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Developing, testing and applying instruments for measuring rising dependency‐acuity's impact on ward staffing and quality

Sue Smith (Infection Control and Patient Safety, Nottingham University Hospitals Trust, Nottingham, UK)
Ann Casey (Barts and The London NHS Trust, London, UK)
Keith Hurst (Leeds University Health Sciences Institute, Leeds, UK)
Katherine Fenton (NHS South Central, Newbury, UK)
Hilary Scholefield (Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 6 February 2009



This paper aims to explains how relatively simple nurse staffing formulas from “best practice” ward dependency‐acuity data can be used for nursing workforce planning and development.


The paper combines literature, detailed ward surveys, workshop and expert group/stakeholder information to generate and test care levels/nurse multipliers for setting ward establishments.


The paper finds that professional‐judgement based ward staffing can be abandoned, while complex acuity‐quality, timed‐task and regression‐based nurse staffing algorithms for setting ward establishments may be unnecessary since the new multipliers, underpinned by robust validity and reliability testing, seem to be remarkably accurate nurse‐staffing determiners at a fraction of the cost.

Research limitations/implications

As care levels and multipliers stand they are suitable only for UK National Health Service acute wards. Primary care, mental health, learning disability and other specialist group care levels and multipliers need developing.

Practical implications

Users, at a minimum, can adopt care level data and multiplier staffing recommendations for benchmarking purposes. Ultimately, the algorithms can be used to: adjust ward establishments according to workload; or set staffing for new, inpatient services.


The paper offers a simple system for assessing patients' nursing needs and setting ward staffing accordingly.



Smith, S., Casey, A., Hurst, K., Fenton, K. and Scholefield, H. (2009), "Developing, testing and applying instruments for measuring rising dependency‐acuity's impact on ward staffing and quality", International Journal of Health Care Quality Assurance, Vol. 22 No. 1, pp. 30-39.



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Copyright © 2009, Emerald Group Publishing Limited