Supporting Gen Y and Z: what it takes to retain newly qualified nurses
How a team of senior nurses is helping newer recruits thrive – and improving retention
How a team of senior nurses is helping newer recruits thrive – and improving retention
- Newly qualified nurses at Barking, Havering and Redbridge University Hospitals NHS Trust can access support from the senior intern team, a group of experienced nurses
- The programme combines coaching and pastoral support, and has boosted recruitment and retention rates at the trust
- The team uses the broad characteristics of each generation to predict the support that new nurses may need, as well as those new to managerial posts
Before introducing its senior intern programme in 2017, Barking, Havering and Redbridge University Hospitals NHS Trust was losing a quarter of newly qualified nurses (NQNs) within a year of recruiting them.
The programme, which started with senior interns Beverley Sawer, Anne Honey and Maxine Ainah, aims to prevent new recruits becoming disillusioned and demotivated, by combining coaching and pastoral support with a deeper understanding of what today’s new nurses need to settle into the profession.
‘Most of our newly qualified nurses are millennials and what we have found is they want your time. We have an open door policy for them to come to see us and they pour in’
Beverley Sawer, senior intern, Barking, Havering and Redbridge University Hospitals NHS Trust
The trust’s retention rates have since improved dramatically; in the year after the team’s introduction, the attrition rate among NQNs fell to 7%.
An unlikely source of inspiration for the senior intern programme
Chief nurse Kathryn Halford knew how vulnerable new nurses could feel, but she got the idea of enlisting experienced, older, nurses to support them from an unusual source – a Robert De Niro film. In the 2015 comedy The Intern, Anne Hathaway plays a young businesswoman who benefits from the wisdom of De Niro's character, a 70-year-old widower who comes out of retirement to be a senior ‘intern’ at her start-up company.
Inspired by the idea, Ms Halford secured funding from Health Education England (HEE) and recruited a small, dedicated team of experienced nurses nearing retirement to work as mentors and coaches. The senior interns have experience across adult and children’s nursing and midwifery.
Team lead Ms Sawer says the role is so varied and no two days are the same. ‘We have regular meetings with all new staff. We could be working one to one with a newly recruited band 5, working on drug rounds or helping with paperwork.’
The team also supports nurses with difficulties outside their professional role. ‘We have arranged changes in accommodation and prevented cars being repossessed,’ says Ms Sawer. ‘We listen and help nurses access the right people to sort out their issues.
‘Most of our NQNs are millennials and what we have found is they want your time. We have an open door policy for them to come to see us and they pour in.’
The senior interns are highly visible on the wards and cover both hospital sites at the trust. They work across all shifts including weekends and nights. New nurses are given yellow name badges to differentiate them from long-standing members of staff, which highlights that they need more time and support from team members.
- RELATED: Newly qualified nurse badges may encourage patience – but shouldn’t we all be more gentle with each other anyway?
What nurses early in their career say is important to them
- Clear, structured career development and progression pathways
- Care and support (personal and professional) from leaders and teams
- Team spirit – to be accepted, valued and appreciated
- Feedback, guidance and developmental support
- Flexibility to achieve work-life balance
- To be supported and enabled to meet the expectations of patients and the public and have the resources to deliver high quality care
- To be engaged in meaningful work – to make a difference
Source: NHS Employers
Initial scepticism from senior staff gave way to support
The team had to set up and develop its own processes and database, as well as overcome initial concern and scepticism from existing staff. ‘Senior nurses saw our ward visits as an intrusion,’ says Ms Sawer. ‘They were cautious at first, but within six weeks it had turned around and they were calling us to help sort out their issues.’
‘For the first time, four generations of nurses are now working effectively together,’ says Ms Sawer. She explains that the team’s approach is informed by pertinent analysis of the needs of different generations.
The 2015 HEE report Mind the Gap, commissioned in response to concerns about the high turnover rate for band 5 nurses and midwives, highlights the ‘generational differences in values, expectations, perceptions and motivations’ that are ‘highly relevant’ to how engaged nursing staff are – and how likely they are to stay in the workforce.
Analysing the needs of the different generations
The report points to research showing, for example, that millennials or Generation Y (born between 1980 and 1994) place great value on being supported and appreciated. It cites a large scale study by PricewaterhouseCoopers in 2013 that found Generation Y individuals are more likely to leave an organisation due to a lack of support, appreciation and flexibility than for any other reason. The youngest nurses in the workforce, Generation Z (born 1995 onwards) expect to be listened to and acknowledged, and set a high store on personal freedom.
Mind the Gap warns that broad descriptions of any generation are stereotypes and should be considered ‘a general guide to understanding only’. But senior intern team lead Ms Sawer says that ‘generational generalisations’ often turn out to be true: ‘You know before you see someone how they are likely to behave.’
What does your nursing generation want?
Baby boomer (born 1946-1964)
- This group makes up 25% of the NHS workforce
- Motivated, hardworking and team-orientated
- Believes in equality, wants respect
- Driven and experienced, wants to make a difference
- Has high expectations and wants recognition for their achievements
- Takes part in the development of technology, or denies its importance
Generation X (born 1965-1979)
- Makes up 40% of the NHS workforce
- Likes structure and direction, they are practical and independent
- Works smarter not harder; work-life balance is important
- Has high expectations and can be cynical and sceptical
- Doesn’t want to be micromanaged; they are problem solvers
- Can innovate and tends to adapt well to change
- Technology literate but doesn’t 'live' it
Generation Y (born 1980-1994)
- 35% of the NHS workforce
- Ambitious, with high career expectations
- Expects support to achieve
- Prefers flexibility, work-life balance is key
- Will change jobs if their needs are not met
- Wants to work with you, not for you
- Needs mentoring, coaching and reassurance
- Productive and efficient but needs to be given the tools
- Friends are important – needs to be liked
- Needs a sense of purpose and wants to contribute to the greater good
Generation Z (born 1995-now)
- Small part of the NHS workforce but growing
- Expects to be listened to and acknowledged, craves attention
- Keeps up to date with technology – a digital multitasker
- Wants everything connected and can be frustrated by manual methods of working
- Connectivity is extremely important
- Does not want to be ‘force fit’ into a traditional work environment
- Personal freedom is essential
- Expects to be informed and responses listened and responded to
- Will spend more time job hunting and will change jobs more frequently
- Less well-off than parents and struggles with independent household management
*These broad descriptions are only a general guide to understanding the general characteristics of each generation
Source: NHS Employers
Retention and recruitment of nurses is improving
After six months of the senior interns being in post, the NQNs took part in a survey to evaluate the team. It found 97% were happy with the support they received.
It also appears to be attracting nurses to the trust; as well as helping with retention, recruitment has dramatically increased. In 2017, 62 nurses joined the trust, but after one year of the senior intern programme this increased to more than 160.
‘You need to be able to talk to someone other than your ward manager for advice or help. A senior intern team should be available in every hospital’
Fatimah Jah, newly qualified nurse, Queen’s Hospital, Romford
‘I am proud that we have sustained our retention improvements despite these greater numbers,’ says Ms Sawer. ‘It makes for a better experience for patients as they have continuity of care. Fewer nurses are leaving and so wards have more stable staffing and better care as a result.’
How to retain newly qualified nurses
Tips from Beverley Sawer and the senior intern team:
- Consider the support needed by different generations ‘A large number of our newly qualified nurses (NQNs) are from Generations Y and Z and their expectations and needs will be different from your own’
- Be open-minded – you never know what you are going to come across ‘The NQNs that we see all have their own different issues. We have supported nurses through both professional and pastoral issues, such as escaping domestic violence and moving house, as well as working with them to build their confidence in their new roles’
- Get to know how every ward or department works The challenges in critical care and care of older people are very different, but very real for these new nurses
- Understand that NQNs starting in emergency and critical care may be overwhelmed ‘We encourage these nurses to be honest with us – we can then work quickly to move them to a more suitable area. We have prevented numerous nurses from leaving our trust by being able to recognise this and step in quickly’
- Work with colleagues to identify when staff are finding their work challenging ‘I’ve had NQNs maintain that all is well, but their ward manager tells us that they are struggling. We can then work with these staff to help them overcome their problems’
- Be non-judgemental, friendly and show that you are there to help ‘You need to make sure they continue to come back to you’
- It’s not about knowing all of the answers, but rather using the resources available ‘Because the senior intern team are all experienced nurses and midwives, we know who or where we can go quickly to get a particular problem sorted’
Support nurses for nurses who are new to managerial roles
The team’s remit includes 35 new band 7 nurses. ‘We support them with their managerial responsibilities,’ says Ms Sawer. ‘They have the clinical skills they need but are put in management positions earlier than they used to be and so have less experience.
‘And a ward manager remains one of the most difficult jobs in the trust. I had one ward manager who was struggling to deal with the Christmas rota since their promotion as they were trying to please everyone. They needed support to make unpopular decisions.’
‘We have arranged changes in accommodation and prevented cars being repossessed. We listen and help nurses access the right people to sort out their issues’
Due to demand, the team now also supports allied health professionals and junior doctors. ‘The service has been swamped by professionals who need support,’ says Ms Sawer.
Someone to speak to when you need suport or advice
Fatimah Jah came to Queen’s Hospital in Romford, which is part of the trust, as an NQN after training at a different trust. She says: ‘Starting my career at Queen’s was challenging, but the support from the senior intern team gave me the confidence that I needed. I knew I was not alone and there were people I could speak to.
‘Being newly qualified or even moving to a different hospital, you need to be able to talk to someone other than your ward manager for advice or help. A senior intern team should be available in every hospital.’
Everles Banda agrees, adding: ‘I wanted support when I joined as I was new to the trust and was allocated to a different department. It was a huge transition. But Beverley has been very supportive and the team has really helped me settle in. I am so grateful to them.’
So what makes a good senior intern?
Ms Sawer says you need to be open minded and non-judgemental, honest and able to listen to people’s problems so you really understand them. You also need to be able to find the right resources to support people in need. You need to build trusting relationships so people come back when they need to.
It sounds like she is describing the essential characteristics of a nurse. Ms Sawer agrees. ‘It is the same with our patients,’ she adds. ‘We listen and then we act.’
Elaine Cole is RCNi special projects editor