Workforce

The Royal College of Emergency Medicine has collated information and guidance on the Emergency Department workforce. In this section you will find resources for service delivery, recommendations on expanding the consultant workforce, medical and practitioner workforce guidance and relevant toolkits. Use the navigation tool below to explore the information available. 

Baseline Emergency Staffing Tool (BEST)

About BEST

This tool has been developed by the RCN Emergency Care Association (ECA) and Faculty of Emergency Nursing (FEN). As EDs are constantly evolving and new ways of delivering care emerge the tool will be revised annually to ensure it has taken account of such changes. The 2013 review showed a strong correlation between BEST outputs on workload and locally held data sets on attendance. The review also showed the importance of users understanding the assumptions made by the tool about the care delivery process, particularly nurse to patient ratios, this is explained below and in the user guide. It is important therefore that you understand what to tool does and any potential difficulties with using it in your department. ECA members can contact the ECA for support prior to using the tool.

BEST is a workforce planning tool for use at local level in your Emergency Department (ED) to allow any disparity between nursing workload and staffing to be highlighted. The tool allows you to:

  • analyse the volume and pattern of nursing workload in your ED
  • track this against your rostered staffing level
  • calculate the whole time equivalent workforce and skill mix which would be required to provide the nursing care needed in the department during the audit period.

The tool does not produce recommended staffing levels but will allow EDs to work locally to reduce any disparity between workload and staffing. This can be achieved for example by improving patients pathways, departmental and hospital processes, roster designs and actual staffing.

What's required

The BEST calculation requires data to be collected and input for a seven-day period on an hour-by-hour basis. A user guide is provided below, together with the various data collection appendices to explain how to gather your data, how to enter it and what the results portray.

It is important to pay particular attention to the definitions and instructions relating to:

  • how to measure patients dependency in adults and children
  • which staff to include and which to exclude.

Every ED is different and it is important that your results are used by the people who know most about your ED, you. BEST is not designed to define a minimum staffing number or to compare organisations to each other.

How it works

The calculations work by using nurse-to-patient ratios in the various dependency categories.
It is important that these ratios reflect how care is actually delivered in your department, if they do not then the outputs from the tool will not be accurate.

The ratios used by BEST are:

  • total dependency - 2 nurses to 1 patient
  • high dependency – 1 nurse to 1 patient
  • moderate dependency - 1 nurse to 2 patients
  • low dependency - 1 nurse to 3.5 patients

The hourly data sets used by BEST are:

  • patient dependency volume in the department using the Jones Dependency Tool
  • the total number of staff rostered to be clinical on shift in the department.
  • A calculation will also provide an indication of what skill mix breakdown is required in the whole time equivalent workforce in your ED using the FEN competency levels and supporting definitions which can be found at The Faculty of Emergency Nursing

For help and advice or to offer feedback please email us at eca@rcn.org.uk

Accessing the tool and User guide

Access to the tool and user guides are available on the ECA website here.

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