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Workforce: Lack of progress on nurse retention is frightening

Nurses leaving their jobs is a huge preventable cost – and we can't fix staffing shortages without improving retention 


Nurses leaving their jobs is a huge preventable cost – and we can't fix staffing shortages without improving retention 

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The draft NHS People Plan for England has pinpointed the need to improve retention of nurses as a key solution to shortages.

Last year, NHS Employers also identified retention as a critical component in fixing the shortage problem. Health Education England has made the same point. As has NHS Providers. And the RCN.

We all agree. Holding on to nurses makes more sense than having to replace them once they have gone.

Preventable cost

Not all turnover is for the wrong reasons. Nurses are promoted, move between jobs for career development and take time out to study. But every time a nurse leaves for the wrong reasons, it is a preventable cost.

Evidence suggests that the loss of a single nurse costs the employing organisation at least several months’ salary. The cost of losing an experienced nurse working in a specialist area will be much higher. With an estimated national turnover rate of 9%, the overall effect of nurse turnover in the NHS is frightening.

And that does not include the effects on care quality and continuity. Or the cost of stress and burnout for the individual nurse, which is an underlying cause of nurses leaving the profession.

Need for action

You would be forgiven for assuming that the arguments in favour of improving nurse retention are so compelling, and the agreement among stakeholder organisations about the need for action so obvious, that nurse retention must be improving. You would be wrong. Retention rates of NHS nurses in England have been worsening.

Research has highlighted that NHS staff stability decreased substantially between 2010-11 and 2017-18. There has also been a growing gap between the ‘best’ and ‘worst’ NHS trusts, with trusts in London and south east England reporting the lowest workforce stability. Another recent analysis, by the Office for National Statistics has reported a fall in the one-year retention rate of registered nurses.

The root problem, as so often with NHS nursing workforce issues, is a lack of concerted and coordinated action, undermined further by cost saving interventions that actually make things worse. For example, investment in continuing professional development is a critical element in nurse retention, yet the NHS workforce development budget was deliberately cut by 60% over the two-year period up to 2018.

We all agree improving nurse retention is the solution. Now we all need to act together.

James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh

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