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Senior nurses emphasise need to target ‘shocking’ staff retention rates


Successful strategies by employers to retain nurses are only found in “pockets” across the country and more work must be done to tackle sometimes “shocking” turnover rates, senior nurses have warned.

Redeploying staff between wards, unfixed rotas that are published last-minute and a perception of an increasing focus on targets over quality of care are among the problems of greatest concern.

“They are the staff that get moved from place to place, because they are not in charge”

Nicola Ranger

Senior nurses and advisors pointed to poor roster management as one of the main issues when they spoke at Nursing Times’ Deputies Congress event last week.

Nicola Ranger, director of nursing at Frimley Health NHS Foundation Trust, said it was often the newly qualified nurses who suffered the most from highly variable rotas and being moved between wards. At her own trust, she said around 400 nurses were lost each year, which she described as “shocking”.

Around a third were nurses in their first year of employment with the trust, she noted. “They are the staff that get moved from place to place, because they are not in charge,” she said. “They also have the worst off duty….it’s our newly qualifieds that feel the impact.”

She said feedback from band 5 nurses had revealed shift patterns that made her “despair”, which had prompted the trust to now begin a programme of work looking at its e-rostering.

“Looking at a sample of those rotas – some staff have worked a Saturday night, finished at 8am on a Sunday morning and then are back on an early on a Monday. Because someone has counted the Sunday as a day off,” said Ms Ranger.

In addition, the chief nurse said, older nurses were often “a bit disillusioned” because “they feel there is more focus on getting the patient into the bed and out of the bed, and that what actually happens to the patient when they are in the bed is becoming secondary”.

She urged the audience of deputy nursing directors to listen to feedback from not only staff but students, who could be an indicator of future retention problems.

Upon the trust merging to help run struggling Heatherwood and Wexham Park Hospitals NHS Foundation Trust in 2014, she noted Wexham Park Hospital took on around 150 students annually, but only retained three a year.

Department of Health

Critical need to tackle ‘shocking’ nurse retention rates

Lyn McIntyre addresses NT Deputies 2016

Meanwhile, Lyn McIntyre, senior nursing advisor at the Department of Health who worked on the recent Carter review of NHS hospital efficiency, said there was “great variation” in how e-rostering systems were being used.

Of the 136 acute hospitals in England, six did not have these systems in place at all, she said.

Those that did were sometimes only publishing their staff rotas two weeks before the shifts were worked, when the Carter review called for rotas to be released at least six weeks in advance.

“If you’re a member of staff and you don’t know what you’re working in two weeks’ time, or you’ve got vacancies and you need to get bank or agency staff and you need to put that out to the bank, you’re giving them a very short turnaround,” said Ms McIntyre.

Ruth May, executive director of nursing at the new regulator NHS Improvement, said there were some “really great” examples of improving retention across the country but that these were only found “in pockets”.

She reiterated her plan to launch a programme of work looking at how to improve nurse retention across England, as revealed earlier this month by Nursing Times.

“I’d like to do a collaborative approach where we bring together a whole group of trusts up and down the country that says these are the challenges, and ask our staff to help us solve that problem,” said Ms May.



Readers' comments (23)

  • Comment 6.38 am reported.
    I had a wonderful job and amazing work experience in a university hospital in Europe where nurses were offered excellent working conditions in exchange for providing their very best and total flexibility regarding a sometimes challenging shift system. I was there almost twenty years working full time until sadly family duties as a carer altered my situation. During that difficult period I managed a part time MSc course in healthcare management and hoped to use my experience later in the NHS to discretely help to influence change to provide more congenial conditions and team environment where people actually enjoyed working and both they and their patients benefitted. However all the service could offer me after leading a two month project for them and further proposals from two clinical department heads was a junior job on the wards for the newly qualified where there was a shortage and with salary to match. Eventually in desperation I considered taking such a post to regain NHS experience and get a foot in the door until I was told it took up to six months to get a police record check and I did not wish to stay unemployed for that length of time. I changed my plans and took a plane straight back to Europe but not to my former university hospital as I wished to broaden my horizons, but sadly as a result was forced into early retirement but from which I can now reap the benefits in a stunningly beautiful area with plenty to do and a more pleasant climate than in the UK.

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  • I would add to my above comment the paradox of the RCN delivering a lecture on the retention of nurses to a national congress I attended in my country of residence at the beginning of the millennium! It seems the RCN is very good at theorising but has always been a little out of touch with the reality!

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  • 'Frimley Health NHS Foundation Trust, said it was often the newly qualified nurses who suffered the most from highly variable rotas and being moved between wards. At her own trust, she said around 400 nurses were lost each year, which she described as “shocking”.'

    'Upon the trust merging to help run struggling Heatherwood and Wexham Park Hospitals NHS Foundation Trust in 2014, she noted Wexham Park Hospital took on around 150 students annually, but only retained three a year.'

    How do you lose that many people??!

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  • It's very common at my Trust to work four night shifts back to back, finish at 8am on the Monday morning, only to be back on a long day with a 7.30 start on the Tuesday morning. We're told that only an 11 hour break is required between shifts. A colleague recently told me that she had been rostered for seven consecutive duties without a day off and when she raised the matter was told well that's e-rostering for you!

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  • One of the reasons I am leaving my current job is because of unfavourable shift patterns. For almost 3 months I did not get a single whole weekend off. Whilst I realise weekend working is part of being a nurse I do not think it unreasonable to expect to get some whole weekends off to spend with family.

    One week I was on nights Mon, Wed, Fri and Sun - so in for 8 days straight. It was impossible to get into any kinds of sleep pattern and I was exhausted. When I asked if I could do my nights shift in a row I was told no. Why? Because there were some part time staff with children who only did night shifts, who were allowed to choose which nights they worked to fit in with child care. It was also compounded by the fact we were short staffed and relied heavily on agency staff.

    My days shifts are often no better and I regularly worked one day on, one day off etc. One day off is not enough to rest and recover and I often feel as if I am always at work.

    I appreciate that working when you have children can be challenging but although I do not have children I do have a partner, friends and family who I would like to spend time with. Shifts need to be fair to everyone, which is the problem - you will never please everyone.

    Unfortunately the shift patterns are the reason more and more nurses are choosing to do agency work. I am soon to start a new job at a new hospital and time will tell what the shifts will be like there. But if I find myself in the same situation I too will vote with my feet and go agency. This is not really something I want to do as I like being part of a team, but feel in order to get a better work life balance I may have to.

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  • Sometimes it's the 'leaders' of nursing that contribute to nurse stress and dissatisfaction.Whoever in their ivory tower thought that Revalidation was a good idea needs shooting.An example of extra stress being put on an already stressed occupation.

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  • Agreed with the comment that the RCN is more theoretical than practical
    It is divorced from the awful reality of clinical practice
    It needs to become more supportive as I myself am leaving the RCN as it is an anachronism that refuses to strike

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  • Many decades ago faced with problems of variable nurse rosters, inadequate staffing and nurse dissatisfaction a colleague and I were asked to do something about it. We tried just tweaking them but that didn't work. So we went back to basic principles as well as finding out what staff would consider fair. Remember this was using a 3 shift system and student nurses but the principles apply whatever:

    1. Every nurse would have 2 consecutive days off per week
    2. Days off would be preceded by an early shift and followed by a late shift
    3. Sisters would have every other weekend off, staff nurses 1 in 3 and students 1 in 4
    4. Sisters would alternate their weekend off with the Sister on a 'paired' ward to ensure weekend cover
    5. Shift teams were balanced by grade, experience and number to take into account the expected patient demand
    6 . Staff who wanted to change their days off or shift first found a colleague who matched them who had those days/ shift to see
    if they would swop in the first instance before asking the ward manager.

    This was then developed into a 4 week permanent repeating roster which was there for all to see. Finally each member of staff was allocated or chose their 'line'.

    eRostering systems will only be as good as the data that is put in. The criteria today may well be different from those we established those years ago though reading some of the comments some are obviously still relevant today.

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  • milton pena

    As a consultant orthopaedic surgeon with 40 years of experience in the NHS, I can say that the main reason for lack of nurse retention is the appalling working conditions in the wards, when all too often one qualified nurse is responsible for between 12 and 15 or more patients.[ many very dependent or acutely ill or postoperative]. I describe my experience in a book

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  • Some of the many reasons I left the NHS - ward sisters not working on the wards, only having 2 days off after 4 nights, being moved to other wards to cover gaps (often to specialities I had no experience of eg ITU), having staff moved from my ward to cover gaps which left us struggling to get the job done safely and satisfactorily. I could go on but I think I've made my point

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