Analysis

EXCLUSIVE: Nurse director turnover still worryingly high, research reveals

New research shows that more than half of nurse directors in the UK started their job in 2015 or later, adding to concerns about a continued high turnover of nurses at executive level.

New research shows that more than half of nurse directors in the UK started their job in 2015 or later, adding to concerns about a continued high turnover of nurses at executive level

director
The short shelf life of top management in NHS trusts is causing concern.
 Picture: Daniel Mitchell

Nursing Standard research reveals half of chief nurses in the UK have been in post for three years or less, prompting concern about high turnover in senior roles.

More than a third (36%) took up their positions in the past two years, while 17% started in the past eight months.

An analysis of 225 trusts in England, five health and social care trusts in Northern Ireland, 14 health boards in Scotland and seven health boards in Wales found that 137 chief nurses (55%) had taken up their posts within the past three years, of whom 42 took up their positions this year.

‘We need to be confident that we are not losing vital experience at a time when nursing in the NHS needs effective leadership’

Jim Buchan, workforce expert

The only exception to this theme was Northern Ireland, where four of the five health and social care trusts have had chief nurses in post since at least 2013, with one joining last year.

These results reflect similar findings in previous years, meaning that rates have not improved.

RCN Executive Nurse Network lead Christine McKenzie says: ‘An effective, well-led health and social care system is dependent on having strong clinical leadership at board level, with serious demands placed on executive nurses.

34 men

Of the 251 director of nursing posts in the UK, 34 (13.5%) are held by men

‘The evidence suggests that turnover is high, and this makes managing and navigating a complex healthcare environment even more challenging.’

Workforce expert Jim Buchan, professor in the faculty of health and social sciences at Queen Margaret University near Edinburgh, says the relatively short ‘shelf life’ of top management in NHS trusts has raised concern in the health service.

buchan
Jim Buchan

Professor Buchan says: ‘It is clear that we need a balance between continuity and experience on one hand and the scope to inject new blood and energy on the other.

‘The fact that half of these senior nurses have been in post for three years or less suggests a relatively rapid turnover.

‘We need to be confident that we are not losing vital experience at a time when nursing in the NHS needs effective leadership.’

Trying to survive

Norfolk Community Health and Care NHS Trust director of nursing, quality and operations Anna Morgan, who has been in post since 2010, is not surprised by the rate of turnover.

Ms Morgan says: ‘This can be a very difficult job. Any executive roles in the NHS have been particularly challenging in recent years, with finance, performance and expectations.

morgan
Anna Morgan

‘I certainly know a lot of executive colleagues can bounce around every two years to try and survive.’

Ms Morgan says good continuity at executive level relies on the culture and support of the organisation, as well as the support that nurse directors have in place for themselves.

‘Your own resilience plan or strategy can help you stay the course,’ says Ms Morgan, who also mentors two aspiring nurse directors.

16 interim

Around 16 of the director of nursing posts (6.7%) are held on an interim basis

Hounslow and Richmond Community Healthcare NHS Trust interim director of nursing and non-medical professionals Donna Lamb is on a six-month secondment in her organisation.

‘I didn’t realise how different the director of nursing job was to the deputy job,’ she says. ‘It’s far more about the broader agenda of the organisation and how the nursing and clinical perspective fits into that.

‘It’s about taking a longer-term view, balancing the immediate issues around quality of care and supporting the workforce with a view of what nursing should look like in the future.

‘The job is very demanding, which is why it is really important if applying for a director of nursing job you do research into the organisation you are applying to.

‘It has to be the right organisation and culture for you,’ she adds.

Ms Lamb, who has been a deputy nurse director for a total of six years in two different organisations, is also a Florence Nightingale scholar and says taking opportunities for professional development is vital preparation for a step up to the nursing director role.

Quitting at 55

NHS Improvement executive director of nursing Ruth May highlighted concerns last year that directors of nursing opting for early retirement at age 55 was exacerbating turnover rates.

‘If there are leadership or strategic programmes out there, talk to your manager and get involved. You need a broader outlook and to know what is going on in the broader health economy.’

NHS Improvement director of nursing for professional leadership Jacqueline McKenna argues that turnover is a complicated issue and does not necessarily mean talent is being lost from the NHS.

‘Directors of nursing may move on to a more complex organisation, become chief executives at trusts or take on posts in national organisations to help transform care in the NHS,' she says.

When they move on, opportunities open up for talented aspiring nurse leaders to step in and progress their careers.

‘It is important that we continue to support the existing cohort of nurse leaders so that their skills and experience can continue to benefit staff and patients in the NHS.’

‘Making sure that we are doing everything we can to ensure the next generation of leaders in nursing have the support they need is a priority’

Jacqueline McKenna, NHS Improvement director of nursing for professional leadership

Dr McKenna’s organisation has a new, three-year programme supporting NHS trusts to better retain staff.

‘Helping to ease some of the pressure that directors of nursing are under by improving retention rates across the wider workforce is part of the rationale behind our new programme.

‘Directors of nursing have a tough but vital job to do, and making sure that we are doing everything we can to ensure the next generation of leaders in nursing have the support they need is a priority for us.’

Dual roles add to responsibilities

Out of 251 director of nursing posts in the UK, 124 were held by people with titles suggesting responsibility for additional areas.

This included those with a separate title, such as deputy chief executive, director of infection prevention and control, or chief operating officer.

Other titles included nursing and other areas of responsibility such as:

  • Governance.
  • Patient services/experience.
  • Quality standards.
  • Performance.
  • Elective care.

University of Birmingham Health Services Management Centre senior fellow Yvonne Sawbridge has reservations about this.

‘Holding a dual role reduces the amount of time, energy and effort these directors have to expend on leading the largest professional workforce in the NHS.

‘It also demonstrates how little the complexities of caring are understood.’


 

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