The key to making best use of your available and limited nursing capacity is to flex your labour in response to demand - this is not easy. Labour KPIs - specifically the measurement of nursing hours per effective patient day (epd) for Ward staff, and nursing hours per effective Theatre hour, are two important metrics.

There is no particular skill in achieving the Ward KPI target when there are a lot of patients, nor is there particular skill in not resorting to agency staff when you are quiet. The skill is to achieve the Ward KPI when you are quiet and not to resort to engaging agency staff when you are busy.

Whilst patient dependency has a bearing on staffing requirements, a reasonable rule of thumb assuming there is no requirement for 1:1 nursing is for the Ward KPI target to be around 6.0 hours per epd. A reasonable Theatre KPI target is 11.5 - both are +/- 0.5.

The flexing of nursing capacity to patient demand needs to take place in the context of other important considerations requiring management including:

- senior control over the process for engaging agency staff

- building up substantial bank staff capacity through initiatives to encourage this

- minimising of absence through effective occupational health

- adherence to HR processes in relation to return to work interviews

- effective engagement of the workforce to drive up discretionary effort and retention, and to reduce churn within a year of employment

Ultimately, staff are an organisation's most precious resource. Respect, engagement and motivate them well and they will deliver a better standard of care - the most important source of competitive advantage. It is the role of the senior leadership team to act in unison to enable this to happen.

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