Nursing numeracy in context

Debates at a national and international level regarding numeracy in society, the implications for employment and development, and the emerging national focus on issues of patient safety and risk management, have all indicated that there is a need for a greater focus upon supporting and enhancing the numeracy skills of all healthcare staff. Indeed Hoyles et al (2002) have argued that increasing numbers of people are engaged in numerical activity in the workplace and that such work involves increasingly sophisticated mathematical activities. This notion sits uncomfortably alongside the evidence that the 1996 International Adult Literacy Survey (IALS) placed 24% of the population of Scotland aged 16-65 at the lowest level (IALS Level 1) on quantitative literacy (QL, the nearest equivalent to ‘numeracy’ in the survey), with a further 30% at Level 2 (Scottish Executive 2001).

Thus, whilst the initial impetus for this work was provided by concerns about numerical competence amongst professional healthcare staff such as Nurses, Midwives and Allied Health professionals, these challenges have encouraged us to view the enhancement of competence in ‘healthcare-related numeracy’ as part of the broader adult numeracy and literacy strategy. To that end, NHS Education for Scotland (NES) has been working with a broad range of stakeholders to develop a strategy to support numeracy education and skills for staff across NHS Scotland.

A NES reference group was established, including Nurses, Midwives, Pharmacists and Allied Health professionals, alongside Service managers, representatives from Higher Education and Scotland’s Colleges, Professional organisations and Regulators. The work engaged associated agencies such as NHS Quality Improvement Scotland, those involved with Adult and Community Education Literacies partnerships in Learning Connections and wider UK stakeholders such as the Higher Education Academy and the Nursing and Midwifery Council.

This group developed the consultation document ‘Identifying and Supporting the Numeracy Needs of Healthcare Staff in Scotland’ (NES 2004) which focused upon issues associated with the identification, development and measurement of numerical competence in the context of healthcare education and practice. This document was circulated widely across Scotland and received considerable interest across the sector.

The Consultation - Recommendations and Actions

The work made a number of recommendations regarding both policy and practice, several of which are now being taken forward in line with feedback from both the service and education sector. In particular, the following educational initiatives were undertaken:

1. Evaluation of numeracy development needs within NHS Scotland and within Higher Education, Scotland’s Colleges and service-based education provision

The particular learning and teaching approach adopted to support numeracy learning will inevitably depend upon the educational philosophy of each educational institution and the way in which the curriculum is delivered. What is clear however is that there are considerable variations in the amount of time devoted to numeracy learning, and the nature of delivery and assessment within different academic programmes. Therefore NES engaged a subject specialist to;

  • identify numeracy provision within healthcare education programmes in Higher Education, Scotland’s Colleges and within service-based development provision

  • determine particular development needs/opportunities and identifying potential models of, or gaps in, provision

  • explore the perceptions of students, practitioners and educators regarding healthcare numeracy

  • collate and synthesise available data/literature

  • provide the NES Steering group with a structured report

The report identified a number of issues which NES have incorporated into its collaborative working with HEIs and Scotland’s colleges and which we have used to support our discussions at a UK level with the Nursing and Midwifery Council regarding admission criteria, educational standards and essential skills.

2. Development of Healthcare-focused Numeracy provision to support transition from Further Education to Higher Education-based pre-registration Healthcare programmes

A key element emerging from the original NES consultation was the need for greater contextualisation in teaching and learning materials such that they would reflect the clinical and organisational context within which healthcare students were placed, or were seeking employment. It was identified that current provision such as ‘Business Numeracy’ did not sufficiently capture, nor support engagement with, the embedded nature of numeracy within the healthcare environment.

NES provided funding to support this aim in collaboration with the Scottish Wider Access Project (SWAP). The work has supported the following initiatives:

  • Development of contextually-based healthcare numeracy learning and teaching materials – these act as a wrap-around for the existing SQA ‘Business Numeracy’ module.
  • Engagement of Scotland’s College sector with the learning and teaching materials - SWAP/NES has used its network to ensure wide engagement with this project and ensure uptake.
  • Materials Roll-out - NES/SWAP have made the materials available to Scotland’s Colleges and held a ‘Masterclass’ for teachers engaged with supporting numeracy amongst students in Scotland’s Colleges and healthcare staff in the service.
  • Evaluation - Using the SWAP network, we have supported evaluation amongst service and HEI stakeholders, teaching staff and students regarding the uptake, delivery, effectiveness and appropriateness of these materials for practice.

3. 'Healthcare & Numeracy Project Grants'

NHS Education for Scotland (NES) & Learning Connections at Communities Scotland joined forces to provide project funding to education staff, service managers and Literacies Partnerships across Scotland. The Healthcare & Numeracy Project Grants aimed to support new educational developments and opportunities for all staff working in the healthcare sector, and to open up existing innovative work to the widest possible audience.
NES and Learning Connections sought proposals for innovative educational projects which reflected one or more of the following themes;

  • help with numeracy skills for healthcare support staff
  • exploring new approaches to teaching numeracy in the professional healthcare curriculum
  • teaching numeracy skills across wide range of healthcare disciplines
  • working in partnership with others to help learners with number skills

This opportunity provided funding up to a maximum of £4000 each for eight successful projects. In return project teams produced reports of the project outcomes for wide dissemination across Scotland and presented their work at a joint Learning Connections/NES event and the reports have also been made available on the Adult Literacies Online website.

4. Supporting numeracy amongst newly-qualified NMAHPs

Recognising that some newly-qualified staff may continue to lack confidence in their calculation ability, or may find new calculation challenges as their scope of practice develops, NES has purchased 4000 licences to the Authentic World online learning, teaching and assessment programme. These licences have been made available free of charge to newly-qualified NMAHP staff through the Flying Start NHS initiative and provide levels of numeracy support to our new staff unrivalled across the UK.

5. Development of a benchmark numeracy assessment tool

Finally, NES recognised that there has been considerable national interest regarding the development of a standardised numeracy assessment tool for nursing staff at point of registration’ to their profession. Identifying an opportunity for NHS Scotland to pilot work which would have national and international implications, this was viewed as an essential element in the overall strategy and it is this work upon which this report reflects.

Focusing initially upon Nursing, NES has joined together with key academics from across the UK to develop and pilot an online assessment tool which can be used to support this process. The work aimed to establish the core principles/criteria for such an assessment, and recognizes that these can potentially be shared by different delivery models and can be built upon existing numeracy learning and teaching provision.

The pilot assessment approach was supported by an assessment exemplar based upon the ‘Authentic World’ computer model developed by Dr Keith Weeks and Norman Wooley at University of Glamorgan (Weeks
et al 2000 and 2001). This online learning environment uses multi-media technology to represent the medication dosage process and numeracy problem solving techniques employed by clinically-based health care professionals. This tool aims to support robust assessment of numerical competence in an ‘authentic’ context.

The development team, co-ordinated by Mike Sabin, Programme Director at NES, also included Dr Carol Hall (Associate Professor, University of Nottingham), Prof. Diana Coben (Kings College London), Dr Meriel Hutton (Independent researcher) and Dr David Rowe, University of Strathclyde. To support this work, the team established partnership arrangements with Higher Education Institutions and NHS Boards across Scotland to provide feedback on the content and structure of the online tool and to pilot its use with students.


Hoyles, C., Wolf,A., Molyneux-Hodgson, S and Kent,P., (2002). Mathematical Skills in the Workplace. Final Report to the Science, Technology and Mathematics Council. London: Institute of Education, University of London; Science, Technology and Mathematics Council.

NES Numeracy Working Group (2006)
Identifying and Supporting the Numeracy Needs of Healthcare Staff in Scotland (Consultation) Edinburgh NES

Scottish Executive (2001)
Adult Literacy in Scotland: Analysis of data from the 1996 Adult Literacy Survey Edinburgh, Scottish Executive.

Weeks KW, Lyne P, Torrance C (2000)
Written drug dosage errors made by
students: the threat to clinical effectiveness and the need for a new approach
Clinical Effectiveness in Nursing 4 20-29

Weeks KW, Lyne P, Mosely L, Torrance C (2001)
The strive for clinical
effectiveness in medication dosage calculation problem solving skills Clinical
Effectiveness in Nursing 5 18-25

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