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Moving up while staying put: a clear career pathway retains great staff while attracting new recruits

One hospital trust’s imaginative approach to nurse recruitment and retention taps the potential of long-serving as well as new nursing staff 
illustration shows nurses climbing up the side of a mountain to reach the summit

One hospital trusts approach to nurse recruitment and retention taps the potential of long-serving as well as new nursing staff

  • Workforce pressures can be eased by promoting from within and realising the worth of long-serving staff
  • When healthcare employers face recruitment barriers outside their control they need to work extra hard to attract staff
  • Tips for how to recruit and retain the best nursing staff

Tackling nurse recruitment and retention issues is a priority for many employers, but one group of acute hospitals is doing more than looking at the immediate challenges it is developing a career pathway or 'future workforce programme' to help it keep staff in the long term.

Barking, Havering and Redbridge University Hospitals Trust (BHR) runs two hospitals located where the outskirts of east London meet Essex.

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One hospital trust’s approach to nurse recruitment and retention taps the potential of long-serving as well as new nursing staff 

  • Workforce pressures can be eased by promoting from within and realising the worth of long-serving staff
  • When healthcare employers face recruitment barriers outside their control they need to work extra hard to attract staff
  • Tips for how to recruit and retain the best nursing staff

Picture: iStock

Tackling nurse recruitment and retention issues is a priority for many employers, but one group of acute hospitals is doing more than looking at the immediate challenges – it is developing a career pathway or 'future workforce programme' to help it keep staff in the long term.

Barking, Havering and Redbridge University Hospitals Trust (BHR) runs two hospitals located where the outskirts of east London meet Essex. It employs around 1,800 nurses and 325 midwives, as well as almost 900 healthcare assistants and support staff.

Trust’s location can make staff recruitment more difficult

Geographically, it is in an awkward position for attracting staff, as it is on London's outer eastern fringes, says Kenye Karemo, deputy to the chief nurse for workforce development and education.

Many nurses would come but soon move on, she says, often looking to Barts Health Trust – a big central and east London hospital employer – for their next job. At the same time, the trust had a number of healthcare assistants who were rooted in their local community but had little chance of progressing in their careers.

‘We use a career map to think about “what next?”. Where can they look to be in four or five years’ time? Retention is about how we make people feel at work’

Kenye Karemo, deputy to the chief nurse for workforce development and education, Barking, Havering and Redbridge University Hospitals Trust

Ms Karemo recognised that offering staff not just a first job and a route into nursing, but a career path that allowed them to develop their skills, take on new roles, and showed them a variety of ways they could develop, would help recruitment and, importantly, retention too. 


Kenye Karemo

A healthcare workforce strategy rooted in professional development

The trust's future workforce programme maps out the career pathways available to staff, and also aims to offer the trust a sustainable nursing, midwifery and allied health professions workforce.  

An underlying principle is that the trust should try to develop its existing workforce where possible, with a focus on allowing staff to progress through the ranks. This means support workers should have a chance to become nurses, and band five nurses can envisage becoming advanced clinical practitioners without having to leave the trust.

In some ways, BHR has many attractions to nurses. It is big enough to offer a wide range of specialties and opportunities; there is no need for nurses to travel into central London to get specialist experience, for example, because the trust has numerous specialties. And it is big enough to offer promotion opportunities.


Nursing associates – realising the full potential of the role

Ms Karemo felt the nursing associate role, of which the trust was an early adopter, had enormous potential. Staff needed an explanation of how it fitted in to the nursing team and what it could lead to.

The catchment area covered by BHR has a population with relatively low educational achievement, meaning that many people who would have liked to train as nurses did not have the qualifications needed for admission to a degree course. Typically, they would end up as healthcare assistants, often doing a great job but lacking opportunity to progress.

In 2017, the trust selected 56 healthcare assistants to become nursing associates. Of these, 51 completed the foundation degree and last year, 20 began a bridging programme to become nurses. In 2018, the trust also introduced a degree nurse apprentice programme with a cohort of 15 students. 

Underpinning skills and experience with knowledge

Ms Karemo says the nursing associates typically have years of experience in healthcare (which is not usually the case with nurse apprentices) and good interpersonal skills so one of the aims of their training was to encourage them to analyse what they were already doing and gain underpinning knowledge.

‘We want to work as a dating site for careers. If you want to be a diabetes nurse you should be able to connect with our diabetes nurses to have a chat’ 

Kenye Keremo

And demonstrating this was key, says Ms Karemo. ‘They were able to show their matrons some of the skills and knowledge they had, boosting their confidence – they know a lot more than people give them credit for.’

She adds: ‘It has taken senior nurses a while to understand the role, and where it fits in.’

One positive outcome has been that nursing associates are now working in areas where it was originally thought they would not be able to, such as A&E and assessment units. Nursing associates are there ‘not to replace nurses but to assist them,’ she says.


Lateef Jimoh

From support worker to nurse apprentice and beyond

Like many of the new recruits to Barking, Redbridge and Havering University Hospitals Trust, Lateef Jimoh has come to nursing through a circuitous route.

After leaving school, he worked in jobs outside the health service for a while, and then in 2015, started working as a health support worker in the emergency department at Redbridge.

Ambition to do more than a support role allows

‘I felt I had a bit of an understanding of the clinical stuff, whether the patient was ill or not,’ he says. However, his role obviously restricted what he could do and he wanted to be able to do more.

But Mr Jimoh has been able to move forward, first by becoming a nursing associate, and now a nurse apprentice.

‘I have a passion for the patient and they need to be able to trust us in what we do,’ he says. The training is giving him experience in different settings, such as the community, which he had not considered before.

He now spends part of the week working as a nursing associate and two days a week as an apprentice nurse, which includes some academic study.  

In the long term, he would be interested in a number of areas, such as vascular and orthopaedics. However, his dream job is advanced nurse practitioner – something the career maps the trust has developed could help him achieve.  

 

Progession opportunities for long-serving staff

For other staff, especially those who have been at the trust for some time, it was necessary to show them they had the potential to progress there too. ‘It was about giving people alternative ways of broadening their skill sets,’ Ms Karemo says.

‘It is about getting people to talk, not just about jobs but about their career with BHR. Most people here are local – they live within a few miles and have families here.

‘We use a career map to think about “what next?”. Where can they look to be in four or five years’ time? Retention is about how we make people feel at work.’

For 30 nurses, that has meant the opportunity to progress through a band six development programme, which was established last year, with a focus on those who are aiming to get to band seven roles. Others have been on a practice development summer school with the Foundation of Nursing Studies.

The trust has also strengthened the trust’s preceptorship offering to ensure newly registered practitioners get consistent support at this vital point and their supervisors are supported through a development programme.

Our interactive guide to all routes into nursing

Promoting awareness of opportunities available

One big challenge has been making sure staff know what opportunities are open to them. Case studies were used in internal communications to illustrate individuals' career paths, and how their skills and experience had helped them along the way.

‘What we have started doing is getting people to talk about their roles so people understand if you want to be a specialist nurse in diabetes, there are certain things you have to do. We almost want to work as a dating site for careers. If you want to be a diabetes nurse you should be able to connect with our diabetes nurses in the hospital to have a chat,’ she adds.

This work is now focusing on divisions, with attempts to map out, for example, what a nurse would need to do to become a surgical matron.

Nurse staffing solutions: top tips

  • Don’t overlook the staff your trust already has Many of your staffing solutions may already be working on your ward
  • Developing a career map gives you a useful visual tool to illustrate how nurses can progress and what they need to achieve this
  • Help nurses who feel ‘stuck’ and unable to progress Offering them further opportunities is vital if they are not to leave to work elsewhere
  • Telling nurses’ stories is useful Explaning how staff reached their current role can help others understand what they need to do to progress – as can putting nurses in touch with those doing the jobs they aspire to

 

Evaluation of the long-term outcomes for staff and the trust

Of course, the approach is not a workforce panacea. The trust's board still rates getting adequate numbers of the appropriate staff in place as one of the biggest risks on its risk register. It is also recruiting cohorts of nurses from the Philippines.

And at this stage it is hard to show that the project has had a direct impact on turnover and vacancies – although both seem to be declining. Anecdotally, there has been a positive impact, says Ms Karemo, but there will be a need to show what the long-term outcomes are – including staff satisfaction.

However, she says there is much that could be replicated elsewhere – every hospital should be able to explain to nurses and other staff what their career choices could be, what the opportunities in the organisation will be, and help them develop the career they want.

Alison Moore is a health journalist

 

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