Safe staffing unit recommended.

A Safe Staffing/Healthy Workplaces Unit (SSHWU), with an advisory board of district health board (DHB) chief executives and NZNO representatives, is the central recommendation of the Committee of Inquiry into Safe Staffing and Healthy Workplaces. The unit would be established within District Health Board New Zealand and the report recommends that Minister of Health Pete Hodgson be approached to fund its establishment and operation. The committee wants the unit established within six months.

The committee's report and recommendations have been released to DHB chief executives and NZNO members employed by DHBs, for their endorsement and then implementation. The endorsement process should be finished by midJuly. "We are confident these recommendations, when implemented, will make a real difference to patient safety and the safety of the nursing and midwifery workforce," NZNO chief executive Geoff Annals said.

The report is the culmination of nine months' work by the committee, established as a result of the negotiations for the inaugural DHB/NZNO Multi-Employer Collective Agreement (MECA). Resolving workload pressures was a key priority for NZNO during the negotiations and was identified by members as the second most important issue (after pay) to retain nurses.

The report invites the Minister to "endorse" the committee's work and support its recommendations. The 15 recommendations, all of which have a timeframe, aim to strengthen nursing and midwifery leadership, develop processes for situations when staffing is unsafe, improve workplace culture, involve nurses and midwives in change, gather information on the national nursing and midwifery workforce, and support a national post-entry education framework.

"While wholsesale reform is not suggested, the actions proposed in this report require urgent and sustained attention," the report said. "The views of many nurses and midwives, combined with recent national and international research, paint a picture of a workforce under significant pressure." The report identifies seven inter-dependent elements as essential to achieving safe staffing. These are: the requirement for nursing and mid-wifery care; the cultural environment; creating and sustaining quality and safety; authority and leadership in nursing and midwifery; the wider team; and the physical environment, technology, equipment and work design.

"Collectively, these elements describe an appropriately resourced, well organised, healthy care delivery environment, in which patients achieve the planned outcomes," the report states. The report recommends that DHBs, within nine months, ensure adequate access to clinical leadership 24 hours a day, seven days a week at all levels of the organisation. It wants DHBs and NZNO to develop agreed processes to support nurses and midwives and guide managers in the event that staffing is deemed unsafe. Every instance of unsafe staffing is to be relayed to the DHB director of nursing, who will, in turn, report it to the chief executive.

Leadership positions for nurses and midwives

All DHBs are to have leadership positions for nurses and, where appropriate, a separate position for midwives. These leaders will report directly to the chief executive and have decision making responsibility for nursing and midwifery. The report calls on DHBs to support a "no cancellation" policy for any approved education leave, unless at least two week's notice is given. longer term recommendations are about incorporating the elements of safe staffing in their budgeting, forecasting and planning, and with developing strategies to improve workplace culture. Nurses and midwives are to be involved in planning capital projects and in workplace redesign or refurbishment.

The SSHW Unit will develop best practice guidelines for patient forecasting and workload management systems for roll-out in DH Bs. The DHBs and NZNO, in collaboration with tertiary education providers, the Clinical Training Agency and regulatory bodies will develop a national framework to support post-entry education and clinical teaching in nursing and midwifery.

In her foreword, committee chair Diana Crossan says most of the recommendations require a change in focus within the system, rather than a large injection of funds. She stressed the long-term nature of the change process but urged those implementing the plan not to waste the opportunity to make nurses and midwives safer at work. "Visionary and determined leadership is essential," she said.

The report contains a chapter outlining the development of the committee of inquiry and its terms of reference; the process the CoI used, including its limitations; a chapter devoted to substantiating the seven key elements and posing the same questions about each one: Why is it important?, What is our evidence to support this view? What do we know of what is currently happening here? What would we see if we were achieving in this area? How could we measure it? What will support progress in this area? What might hinder progress in this area? and outlining the key messages related to each element. The final chapter, "Putting it all together: establishing safe staffing and healthy workplace", details the ten steps which bring together the seven identified elements and outlines a systematic approach for establishing staffing that achieves the goals of assuring patient safety and satisfaction; supporting staff health and wellbeing; and maximising organisational efficiency. NZNO's representatives on the CoI were chief executive Geoff Annals, industrial adviser Glenda Alexander, former president Jane O'Malley and Waikato emergency nurse Jane lawless. Next month's Kai Tiaki Nursing New Zealand will cover response to the report.