How to attract and retain brilliant nurses
A trust has devised a fellowship to boost the careers of talented staff
A trust has devised a fellowship to boost the careers of talented staff
- A 15-month fellowship programme awards a diploma in leadership and management
- It offers nurses at an early stage in their career a chance to shadow senior leaders, including the chief nurse
- The programme is followed by accelerated development with year-long support
Attracting enough nurses and then doing enough to ensure they stay are among the toughest tests for managers and leaders at hospitals and services around the country.
One trust is trying to tackle its nurse vacancy challenge with a chief nurse fellowship that it awards to talented newly qualified recruits or staff at an early stage in their career.
In June 2019, Gloucestershire Hospitals NHS Foundation Trust’s nurse vacancy rate was 9.41%, equivalent to 254 posts. Staff turnover was 17.4%, compared with an average of 21.8% for large acute trusts.
‘In comparison with other acute trusts we’re quite good,’ says the trust's associate director for education and development, Dee Gibson-Wain. ‘But we still have too many vacancies.
‘We wanted to attract high-flyers to come and wow us with their ideas for improving services and their passion for clinical care,’ says Ms Gibson-Wain, who leads the programme.
But there were challenges from the outset. ‘When we took it to ward managers’ meetings, there was a loud noise about why it was only being offered to external people,’ she says. ‘They felt there were some brilliant people already working in our service who would also like the opportunity.’
‘It’s worth it because those people who are doing the programme are fabulous’
Dee Gibson-Wain, associate director for education and development at Gloucestershire Hospitals NHS Foundation Trust
It was agreed that the offer would be extended to existing staff, despite the risk that the new approach would add to pressures, with staff having to be released from clinical duties for at least one day each week.
‘That’s a challenge for the wards,’ Ms Gibson-Wain admits. ‘There’s a downside. But would we change it? No. It’s worth it because those people who are doing the programme are fabulous.’
The programme is now into its second cohort. It is advertised externally but all the places so far have been filled by applicants who were already working at the trust. ‘But two people have told us they came here because of the fellowship, applying as soon as we advertised. It does work as an attraction,’ says Ms Gibson-Wain.
‘Once you start doing it you’ll be surprised’
Working as a theatre nurse but wanting to do something different, Nur-in Mohammad spotted an internal ad for the fellowship programme. ‘It’s developed skills in me that I thought I wouldn’t be able to do,’ says Ms Mohammad. ‘Something might be outside your comfort zone, but once you start doing it you’ll be surprised.’
That experience began at the outset, when she was asked to pitch a quality improvement project to the panel after being shortlisted. ‘It wasn’t something I’d expected, but I came up with an idea and presented it,’ says Ms Mohammad.
Her idea won her a place in the fellowship’s first cohort, alongside two other adult nursing colleagues. They are due to complete the programme in December.
Ms Mohammad describes herself as a poor communicator, but the course has helped her overcome her natural shyness when speaking publicly and chairing meetings. ‘I’m quite an introverted person, so I’m not good at making friends or taking the initiative.’
‘Without the fellowship, I don’t think I’d have had the confidence to apply'
She took up a new post as a professional education practitioner at the trust in November. ‘Without the fellowship, I don’t think I’d have had the confidence to apply for the role,’ she says.
Over the course of the programme she has been able to pursue her quality improvement project, which involves reducing surgical site infections (SSIs) by warming patients before they go to theatre, helping to reduce risks.
This challenged her to use new skills. ‘I needed stakeholders to become involved, so I had to get in touch with people I barely knew. Many are in high managerial positions and as a band 5 nurse, I’d never encountered them before.’
'Go out there and ask what you can do to improve yourself'
Her initiative, which will continue after she graduates, hopefully becoming part of a trust-wide policy, also won an award from OneTogether, a partnership of professional organisations with an interest in the prevention of SSIs, which was presented in November.
‘If it wasn’t for the fellowship I wouldn’t be able to do this,’ she says. ‘After you’re qualified, you can feel a bit stuck wondering what’s next, but my advice is go out there and ask what you can do to improve yourself. Nursing is dynamic and we never stop learning.’
The scheme is the brainchild of chief nurse Steve Hams, who joined the organisation in October 2017. He was inspired by what he’d heard about a similar concept developed by Nottingham University Hospitals NHS Trust.
‘It felt like the right thing to do to raise the profile of nursing here,’ says Mr Hams. ‘We assumed it would attract people, particularly into clinical specialties that are harder to fill, such as elderly care.
‘A retention programme that has gone from strength to strength’
‘But in reality that didn’t quite happen. Now we see it as a retention programme, which has gone from strength to strength.’
As the programme is in his job title, he’s involved in what happens, taking part in learning sets and career development. Participants can also shadow him.
‘People bring different perspectives, sometimes asking what they think is a silly question, but there is no such thing,’ says Mr Hams. One of the fellows worked with him to recruit a senior nurse.
‘Her insights were incredible. It gave a totally different perspective from the point of view of what it would feel like, as a band 5 nurse, to be managed by this person.’
Among the aspects that set this programme apart is the leadership diploma, delivered by external organisation ILM, which provides academic credits. ‘As a new chief nurse, I recognised there had been a number of years when the organisation hadn’t developed nursing leaders,’ says Mr Hams.
‘Nurses who are ambitious for themselves will be ambitious for their patients’
Steve Hams, chief nurse
‘It meant that when posts were becoming available, they weren’t going to internal candidates because they weren’t ready. I wanted to develop a legacy.’
Crucially, he believes, the fellowship has encouraged aspiration. ‘In nursing, I think there can be a sense of embarrassment about being ambitious for your career,’ says Mr Hams. ‘But nurses who are ambitious for themselves will be ambitious for their patients.
‘We need to develop professional pride and a professional voice within the organisation that clearly articulates the contribution that nurses, midwives and allied healthcare professionals bring to great quality care.’
‘This is equipping me to go for that next step’
Although she is still in the early stages of her nursing career, the fellowship programme has inspired Charlotte Jakab-Hall to aim high.
‘I feel I could become more senior or a leader of some kind, and this is equipping me to go for that next step,’ says Ms Jakab-Hall, who qualified in January 2018 and is now working in the emergency department. ‘I aspire to be the best leader in nursing I can be, to influence.’
She joined the fellowship’s second cohort in June as one of 11 staff who include midwives and allied healthcare professionals. ‘The programme is what’s kept me in the trust,’ she says. ‘I’m getting an accelerated opportunity to develop my leadership skills.’
Learning more about management has been key to her experience so far. ‘I feel we covered leadership well at university and I felt ready for that aspect – for me, you’re a leader from the moment you become a student nurse.
'I didn’t know about management, including managing people'
‘But I didn’t know about management, including managing people. This is giving me that exposure, and it’s a turning point in my capability.’
Another pivotal moment was shadowing deputy chief nursing officer for England Mark Radford for a day in October, at her request. ‘It was a priceless and insightful experience,’ says Ms Jakab-Hall. ‘I thought I knew a lot about what the role entailed, but a lived experience is totally different. It’s opened my eyes to what I need to focus on if I want to set my own path.’
Before joining the programme she worked with a colleague to set up Gloucestershire Hospitals staff transition and support network for newly qualified professionals, known as GloStars.
'I need to do all I can to promote nursing as a great career'
‘After preceptorship we felt something was missing and staff needed a bit extra, so we worked closely with the education team to build it,’ says Ms Jakab-Hall. ‘It’s there to promote staying and flourishing within the trust.’
They hope to use it as the basis for a research project, with backing from the fellowship programme. ‘I’m a very motivated and driven person and I want to try to make things the best they can be,’ she says.
‘We face many challenges in healthcare, not just in the UK but globally, and they cast a shadow over the nursing profession. I need to do all I can to promote it as a great career and tell people not to be put off.’
What nurses on the fellowship can expect
The 15-month programme includes:
- A diagnostic welcome session provided in-house, which includes personality preference profiling
- Completing a quality improvement programme through the trust’s Gloucestershire Safety and Quality Improvement Academy, established in June 2015
- Leadership development, with a level 3 diploma in leadership and management. As it is a formal apprenticeship, fellows have protected learning time of about one day each week
- Regular facilitated action learning sets
- Leadership coaching with a qualified coach
- Opportunities for shadowing senior leaders, including the trust’s chief nurse
- Fellowship project meetings to help shape the direction of future programmes
- Automatic enrolment onto the trust’s accelerated development pool at the end of the programme, with a further year of support
Lynne Pearce is a health journalist
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