A community trust in Gloucestershire has cut its nurse vacancy rates from an average of around 40% down to 5% in the space of two years, following a drive to improve the recruitment and retention of staff via better post-registration training opportunities.
In 2014 Gloucestershire Care Services NHS Trust had between 35% and 48% of its community and district nurse posts empty across all of its 60 teams, which should have had 200 whole-time equivalent band 5 and 6 nurses.
“Clinical development and CPD is not just an add-on. It is what [nurses] should be doing to work to [their] code”
A subsequent Care Quality Commission report in 2015 concluded that the organisation ”requires improvement” after it found the trust was struggling to recruit enough nurses, especially band 6 district nurses and community nurses.
The pressure on services and staff that had been caused by the empty posts was “really concerning”, said the senior nurse who has led the turnaround at the trust, which has now reduced vacancy rates to an average of 5% across all teams.
During a recent presentation at the Queen’s Nursing Institute annual conference, she noted that the situation had also led to some healthcare assistants taking on more tasks from nurses without any clear framework for delegation from nurses.
To tackle the problems the trust increased continuing professional development opportunities, including re-introducing specialist district nurse training, providing career progression into management roles, and clearly outlining HCA practice to ensure they supported nurses within a delegation framework.
Nurses on band 5 and 6 of the NHS Agenda for Change payscale were offered the chance to gain the district nursing specialist practitioner qualification (SPQ) on a part-time basis over two years, leading to promotions to help fill vacancies at a higher level.
“The key things to improving vacancy rates are…providing equal access to CPD to both new starters and people in the system”
In addition, the organisation doubled its band 7 professional leadership posts – from three to six – and introduced a new senior community nurse role to ensure staff working at a band 6 level had a health-related degree, had qualified at least three years previously and also had a minimum of one year’s experience working in community nursing.
HCAs were stopped from carrying out tasks such as VAC therapy, compression, and applying fentanyl patches, while a review took place of their scope of practice and frameworks for training and delegation were drawn up.
As a result, they are now able to carry out some tasks – such as giving insulin injections – following training, while other procedures, such as applying fentanyl drug patches, are delegated on a case-by-case basis.
Dawn Allen, professional head of community nursing at the trust, who has led the changes over the past two years said that, while the scope of practice for HCAs – and especially those working as band 4 assistant practitioners – had increased and helped to free up nurses’ time, it did not mean fewer nurses were needed.
She told Nursing Times that investment in training and CPD for nurses was one of the key changes that had helped improve staff retention and recruitment.
“[In the past] I don’t think we, as an organisation, were as proactive as we could have been in saying ‘clinical care changes and you need to develop and evolve, and if you want to stand still – you can’t’,” she said.
“That is something I’ve been very clear on since I came into post – your clinical development and CPD is not just an add-on. It is what you should be doing to work to your code and be an accountable practitioner. I think some nurses saw it as optional before,” said Ms Allen.
She added that the trust had just secured £500,000 from its clinical commissioning group to employ an additional 10 nurses, despite the organisation having already virtually met its establishment target.
“The key things to improving vacancy rates are a really solid preceptorship programme, a clear focus on CPD and developing talent, providing equal access to CPD to both new starters and people in the system, being creative about roles you need in the future and liberating skills at all bands,” she told Nursing Times.