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How over-recruiting saves cash

If two good nurses apply for one post, an increasing number of NHS trusts will appoint both. Over-recruitment secures good staff when they are available, saves on recruitment costs and avoids the need to fill gaps with agency staff.

You are a senior nurse interviewing for a band 5 to join your team. You have seen two equally good applicants, both well-qualified for the role and bubbling over with enthusiasm. How do you decide which to appoint?

The answer in some trusts is that you don’t have to decide: you can appoint both, even if doing so takes you over-establishment.

This is an approach that has been adopted at University Hospitals Birmingham NHS Foundation Trust for some years. The trust’s chief executive Dame Julie Moore urges nursing directors to over-recruit, and says: ‘Never allow a good person not to be recruited. If you interview two good staff nurses for one job then employ them both.’

She has suggested that managers should over-recruit by 10% – in reality, she says the turnover of staff has meant that the trust ends up 2% or 3% over-establishment and has never reached 10%.

Over-recruitment was more common in the past – some nursing directors today remember it being common policy when they were training. But it could make a comeback as nurse recruitment gets ever harder.

So why would any hospital want to over-recruit nursing staff? There are a number of reasons. First of all, the practise secures good staff who have indicated a willingness to join the trust – no one can be certain that future applicants will be as good. Secondly, it saves costs around recruiting – shortlisting and interviewing candidates again in a few weeks’ time when another vacancy arises does have a cost, even if it is predominately staff time. And thirdly, it can avoid a staffing shortfall that might have to be filled by more expensive agency staff; it can take weeks, if not months, to get new staff in place once someone has moved on. Salford Royal NHS Foundation Trust has a similar scheme and the RCN says a number of other trusts in the West Midlands have tried to return to the practise.

Several years ago, when some newly-qualified nurses were struggling to find a permanent job, many trusts would offer unsuccessful candidates bank work, with the prospect of moving to a full-time permanent position when one came up.

In demand

However, the labour market for nurses has changed dramatically over the past three years, with newly-qualified nurses often in great demand. Trusts may now have to offer a permanent position to keep them engaged; a nurse who is only offered a bank post may quickly leave for a post elsewhere.

Safe Staffing Alliance chair Susan Osborne believes that a number of trusts are reviewing recruitment. When she was a director of nursing she used to over-recruit, she says, placing a recruit in the nursing pool until a job came up.

Picture credit: iStock

With so many trusts reporting that they are not at safe staffing levels, getting vacancies filled quickly is important, she adds. ‘There’s always somewhere you can place a nurse. It is about them getting some good experience out of it as well.’

Over-recruitment works best for large trusts, which will have many nurse vacancies coming up within a short time, suggests RCN head of policy and international affairs Howard Catton. It may be less appropriate for smaller organisations or very specialist settings. He says it might make it harder for community and primary care to compete against well-regarded teaching trusts – but he is not overly concerned.

‘All trusts are trying to stay ahead of the curve – they know this is the most competitive labour market they have been in for a long time. We are starting to see more forward thinking and planning. I don’t think over-recruitment is as risky as some might suggest. I think it’s shrewd,’ says Mr Catton.

Workforce expert James Buchan of Queen Margaret University in Edinburgh adds: ‘In competitive labour markets any HR practice that gives a trust an edge and makes it more attractive is worth considering. A trust that offers greater certainty of a permanent post is going to be top of the list as far as recently qualified nurses are concerned’.

Over-recruitment: A ‘sensible strategy’ that ‘makes sense’

University Hospitals Birmingham NHS Foundation Trust is the employer of choice for many nurses graduating from the area’s universities, and its over-recruitment policy means that it does not let good candidates get away.

They will be appointed under the normal pay and conditions and will be used to allow wards to be slightly over-establishment, with an extra trained nurse available on some shifts – without the additional recruit being made to feel supernumerary. The ward staff will often sort out rotas among themselves – so if one is needed to cover on another ward, there will be a discussion and it won’t always be the same person who moves across.

Chief executive Dame Julie Moore, who has a nursing background, says that the policy was driven by quality concerns. If there were more than two agency nurses on a ward, quality indicators started to slip. Replacing a nurse who left could take several months, with the chance that an agency nurse would be needed for much of this time.

The change in policy came in several years ago. The trust’s finance team recorded savings of £850,000 at the end of the first year.

‘It just makes sense. At times we are over-establishment but the wards are then expected to cover for each other if there is someone on sick leave,’ says Dame Julie.

‘Having these extra people meant we were able to open extra wards very quickly over winter with very high-quality care.

Greater productivity

‘It was questioned by the Care Quality Commission, which clearly did not understand these things – how was it an efficient use of money? Actually, it saves money.’

Agency may not have been trained on equipment or be familiar with processes, so having cover internally allows for greater productivity. Drug rounds is one area where a permanent member of staff is likely to be used rather than an agency nurse.

Over-recruitment mostly applies to band 5 nurses but does occur among other grades as well. The trust also has a bank system and tries to use nurses from the bank to cover additional shifts – leading to a relatively low agency spend.

RCN regional director in the West Midlands Paul Vaughan says: ‘In terms of the turnover of the nursing workforce, I would say it is a sensible strategy.’

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