Maggie Maxwell A reduction in cancellations of elective cardiothoracic operations attributed to critical care nursing staff

Overview 17% of elective cardiothoracic operations are cancelled at Papworth Hospital Nationally cancelled operations equate to 1%

The problem is 66 cancellations of elective cardiothoracic surgical operations due to the lack of available critical care nursing staff in the last 12 months

The objective There will be a 50% reduction in cancellations of elective cardiothoracic operations attributable to the lack of critical care nurses by June 2015

contributory factors include- Vacancy rate- 9% of qualified staff Maternity leave- 3% Sick leave- 6% Higher paid job offers at local hospitals, few opportunities for promotion 33 bedded unit, with high acuity patients Poor communication between teams, and lack of team work- 250 WTE Lack of clinical support Location of hospital and near London Relocation of hospital to Cambridge 20,000 qualified nurse vacancies and national shortage of critical care nurses Root cause attributed to the high turnover of nursing staff within the unit- 27% of WTE per annum

Strategy To engage multidisciplinary teams in critical care to further explore reasons behind high turnover, and sickness rates in a variety of ways questionnaires, team meetings, posters, blogs To identify an Executive sponsor and engage the Executive team particularly HR and finance Design event with internal and external stakeholders to agree ways forward To identify 30, 60 and 90 day action plan available to all of the above with key identified leads To include a “you said we did” feedback to all staff

The implementation plan Divided into 6 key areas with identified lead, timeframe- each area leading to multiple outcomes Reducing vacancies- recruitment and retention of nursing staff Education and development Roster management Team structure Absence management Ward round and handover

Key outcomes included The introduction of competency pay progression and increased overtime rate A review of the overtime rate The introduction of new nursing team structures with alignment to the medical staff Changes in name badges to aid easy identification of new starters A review of the teaching team and education days to spend more time with staff on the unit and less in the classroom A review and changes to induction and the supernumerary/ Supervised practice of new starters A review of handovers and ward rounds with the aim of reducing duplication Revised roster and implementation of phone texts to liaise with staff Proactive managing of staff sickness, a review process and additional support The introduction of regular ‘you said …we did’ communication

The evaluation plan A monthly review against plan of The number of cancellations due to the lack of critical care nurses The numbers and percentage of staff turnover and reasons why The vacancy factor Staff sickness CCA occupancy and acuity Differentiate between process and outcome indicators

Discuss what you learned through this process Targets were flat lined- need seasonal variation with regard to human factors Success of competency based pay progression- a win win for patients and individual staff and a recruitment and retention strategy going forward Further review of overtime payments

Positives so far- early days but A significant reduction in cancellations due to the lack of critical care nurses- 12 against a plan of 24 Reduced staff turnover- 13% against a plan of 20% Reduced vacancies- 15 WTE against a plan of 2- WTE Reduced levels of short and long term sickness- 5.7% against a plan of 5% Additional benefits Reduced agency nurse usage and spend Reduced serious and moderate incidents reported Positive staff survey