Analysis

Want to quit your job? Here’s how the NHS is trying to change your mind

Retention programme has 800 success stories so far, but can it make a real difference?

A national retention programme has 800 success stories so far, but can it make a real difference?

  • Programme is being rolled out to all trusts across England
  • Trusts are helped to develop retention improvement plans, offering support for career progression, changing specialty and work-life balance
  • Critics say the programme only targets one element of nursing shortfall crisis

Picture: iStock

Ever thought of leaving your job, or even the NHS altogether?

A programme being rolled out across England aims to convince nurses to stay.

About 800 nurses who might have left have instead stayed in the NHS thanks to the retention programme, according to NHS England.

The scheme, which has so been implemented at 145 trusts in four waves, is being extended to all trusts in England.

Under the programme, run by NHS Improvement and NHS Employers, trusts are supported intensively for three months to develop retention improvement plans, which must aim to reduce turnover rates within 12 months.

145

trusts so far have joined the programme

(Source: NHS England)

Plans have included initiatives to improve inductions, extend preceptorships, increase flexible working opportunities and make it easier to move specialty within an organisation.

Staff turnover rates have fallen since it began

Since the national retention programme began in the summer of 2017, national nursing staff turnover rates have fallen from 12.5% to 11.9%, and mental health clinical staff turnover rates have dropped by one percentage point to 13.4%.

Fourteen of the 35 trusts in the first wave saw an improvement of more than two percentage points in turnover in the 15 months after the programme began, according to NHS England.

While NHS England has not set out exactly how it calculated that 800 nurses had been persuaded to stay, there's no doubt that any improvement is to be welcomed.

‘I was happy in my job but I wanted to branch out’

Louise Karagoz, who worked as a band 6 school nurse at Guy’s and St Thomas’ NHS Foundation Trust, used a secondment opportunity to try out a new post as deputy clinical nurse specialist in infection control.
Louise Karagoz

Louise Karagoz, who worked as a band 6 school nurse at Guy’s and St Thomas’ NHS Foundation Trust, used a secondment opportunity to try out a new post as deputy clinical nurse specialist in infection control.

Although she was enjoying her post in specialist community public health nursing, after moving to band 6 she felt her chances to try out different roles were diminishing.

‘I think as you follow a pathway and become more specialised it can become quite difficult to change to another specialty. As a band 5 you can move anywhere, but as a band 6 it becomes more difficult.’

Internal transfers and secondments

In a chance meeting with the retention nursing team she learned about internal transfers and secondments. She moved to her new role a year ago, and it has since become permanent.

‘While I was happy in my job, I wanted to branch out. The process was absolutely painless and the only awkward bit really was discussing it with my manager,’ she says. ‘I wanted to stay with the trust as they listen to and look after their staff.’

 

‘Only half say the NHS is flexible enough as an employer’

The programme was begun by the then health secretary Jeremy Hunt after turnover rates had risen for five consecutive years.

The NHS is in the grip of a staff shortage that has led to 40,000 nursing vacancies in England alone. This means keeping hold of skilled and experienced staff is critical for employers.

‘It’s right that local NHS employers are now themselves increasingly taking common-sense action to support, develop and retain their staff’

Simon Stevens, NHS England chief executive

NHS England chief executive Simon Stevens announced the expansion of the programme in July, saying: ‘Three quarters of our staff are women but only half say the NHS is flexible enough as an employer.

‘So as well as a need for action on areas such as pensions, it’s right that local NHS employers are now themselves increasingly taking common-sense action to support, develop and retain their staff.’

Essex Partnership University NHS Foundation Trust has put a big focus on flexible working to meet the needs of its staff as part of the programme.

The trust’s head of staff engagement, Jo Debenham, says that as pay, pensions and other terms and conditions are the same across all NHS employers, being flexible is an area that can help make the trust more attractive to nurses.


Jo Debenham: ‘Give staff what they want’

‘The most popular request is for shifts at the same time every week’

‘Like most trusts, we have done flexible working for years, but we have had a rethink of our attitude towards it because a lot of managers think they can’t accommodate it in a clinical area.

‘But we were losing staff and they were sitting on bank. So my mantra is to give staff what they want.’

Ms Debenham says the most popular request is for regular shifts at the same time every week, mainly to help with arranging childcare. In the April-June quarter of 2019 the trust granted all flexible working requests. ‘Our agency and bank spend is down,’ Ms Debenham says.

Are you a line manager?

Advice for ward sisters, charge nurses and managers on improving staff retention:

  • Manage flexible working requests to accommodate individuals’ preferences and the needs of the service
  • Support staff to develop their career and gain new skills by offering opportunities to attend training, work with a mentor or take up a rotational post
  • Actively seek, listen to and respond to feedback from the team
  • Build trusting working relationships with team members

Source: NHS Employers – Improving staff retention: a guide for employers 

 

Simpler transfers and career coaching

In London, Guy’s and St Thomas’ NHS Foundation Trust has been looking at reducing staff turnover since 2017.

100%

of flexible working requests made by staff at Essex Partnership University NHS Foundation Trust from April-June 2019 were granted

(Source: Essex Partnership University NHS Foundation Trust)

While the initial rate of 12.6% in the year to April 2017 was not as high as at some other London trusts, exit interviews revealed that 40% of leavers were going for reasons the trust might have been able to prevent. These included career progression, a desire to change specialty, work-life balance, and relationships with line managers.

Retention hotspots were found in community settings, theatres, critical care and acute medicine.

Guy’s and St Thomas’, has introduced a range of changes, including making it simpler to transfer between specialties, introducing career coaching for nurses and further developing flexible working.

‘Stay discussions’, in which managers are encouraged to support staff, have also been rolled out across the trust.

‘Speak to staff about what they want and often they will come up with solutions’

Lynn Demeda, director of workforce programmes at Guy’s and St Thomas’ NHS Foundation Trust

It is early days, but staff turnover at Guy’s and St Thomas’ fell to 12.2% in the year to April 2018, and the preventable leavers rate fell from 40% to 34% in the previous year.

The trust’s director of workforce programmes, Lynn Demeda, says one of the most important aspects has been working with ward sisters, charge nurses and other nursing managers on having open discussions with their team members. This can mean supporting them to work elsewhere in the organisation if they want a change of specialty.

The need to support line managers has also been highlighted by NHS Employers in its Improving Staff Retention guide. This stresses that line managers should be empowered to make decisions about their team, ward or department.

‘When managers are open to having discussions, that is key to unlocking some of the retention issues,’ says Ms Demeda. ‘Speak to staff about what they want and often they will come up with solutions. There is no one-size-fits-all approach to issues such as flexible working, but some managers have done an amazing job at coming up with different rotas.’

Thinking of leaving?

How to change jobs and advance your career:

  • Be prepared to go out of your comfort zone and approach people you don’t know
  • Schedule regular time in your diary to sit down and think about your job, career, options and aspirations
  • Organise a meeting with your line manager to discuss opportunities – this could include taking on more responsibility at work, being involved with training new staff or doing a mentorship qualification
  • Use your one-to-one or appraisal to discuss development opportunities with your manager and agree some goals
  • Embrace networking – attend events, jobs fairs, conferences, RCN congress, local groups and recruitment open days, and create a LinkedIn account and reach out to other healthcare professionals or employers
  • Seek out shadowing opportunities – explain to your manager why shadowing would improve or enhance your practice or knowledge in your current post
  • Arrange an informal visit to a prospective employer to gain insight into a new workplace environment and assess whether you think that environment would be right for you
  • Ask for what you want – you may be turned down or told no, but never let this put you off

Adapted from RCN career progression tips

Book your place at the next RCNi Careers and Jobs Fair

 

Recruiting more nurses goes hand in hand with retention

 ‘Improving retention is key to fixing the leaky bucket, but holding on to current staff doesn’t fill vacancies.’
Jane Ball

The national retention programme has been welcomed by the RCN as ‘encouraging’. 

Southampton University professor of nursing workforce policy Jane Ball agrees it is a useful approach, but says more needs to be done about the shortfall of nurses.

‘Any action to try and improve working lives by listening to what staff want and giving nurses more choice and control is to be welcomed,’ Professor Ball says.

‘Improving retention is key to fixing the leaky bucket, but holding on to current staff doesn’t fill vacancies – it just stops vacancy rates getting worse. It is vital that we have national strategies for increasing the supply of registered nurses to match demand, particularly in under-resourced areas that the NHS has pledged to improve, such as mental health.’

‘Improving retention is key to fixing the leaky bucket, but holding on to current staff doesn’t fill vacancies’

Jane Ball, professor of nursing workforce policy at Southampton University

With 800 staff retained across 145 trusts, this averages out at fewer than six retained nurses per trust over the first 15 months of the retention programme. Whether nurses on the ground are actually seeing any difference is not clear.

Nuffield Trust senior fellow Billy Palmer says front-line nurses are unlikely to notice much difference from having six extra nurses across an entire trust.

‘Eight hundred is definitely better than none, it helps, but it is important not to take your eye away from the larger picture, which is a large shortfall of nurses,' says Mr Palmer. 'There are real issues in terms of student training numbers, which are 4,000 a year fewer than at the peak.

‘I don’t want to belittle the effect, but I don’t know what resources have gone into this and you tend to ask yourself if it’s proportional.’

‘Think about the needs of your employer and colleagues too’

Hannah Beckwith, a staff engagement coordinator at Essex Partnership University NHS Foundation Trust, has twice successfully applied for flexible working.
Hannah Beckwith

Hannah Beckwith, a staff engagement coordinator at Essex Partnership University NHS Foundation Trust, has twice successfully applied for flexible working.

After having her second child she returned to work for two days a week, but with her older child approaching school age she was unsure how she would manage the school run with her agreed hours.

‘I was worried about how I would juggle two children going to different places and getting to work on time. It means a lot to me to be able to take my daughter to school and I want the reassurance that she is in school safely before I leave for work. I also need to take my son to a different place to be looked after,’ she says.

Flexible working supports my well-being

After talking to her line manager she was able to change her hours, and now starts and finishes later. ‘Not only has this helped my family, it has also had a positive effect on my mental well-being. I feel calm and ready to start the day knowing my children are where they need to be.

‘I also feel that I am giving my best to my team and the trust as I am able to focus my attention on my work, rather than worrying about my home life,’ she says.

For others who would appreciate flexible working, her advice is to think about the needs of the employer too.

‘It is important that your request is accommodating and flexible, to make sure that everyone is benefiting from your request. I have agreed to be as flexible as I can. If I need to be at an event or meeting that starts early then I will make alternative arrangements with my husband to accommodate my work, and my team have agreed to give me as much notice as possible.’


Erin Dean is a health journalist


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