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Creative nurse retention strategies go a long way to solving safe-staffing woes

Organisations should sometimes be willing to pay a premium to retain staff

Organisations should sometimes be willing to pay a premium to retain staff


Staff and managers get together in the structured environment
of a Schwartz Round. Picture: Southwest News Service

Good nurse leaders work hard to make their services attractive places for nurses to work in and patients to experience. This starts with paying attention to the needs of nurses who are already employed, rather than focusing solely on recruitment. It is led from the top of the organisation – the board and executive directors – and requires imagination and determination.

Recently, the eminent nurse academic Linda Aiken told the RCN international nursing research conference that workforce shortages should not be used as an excuse for inaction on safe staffing. She said the government should implement safe staffing ratios in England. But she also told Nursing Standard that even in times of workforce crisis, some hospitals have good vacancy rates – proof that sound management and creativity does produce solutions. 

Don’t underestimate the importance of sound nurse management 

We know it is difficult. Demand is high, pressure from vacancies great and nurses get worn out. Patients and the public rightly have high expectations. Defined nurse-patient ratios are seen as part of the solution but, as Dr Aiken has emphasised, good management is also important.

‘Money matters to nurses and sometimes it is reasonable to pay a premium to retain people’

Engagement between managers and staff is key; nurses know when a manager is disconnected from the clinical service. Managers have to be seen, be approachable and understand what is happening.   


An approachable manager is well placed to get a better understanding of the service.
Picture: John Houlihan

This can be made possible by an open-door policy or back-to-the-floor sessions. Knowing the service helps managers and leaders to adjust staffing to meet the demands on given days, as set ratios do not always work. The staffing need fluctuates and is affected by the requirements of the patients at the time, the environment and the skills of team members. 

Flexibility is important. A flexible approach to the contracted hours and working pattern of individuals, for example as retirement approaches, may enable nurses to continue working. Equitable rotas, assisted by electronic rostering systems that give nurses the option to select shifts within defined criteria, are important in making the workplace attractive. Secondments and sabbaticals may cause short-term gaps but can result in a longer-term benefit.

Ensure fairness in how nursing roles are banded

Fair use of the job banding system is essential to establish appropriate remuneration for the role. Nursing makes up a big part of the employer's pay budget, but keeping large numbers of people on low bands makes their roles unattractive, especially when compared to the banding used for positions in other smaller disciplines that consume less of the budget. Money matters to nurses and sometimes it is reasonable to pay a premium to retain people.

‘Effective team structure, support from nursing colleagues and the multidisciplinary team are critical, along with equipment – everyone needs the tools for the job’

In my experience, education – supported by funding, release from work, a supportive manager and links to the nurse’s work – is one of the best retention tools. The changes in funding promised for continuing professional development are very important for safe staffing. 

Well-being initiatives, shared governance and initiatives such as Schwartz Rounds to help nurses deal with the emotional aspects of their work, and contribute to a supportive and collaborative culture. 

Facilitating a move from one area to another when a valued person needs a change can be very productive. An effective team structure, support from nursing colleagues and the multidisciplinary team are critical, along with resources such as equipment or training. Everyone needs the tools for the job.


Workplace culture that values fairness is essential to safe staffing. Picture: John Houlihan

Workplaces need to resist the rush to blame when mistakes happen 

The way senior staff deal with mistakes affects the climate of a workplace and has an impact on individuals. NHS Resolution published a paper recently about the need to stop rushing to blame individuals following incidents and instead embed a ‘learning and just’ culture. Everyone should be doing this already. It calls for a balance of fairness, justice and learning – all essential to ensuring safe staffing.

Recruitment processes run alongside efforts on retention and should be engaging and modern, using digital resources such as social media and an efficient, personalised approach.   

Safe staffing of clinical services is a product of collaboration between nurses, managers and human resources, with all ideas considered, and an unwavering focus on retention and recruitment. It is a multifactorial and continuous process. And it has to be creative because competition between employers is great and nurses have choices.  


Caroline Shuldham is chair of RCNi ’s editorial advisory board and a former nurse director. She is an independent adviser on research, teaching and mentoring

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