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”
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”
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.
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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”
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.