Question 1

1. Introduction

Accepted Answer

The Neonatal Nursing Workforce Tool (2020) has been adapted from the CRG Workforce Calculator (Dinning) Tool (2013) and has been developed with the National Lead Nurses Group. It is intended to support neonatal nurse managers and their colleagues by providing a consistent method for the calculation of nursing establishment requirements which meet national standards i.e. BAPM (2022); NHSE Neonatal Service Specification (2024); NHS (2009).

Question 2

2. Definitions

Accepted Answer

Declared Cots:
The number of cots, by care level, which a unit are operating

Required Cots:
The number of cots, by HRG, required to deliver the activity undertaken in the reporting period at an average occupancy of 80%

HRG 1 / IC:
Intensive Care as per HRG 2016

HRG 2 / HD:
High Dependency as per HRG 2016

HRG 3-5 / SC:
Special Care, and any other care HRG 3-5 that takes place on NNU, as per HRG 2016

WTE:
Whole time equivalent. This will differ from headcount according to the number of staff working part time

Question 3

3. Inputs

Accepted Answer

Yellow boxes are for the input of local Trust/unit level data.

3.1 Unit Details:
	-	Enter local unit details for reference
	- 	The designation of unit should be selected from the drop down box

3.2 Activity:
	- 	Activity data for a full year (365 days) should be used but can be for a calendar or financial 
		year. (This data may be provided from the Neonatal ODN)
	- 	Intensive Care is HRG 1, High Dependency Care is HRG 2 and Special care is any activity
		which takes place on NNU HRGs 3-5
	- 	Data for Transitional Care Activity should be excluded as the calculations are for care
		provided 
	- 	The calculator can be used to model workforce requirements for service developments or
		changes. For example, use activity data which includes 'lost' activity to model cot-base 
		requirements, or subtract activity from NNU where that activity will be delivered on a 
		Transitional Care Unit

3.3 Staffing Numbers:
	- 	Enter numbers of WTE funded establishment and WTE actually in post by qualification i.e. 
		Nurse/Midwife with QIS, Nurse/Midwife without QIS and Nursing Associates/Non-
		registered staff
	- 	The WTE numbers should be for nursing workforce providing direct patient care only. 
		Time allocated for additional roles such as management, education, outreach etc. should
		be excluded

Where staff work some of their contracted hours providing direct patient care and some hours in non-direct patient care roles please ensure that only the hours worked to deliver direct patient care are included in the tool. For example: A nurse educator is contracted to work 1 WTE (37.5 hours); of these 0.4 WTE (15 hours) are spent providing education to staff and 0.6 WTE (22.5 hours) are worked clinically caring for babies. Therefore only 0.6 WTE should be included in the tool calculations.

- 	A supernumerary nurse in charge will be included in the calculations for all units. This 
		should be a neonatal nurse who is Qualified in Specialty
	- 	Transitional Care staffing numbers should NOT be included

Question 4

4. Outputs

Accepted Answer

Once all yellow boxes have been filled the calculator will generate figures for the following:

4.1 Activity:
	- 	The number of cots required (by HRG) to deliver the activity undertaken in the reporting
		period declared at an average of 80% occupancy
	- 	Where the cot requirements include a decimal fraction it is assumed that cots can be 
		flexed down to a lower level of care but not up i.e. a cot designated for Intensive Care can 
		be used to provide High Dependency care but a cot designated for High Dependency 
		cannot be used to provide Intensive Care.  There fore the number of critical care cots 
		required is rounded up to the higher level of care. For Special Care the number is rounded
		to the next whole number. For example:

https://static.wixstatic.com/media/6ba139_d22a5608b836469cb6837c1ad3b99350~mv2.png

4.2 Nursing Workforce:
	- 	The total number of WTE staff required to staff the declared cots will be shown in the 
		Nursing Workforce output table
	- 	The total number of WTE QIS required to staff the declared cots will be shown in the 
		Nursing Workforce output table
	- 	A multiplier of 6.07 WTE has been used to provide 1 nurse per shift:

Calculation of multiplier 
https://static.wixstatic.com/media/6ba139_611706cce7c94bdfbdb0e6371fcf9f06~mv2.png

- 	In line with the recommendations in the DH Toolkit for Neonatal Care (2009) the 
		multiplier includes an uplift of 25% for annual leave, study leave, maternity/paternity leave
		and sick leave
	- 	The multiplier is based on a 26 hour day to include two hours per day for shift handover
		and supervision (such as appraisals)
	- 	Nursing workforce requirements are calculated to meet BAPM nurse: baby ratios i.e. 
		HRG 1 (IC) 1:1. HRG 2 (HD) 1:2, HRG 3 – 5 (SC/TC) 1:4
	- 	The calculator will give the actual WTE staff requirements based on the number of cots 
		needed to deliver the activity for each level of care, at an average of 80% occupancy 
		across the year
	-	Calculations are made for an average of 80% occupancy because evidence shows that 
		outcomes, mortality and morbidity are not as good when occupancy exceeds this level
	- 	Unit nurse staffing should be established to 100% to ensure that peaks in activity can be 
		managed without an adverse effect on outcomes, mortality and morbidity
	-  	In all units, at least 70% of Registered Nurse/Midwifery staff should hold a post 
		registration qualification in neonatal care i.e. Qualified in Specialty (QIS). This does not 
		include nurses in training for QIS (NHSi, 2018)
	- 	All intensive and high dependency care should be provided by QIS staff, so where a unit 
		has a high proportion of critical care activity , the percentage of QIS staff required will be 
		greater than the 70% minimum
	- 	A minimum of 2 registered nurses are required per shift to meet National Toolkit 
		standards. Therefore the minimum number of registered nurses required per shift is 12.14
		WTE (6.07 x 2). The calculator allows for this

Question 5

5. Limitations

Accepted Answer

The calculator cannot accommodate every variation within local nursing workforce provision. However it can be used to provide a standardised method for calculating nursing workforce requirements which can then be supplemented with local detail and any additional requirements. For example:

- 	The calculator does not allow for services which require more than one supernumerary 
		nurse in charge per shift, for example those that are delivered across separate sites. 
		However the multiplier of 6.07 can be used to calculate the number of extra nurses 
		needed and this can be added into the calculations at individual service level.
	- 	The calculator does not allow for services which require more than one supernumerary 
		nurse in charge per shift, for example those that are delivered across separate sites. 
		However the multiplier of 6.07 can be used to calculate the number of extra nurses 
		needed and this can be added into the calculations at individual service level.

Question 6

5. References

Accepted Answer

British Association of Perinatal Medicine (2022). A BAPM framework for practice. Available at ; Service and Quality Standards for Provision of Neonatal Care in the UK | British Association of Perinatal Medicine(https://www.bapm.org/resources/service-and-quality-standards-for-provision-of-neonatal-care-in-the-uk)

NHS England (2024) National Neonatal Critical Care Service Specification. Available at Neonatal-critical-care-service-specification-March-2024.pdf(https://www.england.nhs.uk/wp-content/uploads/2015/01/Neonatal-critical-care-service-specification-March-2024.pdf)

NHS (2009) Toolkit for high quality neonatal services. Available at; [ARCHIVED CONTENT](https://webarchive.nationalarchives.gov.uk/ukgwa/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_108435.pdf)

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