Planning to leave nursing: what will it take to make you stay?

Thousands of nurses say they are planning to leave the NHS. We look at what practical support employers can offer to keep them. Learn more about staff retention at Nursing Live, RCNi’s unique event

Thousands of nurses say they are planning to leave the NHS. We look at what practical support employers can offer to keep them. Learn more about staff retention at Nursing Live, RCNi’s unique event

  • More than half of nurses plan on quitting the profession as they are so dissatisfied with the job, according to an RCN survey
  • What nurse employers can do to boost retention, including the initiatives and support staff say matter to them
  • The value of ‘stay conversations’ and how some NHS trusts are using them to support professional development
Nurse standing in front of a street sign with red ‘leave’ sign pointing one way and blue ‘stay’ sign the other way, against a background of a blue sky with clouds, representing the choice nurses face over remaining in or leaving the profession
Picture: iStock

This article was updated on 11 October 2023

Feeling undervalued and overworked? Wondering whether nursing is really your future? You are not alone.

In a recent RCN employment survey, more than half of nurses said they are so dissatisfied with the job that they are making plans to leave the profession. Against a backdrop of industrial action, a cost of living crisis and an unprecedented 40,000-plus nurse vacancies in the NHS, the question of how to retain staff has never been more critical.

Why are nurses leaving?

Nurses comments on social media suggest that the war on nursing attrition will need to be fought on many different fronts: everything from hot food to free parking, decent wages and nursing voices being heard in every layer of decision-making.

So, what will it take to reverse the trend and hold on to nurses?

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On Twitter, a Nursing Standard editor recently asked nurses about their morale and how they felt about their jobs. The feed quickly filled with replies. Though their tone varied, the consistent elements were anger, frustration, exasperation and weariness.

Nurses said that feeling appreciated and valued means working in a culture that respects and acknowledges ‘we leave on time and take our breaks’.

They pointed out the dangers of employers only paying lip service to caring for their staff. ‘Posters up everywhere saying how much you care about staff well-being – but you still call and ask me to work on my day off,’ said one respondent.

The need for protected time for regular, professional development was also highlighted by some. One person called for ‘time to plan, learn, develop, be a team’; another for ‘clinical supervision where the nurse being supervised can choose the topic’.

Beyond this, nurses said they want the basics, including not being asked to work extra hours, not being expected to pay to park miles from the hospital where they work, and having access to hot food during long shifts, as well as the time to eat it.

What are the figures for nurses leaving the profession?

Research backs up these comments. Studies show that excessive workload, burnout, lack of support from management and stress caused by the pandemic, all contribute to high turnover of nursing staff.

‘We know that when workplace conditions are good, retention is higher. It’s important that employers look at other organisations that are doing this well’

Jane Ball, professor of nursing workforce policy, University of Southampton

It is not just the NHS that is suffering from a shortfall of nurses; all types of nurse employers in the UK face similar issues. Tens of thousands of skilled nurses are leaving the profession, the RCN says, many long before they reach retirement age.

Between 2018 and 2022, 42,756 nurses on the Nursing and Midwifery Council (NMC) register aged between 21 and 50 left the profession.

What is required to improve nurse retention?

University of Southampton professor of nursing workforce policy Jane Ball says: ‘We need better staffing levels. There’s a limitation on what else can be achieved while that’s such a big issue.

‘The system simply won’t work if there aren’t enough people. In many cases, there’s been a 10% shortfall in staffing for five or six years – so the system doesn’t have the resilience it needs. Beyond that, there are two distinct things that employers need to do: stop doing the bad things that cause people to leave, and do more of the good things that encourage them to stay.

‘We know that when workplace conditions are good, retention is higher. It’s important that employers look at other organisations that are doing this well.’

Professor Ball points out that the 1980s MAGNET study, conducted mainly in the US to identify work environments that attracted and retained well-qualified nurses, showed that there are a range of different factors that lead directly to better staff retention. These include professional development and not feeling compromised in practice.

Recently, US researchers found that – along with recognition, competitive pay and benefits – shared decision-making was important in retaining nurses.

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Included in the programme is the talk: Developing a toolkit to drive enhanced retention: the role of education and career development. Led by Ronke Akerele, director of culture transformation and Em Wilkinson-Brice, national director for people, NHS England, it will be held in Learning Lab 1 on Friday 10 November at 4.05pm.

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What are nurse employers in the UK doing to support retention?

There are initiatives in place here with the goal of retaining nurses, with many NHS trusts welcoming NHS best practice guidance on developing a strategy for staff retention. This contains advice on retaining staff at different stages of their careers – for example, creating attractive packages for new starters, simplifying recruitment processes and running effective inductions.

‘You can’t underestimate the importance of things like free parking, free breakfast and subsidised hot meals’

Yvonne Christley, chief nurse, Milton Keynes University Hospital NHS Foundation Trust

At Milton Keynes University Hospital NHS Foundation Trust, the senior team are on the front foot. Chief nurse Yvonne Christley explains: ‘When we think about how to retain our staff, we look at why people leave. But importantly, we also focus on why people stay. Often, it’s linked to our culture: there’s an organisational commitment that provides support for individuals’ progression and professional development.

‘We see our ward managers as being the key to it. We invest a lot in their training, development and make sure that they’re supported.’

Ms Christley adds that in areas where it may be harder to recruit, such as older people’s care, the trust ensures that it has clear developmental paths and enrichment programmes for nurses, so they have opportunities to develop their skills.

‘We try to give all nurses access to decision-making forums and we believe that everyone has leadership responsibility. There is clear visibility of senior management. Where issues are raised, we follow up with problem solving.

‘To help relieve stress on the teams, we look carefully at the efficiency of the roster and check that staff are distributed evenly with a balance of different experience levels in the team.’

Ms Christley acknowledges that it is also about getting the basics right. She says: ‘You can’t underestimate the importance of free parking for staff. We offer that here, as well as things like a free breakfast, free tea and coffee, and subsidised hot meals.’

‘Opportunities to develop and supportive managers are why I stay’

Milton Keynes University Hospital NHS Foundation Trust senior sister Mariama Bah says the supportive culture at her workplace has helped her stay and progress in nursing.

 Mariama Bah, senior sister at Milton Keynes University Hospital NHS Foundation Trust
Mariama Bah

‘I manage over 40 staff on the acute medical wards, and it’s a pressurised, fast-moving environment,’ she says.

‘The trust has a policy to encourage nurses to apply for internal promotions, so their skills are kept within the trust.

‘Staffing is a huge challenge. Newly qualified nurses need a lot of support and training, but once they’re trained up they go off. It’s understandable that they want to explore new opportunities, but it can be frustrating.

‘The rising cost of living has been a factor. Some people say they can’t afford the cost of commuting anymore. I have healthcare assistants say to me “I’d rather go and work in a warehouse. You get paid more and it’s less stressful”.

Someone who says ‘you can do it’

‘I’ve had low times. For example, what we were exposed to during the pandemic, and times when we’ve had very low staffing, and I know that I’m going to have to start all over again with recruiting and training. But I’ve also had a lot of opportunities to train and develop my skills here, which is what I value.

‘I’ve done management and leadership training, as well as advanced clinical skills. I also have supportive seniors, which makes all the difference. I know I can call or text my matron any time, and also our chief nurse, and I will be listened to.

‘My experience is that you can do a lot, but often you do need support. You need someone to say “You can do it”.’

What has pay got to do with it?

In the RCN’s Building a Better Future for Nursing survey, 73% of respondents said higher pay would make them feel more valued. Nursing unions are calling on the government to implement a significant pay rise for nursing staff, and reduce existing inequalities in pay and conditions across the NHS.

The RCN argues that the government should recognise that paying more to keep experienced nurses makes sound financial sense.

As Professor Ball says, ‘the cost of training, losing nurses and recruiting nurses, as well as paying more for agency nurses is a continual drain on the finances’.

According to the RCN, the cost per nurse of international recruitment is 2.4 times higher than the cost of giving a 17.3% pay rise to an experienced nurse.

However, Ms Christley adds that when it comes to nurse retention ‘pay is a factor certainly, but if it was just about pay, we’d all be doing other things’.

What is a ‘stay conversation’?

Illustration showing two nurses sitting at a table with speech bubbles above their heads, suggesting a ‘stay conversation’ is taking place
Picture: iStock

Many managers now conduct conversations with staff – sometimes called ‘stay interviews’ – to discuss and resolve any possible issues before the member of staff reaches the point of handing their notice in.

Royal Wolverhampton NHS Trust deputy director of nursing Cath Wilson says that stay conversations can help identify issues that may otherwise not be addressed.

‘We try to have them at least annually with staff,’ she says. ‘We ask how they are finding things, how managers can support them and specifically what would keep them here.

Issues that might not otherwise get raised

‘A whole range of issues come up. Some of them are relatively minor and easy to resolve. As a manager you get to hear about things that you wouldn’t otherwise know about.

‘For example, someone told me they would probably have to leave because they wanted to teach at a college. But I was able to connect them with someone who had contacted me about finding someone to teach on their course, and so they were able to combine teaching with part-time nursing here, and we didn’t lose them.’

What about flexible working – can it help?

‘Flexibility means something different to everyone,’ says Professor Ball. ‘We tend to take too much of a broad brush approach. In fact, there are many different types of nurses and their needs are different. What a 51-year-old community nurse might want at work may be very different to a 23-year-old emergency department nurse, or someone in a single-income household. If employer strategies are too untailored, they’re unlikely to work.’

Royal Wolverhampton NHS Trust deputy director of nursing Cath Wilson says that senior staff have benefited from talking directly to newly qualified nurses at recent ‘stay’ events that the trust has run for staff. These events highlight development and support opportunities on offer, and give direct access to the senior team.

‘I had thoughts of leaving due to the shifts I was being offered, but I’m now working through the issues with managers’

Gemma Gessey, nurse practitioner

‘I notice generational differences,’ says Ms Wilson. ‘Particularly with younger nurses coming through. They’re not juggling childcare or settling down with mortgages yet, but their work-life balance is important to them, and they may want their shifts to work with other things they want to do.

‘Often, we’re able to say to them that they can do that course, or whatever, while staying here. They don’t need to leave.’

A nurse in uniform in an underground car park, with parked cars around her. Free parking for staff is an initiative some workplaces have implemented to encourage staff to stay
Free parking, free meals and flexible shifts can be the support that makes a difference between leaving and staying Picture: iStock

Nurse practitioner Gemma Gessey attended one such recent event. ‘It was useful meeting senior clinical and non-clinical staff, and being assured we could approach them,’ she says.

‘It did reinforce that the trust values its staff and will try to work in partnership to keep them. I had thoughts of leaving my current role, due to the shifts I was being offered, but I’m now working through the issues with managers and I think my future lies here.’

Ms Wilson says: ‘We’ve also run a menopause support event, and we’re recruiting “legacy mentors”, a scheme where retired nurses return in a part-time mentor capacity to support nurses in the early stages of their careers.’

At Milton Keynes, flexible working policies are valued by many staff. ‘We have a policy of looking at how we can be as flexible as possible from the outset,’ says Ms Christley.

Further information

Yvonne Covell is a journalist

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