Expert advice

Workforce: The problem that's bigger than staff turnover

When it comes to staffing, there's a larger, system-wide issue, says James Buchan

When it comes to staffing, there's a larger, system-wide issue, says James Buchan

Picture: iStock

Every time a nurse leaves an organisation the turnover in staff can have a seriously negative impact, including delayed care, lost skills, costs of replacement and a lowering of staff morale.

My recent international review of nurse retention, published by the International Centre on Nurse Migration in July, reminds us that the financial impact of nurse turnover on the employer can be equivalent to at least several months’ salary per nurse.

With tens of thousands of vacant NHS nursing posts, these problems escalate. So it is little wonder that the lost productivity and the time and cost of finding replacement nurses are major concerns for most NHS employers.

Improving retention

In July last year I wrote a column about a pilot programme initiated by NHS Improvement (NHSI) ‘to improve staff retention in trusts across England and bring down leaver rates’. 

The staff retention support programme targeted trusts with above average leaving rates for nurses, and NHSI worked with these trusts to analyse staff turnover and implement improvement plans targeting the reasons why staff were leaving.

Full-year data is yet to be published but NHSI has already announced the success of these pilots, claiming early evidence of reduced turnover.

The national problem

The NHSI initiative, with a focus on local-level analysis and diagnosis, can lead to local improvements. Tried and tested solutions include flexible hours and increased emphasis on continuing professional development and in-service training.

With concentrated national support, creating islands of relative success in a troubled sea is fairly straightforward. But it becomes a much bigger challenge to implement and sustain these claimed improvements system-wide across time.

Too many employers are chasing too few nurses. Without national improvement in the availability of nurses these local successes in improved retention may remain localised, achieved in part at the expense of other localities; retain your nurse and he or she does not move to fill a vacant post elsewhere.  

Reducing unnecessary turnover can benefit the patient, the nurse and the system, but it cannot resolve the underlying problem of system-wide staff shortages.

About the author

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



Further information

This article is for subscribers only