Analysis

NHS must attract lapsed registrants back to nursing – but get better at keeping staff too

Strategies to lure nurses back need to be matched by changes in the workplace

Strategies to lure nurses back need to be matched by changes in the workplace

  • NHS Interim People Plan has outlined return-to-practice measures including free training for lapsed registrants
  • Employers must face up to the reasons nurses quit and embrace flexible working if they want to lure staff back
  • Pledge to restore CPD budgets in England over the next five years is ‘of huge importance’
Funded return-to-practice education is a cornerstone of the interim NHS People Plan's
strategy for the nurse workforce. Picture: iStock

Working with Mumsnet is the latest way the government is trying to tackle the nursing workforce crisis and tempt nurses back into the NHS.

A marketing campaign on the parenting website is targeting those who have left the profession, by giving information and advice on how to return.

Details were outlined in the Interim NHS People Plan, which sets out how the health service in England is going to recruit, retain and develop staff.

Campaign on Mumsnet.

‘The most urgent workforce challenge’

The interim plan states that addressing nursing shortages – estimated to stand at about 40,000 in England – is the ‘most urgent workforce challenge’.

It sets out a number of ways to tackle workforce shortages in addition to providing return-to-practice courses. These strategies include online degrees, more clinical placements and restoration of continuous professional development (CPD) budgets.

‘Research with return-to-practice leads has shown that the majority of nurses who return to the NHS left after starting a family,' a spokesperson for Health Education England, which oversees return-to-practice courses, tells Nursing Standard.

‘Our short-term partnership with Mumsnet aims to find these nurses, inspire them to come back and support them on their journey.’


Watch: We Are Returning Nurses


 

Lisa Bayliss-Pratt, chief nurse at
Health Education England.

Why the focus on return to practice?

The financial benefits are clear: it costs about £2,000 to return a nurse to the register compared with an average £50,000 to train a nurse from scratch.

And there appears to be a wealth of experience out there, with figures obtained by the Labour Party earlier this year revealing that 200,586 nurses left the NHS in England between 2010 and 2018.

HEE has recruited about 6,000 people to return-to-practice courses since they started back in September 2014.

There are now 40 courses around England, which usually take between three and 12 months to complete, depending on how long ago a nurse's Nursing and Midwifery Council (NMC) registration lapsed.

The courses are fully-funded and participants are given £500 to offset travel, book costs and childcare.

‘We know we need to address working conditions and make working environments safe and healthy for staff and patients.’

Kim Sunley, RCN national officer

HEE chief nurse Lisa Bayliss-Pratt says: 'I always say once you’re a nurse, you’re always a nurse and I’d encourage anyone currently on a break from their nursing career to explore the wide range of information and support available to help them return to a great career.'

A spokesperson for HEE says almost 4,000 people have completed a return-to-practice course since 2014, with the remainder still on the courses, but say it is not possible to say how many of those have returned to the workplace.

‘We can’t be precise on exact numbers who have returned to the NHS, it’s a complex process involving a number of partners,' the spokesperson adds.

‘We recognise this is an important next step in the programme and have been working to see if we can get this employment data.'

‘A golden hello and timely mentoring would be helpful’

Return-to-practice courses are funded, but the financial incentives ‘could be better’ Picture: Alamy

Laura* completed a return-to-practice course five years ago after taking a career break when her children were born.

She says while the course paved the way for her to return to the profession she loved, she found the decision dented her finances.

'More could be done to ease the short-term financial burden while you are on the course,' she says.

'While it was great to have it fully funded, the money for expenses doesn't go very far. Most of the people on my course were in the same boat – mothers with mortgages, cars to run, living costs and childcare issues to consider.

Why not for nurses?

'We are skilled, experienced, compassionate professionals, but we have bills to pay: if the NHS needs us back, the financial incentives could be better.

'You see people offered golden-hello packages to get into teaching, why can't the same happen for nurses?'

Laura now works part-time at a large hospital trust, but says she struggled in the early days coming back, adding that employers should give extra support to returners.

'It is really daunting to go back into the workplace. Flexibility over working hours, particularly in the early days, and mentoring from people who have gone through the same process could really help.'

*Name has been changed

 

Alternative routes back to practice

Recently, a joint report by the King’s Fund, Nuffield Trust and the Health Foundation recommended a full review of return-to-practice to understand whether expectations are correctly calibrated and how schemes could be improved.

1,200

nurses a year on average have been on return-to-practice programmes in England since 2014

(Source: Health Education England)

But those who can't commit to a course lasting several months or don't have a course nearby, the NMC is bringing in a more flexible option.

In March, the regulator announced that from 2020 nurses and midwives who want to re-join the register will be able to take a competency test instead of a completing a course.

It is hoped the test, mirroring the assessment taken by overseas nurses wishing to join the UK nursing register, will speed up and simplify a nurse’s return.

'It's about returning, but also retaining nurses'

Convincing nurses to return is one thing, but retaining their expertise involves addressing the reasons they quit in the first place, say nursing experts.

Figures analysed by the Labour Party show that 200,000 nurses left the NHS in England between 2010 and 2018.

‘We want to change the perception of flexible working being all about working mums – it is for everybody.’

Kate Jarman, co-founder FlexNHS

Childcare and work-life balance are
big considerations to many nurses.
Picture: iStock

Over those eight years, just under 97,000 nurses had ‘voluntary resignation’ recorded as a reason for leaving. Of that number, 17,250 cited work life-balance as their reason for resignation.

RCN national officer Kim Sunley points to a 2017 survey of nurses who had left the register that found 44% had quit because of working conditions.

Stress and pressure and a lack of flexibility were catalysts, which Ms Sunley says all need to be addressed to keep staff in the NHS.

She says: ‘It is about returning, but also about retaining nurses.

‘What we know from statistics on nurses leaving the register is that we need to address working conditions and make working environments safe and healthy for staff and patients.’

Flexible working

Kate Jarman is co-founder of FlexNHS, a support and resource network that calls for flexible working in the health service.

She is also director of corporate affairs for Milton Keynes University Hospital NHS Foundation Trust, which is introducing a benefits programme for staff.

The benefits programme includes flexible working with electronic rostering so staff can book their own shifts, free car parking and investment in staff rooms.

Electronic rotas allow nurses to book their own shifts. Picture: Jim Varney

Ms Jarman says flexible working is not only key to nurses returning to the profession, but across the workforce as a whole.

‘Flexible working requires a whole change in thinking and a change in structures to enable it to happen,' she says.

'But it is fundamental in terms of attracting and retaining the workforce.

The freedom to choose your own start time

Luton and Dunstable University Hospital NHS Foundation Trust recently relaunched its day nurse pool with more flexible options.

The pool system allows nurses to choose their start times, hours and shifts per week using a self-rostering system over a four-week rota.

Over a 12-hour day shift, from 7am-7.30pm, nurses can book a minimum of six hours at a start time that suits them.

Trust assistant director of nursing Helen Judkins says her organisation is 'trying something new' as part of its retention work.

'We recognised by developing and improving our approach to flexible working we could offer staff a better work-life balance that in turn would improve staff retention.

'By offering staff self-rostering and different start times we aim to retain skilled and experienced staff. 

'We hope we will also attract registered nurses who currently have restricted availability, most commonly due to child or care commitments.'

 

‘Flexibility is not just for working mums’

Ms Jarman says ‘moral judgements’ are often made about those who want to work flexibly.

Flexibility can mean very different things, she adds. Some staff want to pick shifts on a weekly basis, while others want set working patterns to accommodate childcare commitments.

£2,000

The cost to return a nurse to the register compared with an average £50,000 to train a nurse from scratch

(Source: Health Education England)

‘FlexNHS is about opening up conversations about what barriers there are for flexible working and how can we tackle these,' she says.

‘We want to change the perception of flexible working being all about working mums – it is for everyone.’

She adds that attracting and retaining nurses requires employers to make changes to their organisational cultures.

‘We have to understand why they left and what the compelling reasons are to return,’ she says.

‘And if some of those reasons are lack of flexibility and affordability, then we have to be able to say what is different and in a way that appeals to people.’

Training and development

The interim People Plan outlines how the NHS needs to become a modern, compassionate employer for the whole workforce, supporting whistle-blowing, physical and mental well-being, and flexible working.

39,148

vacant nursing posts in the NHS in England
(Source: NHS Improvement quarterly figures)

Queen’s Nursing Institute chief executive Crystal Oldman says that as well as flexibility, returners will be looking for career development.

Crystal Oldman, chief executive of
the Queen Nursing Institute. 

She adds that the pledge to restore CPD budgets in England over the next five years as part of the interim People Plan will be of 'huge importance'.

‘There are more choices than ever before for people in the workforce, and employers should ask nurses themselves why they leave the profession and what they can offer to bring them back.’

‘We know nurses leave when they are not confident in their skills when asked to do more complex work. Some of this is down to the lack of CPD being available or having the time to be released.'

Dr Oldham says leadership is also crucial. ‘We also know nurses leave when the leadership is poor – England’s chief nursing officer Ruth May has this as a priority so many opportunities for leadership development are now being opened up.’


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