In 2021, the RCN Foundation funded Cardiff University to undertake a qualitative comparative study of nurses’ use of professional judgement in nurse staffing systems in England and Wales.
Very little is known about how nurses’ professional judgement is deployed in decision-making in nurse staffing systems. The aim of this study, called Pro-Judge, was to address this gap in understanding. The RCN Foundation provided funding of over half a million pounds to Cardiff University to undertake this study.
Two types of professional judgment were identified at different levels of the organisation: one based on the understanding of individual clinical areas by clinical nurses, and a second based on prior clinical experience, knowledge of staff, and organisational priorities by senior nurse managers. These judgements were combined to make decisions.
Watch the animation below which summarise the main study findings and their implications
The study was carried out over three NHS trusts in England and three University Health Boards in Wales - the rationale for the focus on these two countries specifically is based upon their differing underpinning legislation.
The study took place between January 2021 and March 2023 during which interviews were conducted with various key individuals involved in the nurse staffing systems, staffing meetings were observed, and formal documents, tools and technologies were analysed. Despite being hampered by the pandemic and lockdown, a limited number of observations in clinical areas were also conducted to gain insight. This data was collated to construct an understanding of the role of professional judgement in the staffing systems in each case.
For more information about the study, read the Lay Summary.
Summary of findings
The study highlights that while nurses are relied upon to use professional judgment to manage risks during staff shortages, their judgments do not carry the same weight when it comes to agreeing on staffing levels at Board level. This may result in safe but not necessarily high-quality patient care, which in turn could impact nurse retention and increase staff shortages.
To address this, the research recommends a number of actions to address the findings:
- Equipping nurses with a vocabulary to articulate their professional judgment for strategic decision-making
- Being more inclusive of expert nursing clinical and contextual knowledge in healthcare organisations
- Refining staffing systems to generate data that better captures the complexity of care.
Read the full report here.
A Policy Lab was held in October 2023, where key stakeholders listened to the key findings and worked together to make suggestions for the next steps. This includes further dissemination to an international audience at the Organisational Behaviour in Health Care conference 2024.
Further work is planned with University of Southampton who developed the original professional judgement framework. This work would aim to see whether there are areas which could be refined in light of the findings of the Pro-Judge study. The team also plan to work with ward managers on a structured organisational template to promote decision making in practice but also document the basis of judgements to provide transparency in decision making from ward to board.