Public Board papers 31.03.22

We continue to see an increase of staff reporting symptoms of stress and anxiety working through the pandemic. There has been flexibility in managing individual staff needs and personal challenges, e.g., working from home, and supportive measures implemented within the ward team, including signposting to specific resources. The working environment remains a challenge with particular attention to the management of patients with an altered airway in an environment with very little ventilation, windows and side rooms suitable to safely observe patients within this vulnerable patient group. This has been difficult, particularly in the management of COVID in addition which has required ongoing infection control input and advice. Due to the staff sickness and absence, maintaining PDRs and Essential training compliance has been challenging but we have clear actions to address this. Recently we have seen a number of experienced staff move on for career progression and this has caused a reduction in the percentage of staff able to work on the lower BMRU. In addition, we have found it challenging to train new staff due to staffing pressures however the recent increase in ward PEF has supported this. • Achievements Due to an ongoing high number of COVID related absence and isolation, the wards have been required to support each other more with staff, which has seen an increase in the number of staff movements in between areas. Following a review of Ward 4 and the BMRU we can confidently say that we have a sufficient number of budgeted registered nurses with the required specialist knowledge and skills to be able to deliver the service that we continue to provide to a high standard. I do, however, recognise the increase in patient acuity and complexities and therefore feel that to meet the increasing needs of our patients we need to review our budget for HCA’s. Over the last 12 months we have decreased our bed capacity to comply with social distancing measures which has meant that we have been able to provide a nurse-to-patient ratio of around 1:6, which is what we feel is required to sustain our high standards of care and quality. This is reflected in the reduction of pressure ulcers acquired during admission, falls with harm and staff and patient feedback. The bed capacity has gradually increased however we have maintained nursing at a 1:6 ratio.

Ward 11 Ward Managers professional judgment (achievements & challenges) • Evolution/development of service

Additional budget has now been allocated to provide sufficient staff to safely care for up to 24 patients on the Ward, and we are actively recruiting to these posts. Therefore the budgeted establishment is now correct. By utilising the Nurse Associate role to complement the Registered Nurse establishment and take a team of patients, we have achieved a RN/NA:patient ratio of 1:6 during the first part of the year. As bed capacity pressures have increased, alongside the current level of vacancies, this has caused the ratio to be increased to 1:7 or 1:8 on occasion. • Challenges Ward 11 has had many challenges over the last 6 months with the ward team being initially split between Ward 2 and 11.

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