How to make a case for expanding a nursing team
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How to make a case for expanding a nursing team

Fiona Springall Children and young people’s learning disability and autism specialist nurse, Norfolk and Norwich University Hospital
Tara Webster Adult learning disability and autism specialist nurse, Norfolk and Norwich University Hospital

Two learning disability specialist nurses used the RCN’s Nursing Workforce Standards to lead service improvement

There is a national shortage of registered learning disability nurses – most NHS hospitals typically employ only one learning disability nurse per organisation on a Monday to Friday daytime basis.

Learning Disability Practice. 27, 1, 14-15. doi: 10.7748/ldp.27.1.14.s6

Published: 08 February 2024


Picture credit: iStock

When the scope of a role covers inpatient, outpatient, emergency and elective care pathways, the role’s capacity is clearly and significantly reduced, especially out of hours.

As a result patients often miss out on the care and adjustments they require when accessing hospital services, as reflected across learning disability reports.

Since 2015, there has been a drive to ensure learning disability nurses use their leadership positions to influence policy-making and ensure wider service quality improvements for people with learning disabilities. However, hospital specialist learning disability nurses can become torn between direct clinical practice with individual patients and their improvement work to ensure services improve consistently for all patients. Such responsibilities significantly add to their practice burdens.

‘After completing the standards framework, we could drive forward improvements for service users’

If learning disability nurses are freed up to focus on service-wide improvement projects, there would be more consistency and availability of adjusted care led by hospital staff, but clinical pressures reduce the capacity for this work to be prioritised in acute learning disability nursing practice.

Our learning disability nursing team at Norfolk and Norwich University Hospitals NHS Foundation Trust successfully made the case for a new staff member thanks to the RCN’s Nursing Workforce Standards. The standards are applicable to all nurses in different settings, so even if you work in a different setting, we urge you to consider using them to help boost your own team.

The new band 5 learning disability and autism nursing post in our team is specifically for the 0-25 age group and supports our roles as learning disability specialist nurses (TW for adults service users and FS for children), freeing up our time to spend on improving the service for our patients.

Expectations of employees

The standards set out what the RCN expects from employees across three different areas: responsibility and accountability; clinical leadership and safety; and health, safety and well-being. If one or more of the standards are not being met the RCN will support members to raise concerns with their employer.

With this in mind, we set out to complete the standards and understand more about how clinical demand, reduced ability to prioritise organisational improvements and service-level adjustments affect our role’s efficiency and the service we provide to patients. As a result we identified the core areas we needed to address for our team to reach its full potential and drive forward improvements for our service users.

These core areas relate to skill mix and capacity. Having only one specialist nurse role per patient group meant that patients who require more straightforward adjustments to their care are being triaged to the same professional who had to manage complex cases and all the other work.

Advice on using the standards

  • » Work through the standards in reverse numerical order; this will help you to gain momentum with drawing out specifics that may represent bigger gaps as you go along

  • » Remember the standards are applicable to all nurses and can be adapted to fit your role

  • » Use the guide or liaise with someone who has used them, as some of the standards may require context to be applied to your role in practice


Picture credit: iStock

Additional staff

We identified that having additional staff to focus on direct patient care could help specialist nurses with greater accountability to focus more on service-wide strategic improvements and complex patient cases. However, with less than 80% of a whole time equivalent in post in the specialist nurse role we were not meeting service demand.

There was also a lack of cover when this nurse was off work. Therefore our team was unable to protect enough dedicated time to ensure safe and effective care and did not meet the practice development requirements.

When it comes to using the evidence, the standards act mainly as a tool for drawing out themes or identifying gaps, so it is important to have opportunities to reflect on and discuss with others what is required to fill these and action plan accordingly.

We used the evidence gathered to write a business case for an extra member of staff and were assisted by business support in our trust to ensure that the themes were evidenced with data and other information that solidified our request. The potential benefits for patients versus the financial requirements for the request to be met were also covered.

For others looking to embark on a similar project, we recommend having a bigger plan and seeking support from relevant others – such as business support – when turning the themes identified from the standards into a concrete request. This ensures that what you need and what you ask for are well supported by rationalised evidence, including data and service improvement proposals.

The most helpful aspect of the workforce standards was the recognition that there were not enough members of our team to prevent the workforce falling below 80% whole time equivalence. It reaffirmed that, despite how hard we work, there are simply not enough of us to achieve all that we aspire to. Other nurses could use the standards to highlight the lack of capacity in their teams to do all they aspire to do. We also want nurses to use the standards and highlight where those staffing gaps are and use the information gathered to make a reasoned case for getting what they need to fulfil their ambitions and improve patient services.

The RCN standards provide a structured approach to identify and evidence the need for resources that could improve practice, services and the capacity to drive improvements.

Further information

RCN (2021) Nursing Workforce Standards.

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