present and planned in each clinical setting on each shift. This is placed outside the entrance to each inpatient ward (see below).

We would welcome your feedback on whether this information is easy to understand and answer any queries that you may have. Email us at

Alternatively, if you are a patient, service user, carer or a relative and have specific queries about the ward or service that you are using, please do not hesitate to ask to speak with the ward sister / charge nurse or nurse or midwife in charge in the first instance.

Thank you.

Noel Scanlon, Executive Director of Nursing & Patient Experience

Safer staffing - updated daily

We have information boards outside the entrance to each inpatient ward which are updated daily (see below).

Ward Blank for Web

These show the numbers of staff that are planned to be on duty compared to those that are actually on duty. This is broken down by registered nurses (or registered midwives for maternity wards) and care assistant / support staff. These are healthcare assistants, support workers and auxiliary nurses.

Reviewing the staffing areas in wall wards and departments is something that ward sisters / charge nurses and matrons undertake every day / shift.

The numbers of planned staff sometimes differs from those that are actually available on the day.

Sometimes the actual number can be lower if a member of planned staff suddenly becomes sick and unable to work. Where this is the case, we will always make a judgement as to whether the remaining available is sufficient to manage the patient caseload safely. If this is still not sufficient, the ward sisters / charge nurses and matrons work together to try and secure extra help from other wards. Also, matrons work clinically on the wards often to support particularly busy periods.

On some occasions, we may be required to close some beds on a ward, if extra staff cannot be obtained. This is always a last resort but may be necessary in order to keep patients as safe as possible.

Also, there may be occasions when there are more staff actually on duty than the number planned originally.  This is usually where extra / additional staff have been booked to look after, for example, extremely sick patients or those that are confused or at risk of falling and harming themselves.

The boards also display the number of patients per registered nurse. As a guide and during the busiest times on a ward, during day time hours, we would generally aim for no registered nurse to have more than 8 patients to look after.

At nights, the patient caseload activity is usually lower than that required during the daytime. However, if this is not the case, then we will try and increase staffing levels to help support the ward team and to provide the right levels of care to patients.

It is important to note that the numbers of available staff is only one of the contributory factors to ensuring that patients are safe.

Where concerns exist, efforts are made to move staff to help out and, also pool efforts and resources to help busy areas out.

Any undue concerns that cannot be resolved are reported to the Lead Nurse for the area and, if necessary to the Executive Director of Nursing or one of the associate nursing directors.

'I cannot commend the clinic enough. It is marvellous we have this service at all and well done to you all.'

Patient, Coronary Heart Disease / Heart Failure Service, Shotley Bridge Community Hospital