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Exclusive: NHS regulator to target nurse retention


Trusts with the best and worst nurse retention rates are to be targeted by NHS Improvement in a new programme to reduce high rates of turnover, its most senior nurses have told Nursing Times.

In an interview with Nursing Times, they said the volunteer scheme will see directors of nursing share effective strategies that have helped them hold onto staff so trusts with large turnover rates can devise their own actions plans to tackle problems in their region.

“There are going to be a number of possible explanations for nurses leaving”

Ruth May

Poor retention rates among NHS nurses were pinpointed as a “shocking” issue at a Nursing Times event for chief nurses last year, with one director of nursing also noting that around a third of the hundreds leaving her trust every year were newly qualified nurses.

Analysis of the latest official data by Nursing Times has found more than half of the 160 foundation and mental health trusts in England saw at least 15% of their nursing, midwifery and health visiting staff leave in the year leading up to May 2016.

The data, provided by NHS Digital, also revealed that a handful of 20 trusts had annual leaving rates of 20% or more.

Overall leaving rates ranged from 9% at one trust – representing around 90 nurses – to 43% at another, equivalent to 357 people, with an average turnover rate of 16% across the 160 providers.

“It is important for me that we are not just measuring inputs”

Ruth May

NHS Improvement will investigate how retention rates differ across regions of the country, as well as between different staffing grades. It will also assess whether different multidisciplinary workforce models, with varying numbers of different healthcare staff, might be linked to nurse turnover.

Early findings from the first set of analysis carried out by the regulator has shown worse nurse retention in the south of England – particularly London – compared with the north.

The close proximity of a number of employers in the capital that nurses can choose to work for could be a reason for the difference and would be explored further by NHS Improvement, said Jacqueline McKenna, the regulator’s director of nursing for professional leadership.

Mrs McKenna, who is jointly leading the work on nurse retention and joined the regulator in April before being appointed to her new role last month, told Nursing Times that existing projects looking at nurse staffing would be considered when sharing practice between trusts.

As an example, she highlighted the London-wide Capital Nurse programme led by Health Education England and NHS England. It aims to guarantee a job in London for all newly-qualified nurses who train in the capital, and to standardise post-registration training required for specialist nurse roles.

She also cited a successful scheme at University College London Hospitals NHS Foundation Trust that allows nurses who may be thinking of leaving the organisation to swap jobs within it without having to go through lengthy recruitment processes.

Immediate actions that NHS Improvement will want trusts to take will be to share effective health and wellbeing programmes for staff, to ensure they have effective nursing leaders in place who create a sense of belonging for nurses, and to draw up an effective strategy bringing all elements of retention together, she told Nursing Times.

When asked if the regulator would be looking at whether pay affected nurse retention, Mrs McKenna said it was a “difficult” issue to analyse because the national Agenda for Change pay system meant salaries were “more or less the same across the country”.

However, she noted there was a “London issue” due to inner and outer London weightings for staff salaries, which would be investigated further.

Nurse staffing shortages were also “absolutely” one of the factors potentially causing nurses to leave organisations, said NHS Improvement’s executive director of nursing Ruth May, who has previously stated it is currently the main focus of her work at the regulator.

“There are going to be a number of possible explanations for nurses leaving, partly the ageing demographic of the nursing workforce and increasing demand for jobs – but equally nursing shortages, given that we’ve had a supply problem,” she said.

New workforce models would need to continue to be explored to tackle this and help improve retention, said Dr May, who added that the introduction of the new nursing associate role was “part of the jigsaw”.

When asked how far nursing associates could free up nurses’ time and help to tackle poor nurse retention rates, Dr May said NHS Improvement would be working with the organisations piloting the new role to “work that bit out” over the coming months.

“But it is a role within a multidisciplinary team and it will have the training and skills to bridge the gap between what healthcare assistants can do and what the registered nurses are now needed to do,” she told Nursing Times.

“We’ve got every chance we are safeguarding and improving quality”

Ruth May

When asked what NHS Improvement’s involvement was in ensuring nursing associates were deployed safely, Ms May said the “primary role for ensuring safety for patients is through the trusts and the trust board”.

She noted that it was the regulator’s responsibility to develop policies around nursing associates that “continues to support the safe care of patients”.

Trusts would be supported by NHS Improvement to continue to measure inputs – such as the number of hours of care provided by different staff groups – alongside outputs for patients, such as pressure ulcer and falls rates on a daily basis, and also for staff, such as retention rates, she said.

“And, as long as we keep measuring and triangulating that at a local level day in day out, then we’ve got every chance we are safeguarding and improving quality,” she said.

“It is important for me that we are not just measuring inputs but that we are measuring alongside the outcomes for patients – like pressure ulcers falls and the like – the impact and outcomes on staff and that’s where the retention fits in,” added Dr May.

NHS Improvement will begin its nurse retention programme with trusts in the New Year. It will follow a similar scheme launched by NHS Employers this month that has been expanded to work with 100 organisations in England to develop staff retention strategies through workshops.


Readers' comments (13)

  • Racism,Bully and stereotyping is driving BME staff away from NHS to become agency staff and to join private organisations. I am a newly qualified RM, and after 4 months with an NHS Hospital I have resigned because I just could not cope with the Racism and bully in the hospital.

    It was also clear that BME staff are not wanted there. I am now unemployed and i am not sure i will work in NHS again

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  • Bully culture has an awful lot to do with poor nurse retention. One could be forgiven for thinking that some NHS managers are out to hasten the death of some vulnerable patients, the way they manage/mismanage things. Nurses want to help not harm patients but some of those who stay on in bad management areas are not caring people whilst those who leave are really the ones we need to retain. Still, I have a great deal of sympathy for those doing their best in spite of the pure stupidity coming forth from low calibre supervisory bodies.

    So I think it is extremely sensible to record things like falls and pressure sores as part of the assessment as some "supervisory" bodies seem to instigate poor care in selected homes.

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  • Well said by the 2 comments above. Unfortunately I have to agree with them. Bullying is a major problem,often by staff who have worked together for a long time and created a culture that is impenetrable as a consequence.They manage with a divide and rule policy and eventually drive people out. They have often been promoted above their abilities and fear anyone who questions anything they do. This results in the bullying which is often understated and to put it another way, sly!!. They do not have the ability to manage and 1000's of good nurses are lost due to their actions.

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  • One of the most important reason for staff leaving a trust to join another is due to management and other staff behaviour on the ward. This is really a big problem as I recently got a job, however am planning to leave because I don't feel supported by other staff and management. I would not even tell them that am leaving. It's not worth it

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  • i left nhs because they were forcing me to do 12 hour shifts. The matrons and the management were rubbish and nhs staff are not appreciated

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  • Wow!
    None of the reasons I would cite would be for bullying. Unacceptable that staff feel like this.

    I would say something like this.
    Big university hospitals take the "glamorous stuff"(and I used this word to represent funding, growth, training and opportunities). Smaller hospitals struggle with less of the above. Very valued by their local communities, but under resourced and undervalued by strategic bodies. These trusts then battle to make cost savings meaning fewer and fewer opportunities and "perks" (including facilities) for staff.

    Personally I am in it for the long haul, I have rolled my sleeves up, girded my loins and am ready. I will do my upmost to help train staff, make them feel valued and hopefully retain staff and make our hospital great again!!!! (Bit Trumpesque, but you get my point).

    It is about time that someone recognises NHS staff feel low........However, do one Branson we don't want you just yet.

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  • In my experience over the last 38 years, many times staff do not stay because they feel undervalued by management. Having been a manager, before I saw 'the light', I appreciate the pressures they are under to meet targets, but this does not excuse the poor treatment staff receive from line managers.
    A happy workforce is a productive one - a little expression of appreciation for that extra mile gone would be greatly received and result in a much needed rise in morale.
    Having said all that, there is a distinct undercurrent of bullying in both nursing & midwifery which needs stamping out- Trusts preach about bullying but very rarely take action against the bullies - they appear flameproof!!

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  • Retention of nurses in departments and wards is primarliy effected by two elements:

    1. Their boss - people leave bad leaders, they don't leave bad jobs. You can have the busiest job around, high demands, but good leadership can keep your team together. The evidence that A&E departments are not haemmorhaging staff like you would expect given the level of activity shows that there are somem excellent leaders out there.

    2. You can be inventive with people's career pathway, secondments out of the clinical area at each grade give people both variety and a chance to build their CV, whilst staying as an employee. 6 months rotation to ITU? - sorted, likewise to a research post or advance practice.

    If we could sort this out across the profession we would have a signifciant impact on retention.

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  • Money grabbing NMC- low wages-form filling/tick box exercise from start to finish of shifts -revalidation-coaching-PDR- ect ect ect -Patient contact much reduced,Trusts targets met,God help nurses if not!!!!!

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  • I have to agree with what is being said about bullying, having had it done to me whilst working for the NHS, needless to say I will never return to working for them ever again. Management were appalling in dealing with this which didn't help when I challenged them.
    I have found my place in the private sector, yes bullying does happen unfortunately. However, I have needed to whistleblow on 1 occasion when it got silly. Absolutely right about the fact above that not everyone is management material and some managers I have worked under couldn't manage their way out of a paper bag which is why staff turnovers have been high. I'm sure am not the only one with this story.

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