A retention scheme launched to support NHS providers that are struggling with above average nurse turnover rates will be extended to all trusts across England, Nursing Times has been told.
The NHS Improvement programme has shown early progress in helping employers keep hold of their nurses, as previously revealed by Nursing Times.
- Exclusive: Nurse retention scheme shows ‘early promise’
- Exclusive: NHS regulator to target nurse retention
The programme started in July 2017 and initially involved cohorts of trusts. The first was a group of community and acute trusts and focussed solely on nursing posts, while the other featured a set of mental health trusts and targeted all clinical roles.
The trusts were tasked with creating a retention improvement plan and were given a range of clinically-led support from NHS Improvement and its partners including NHS Employers to bring them to fruition.
“People are looking for organisations to help develop and define their career”
The most recent data shows turnover rates in the nursing group has fallen from 16.8% in June 2016 to 15.2% as of March 2018. Clinical staff turnover in the mental health cohort fell from 15.5% in March 2017 to 13.9% at present.
The NHS Improvement programme has already been extended once and has to date involved 110 trusts across the country.
The senior nurses behind the scheme have now told Nursing Times that the regulator has been given the green light to roll the programme out to all trusts in England over the next two quarters of this financial year.
NHS Improvement’s nursing director, Professor Mark Radford, who is leading on the project, said early findings from the programme had revealed key themes in factors that impacted retention across the trusts.
“I want to make sure we get the maximum possible benefits from retaining the valuable workforce that we have got already”
Professor Radford told Nursing Times the breadth of career development opportunities available to staff was one of those factors.
“People often assume that a lot of the people leaving the NHS is due to retirement but actually most of the turnover that we see is a much younger cohort – less than 45 years of age,” he said.
“When we started to work with the individual trusts those that are doing really well is early years career support,” he said. “That is about really good preceptorship, really good pastoral care and importantly it’s around career development.
“People are looking for organisations to help develop and define their career,” he added.
Professor Radford said introducing career development mapping tools and workshops was one move being made by trusts already involved in the programme to give staff a reason to stay.
Professor Mark Radford
The scheme had shown flexible working arrangements were also vital in retaining employees, he noted.
He said: “Interestingly everyone says to me ’it’s about family friendly hours’, but actually everyone is looking for flexibility irrespective of their age.”
He highlighted that trusts had been given help to update their policies around rostering to enable staff to have more control over their working hours.
As part of flexible working, Professor Radford said trusts in the programme were being supported to improve their offer to keep or bring back nurses after their retirement age – known as “retire and return”.
“Only around 10% of the nurses who leave the NHS come back into employment within the NHS and I think that’s a real shame,” he told Nursing Times.
“We absolutely need to make sure we keep that skill and experience but often people coming towards the last part of their career are looking for a little difference in their work pattern,” he said.
“Everyone is looking for flexibility irrespective of their age”
“They may have other carer commitments, they are perhaps looking for less intensity of workload or they are looking for different options around when they come into work or not,” he said.
Professor Radford said it was “perfectly achievable” to retain about 40% of nurses by improving retire and return choices.
The culture of the organisation and how much leaders engaged with frontline staff and the extent to which they included them in policy decision making also played a part in retention, he said.
Despite the efforts so far, latest figures from NHS Improvement show nurse vacancy rates across the NHS in England are increasing.
In the first quarter of 2018-19, there were 41,722 vacant nursing posts – a rise from 35,794 in quarter four of 2017-18.
The retention initiative is being overseen by Dr Ruth May, NHS Improvement’s executive director of nursing and a deputy chief nursing officer for England.
Nurse staffing shortage is ‘top priority’ for regulator
Source: Kate Stanworth
Dr May told Nursing Times that the programme was “vital” and had been the regulator’s main response to the workforce issues facing the NHS.
She added: “We don’t have control over the supply sector, so we can do everything instead to support how we retain our staff and that’s what we have set out to do.
“Mark and colleagues are leading a great piece of work that’s starting to have some results, and I want to extend that over the next two quarters making sure we get the maximum possible benefits from retaining the valuable workforce that we have got already,” she said.
However, Dr May said retention was only one part of the solution. The NHS is currently creating a plan for the next 10 years and Dr May said she was “delighted” that workforce would be featured in it in a way that it wasn’t in the five-year forward view.
Dr May, who is part of the working group advising on workforce in the development of the 10-year blueprint, stated: “We’ve got a job to do in the next couple of weeks to making sure that when the NHS publishes the long-term plan we are able to articulate what that means for the workforce.”
Mentioning the plan at a community nursing conference last week, she also vowed to fight for better training opportunities for qualified nurses to enhance their skills.
Meanwhile, in a case study shared exclusively with Nursing Times, NHS Improvement has highlighted the progress made at Southend University Hospital NHS Foundation Trust since it joined the retention scheme.
The trust was chosen for support because it had an increasing voluntary turnover rate among nurses in their first two years of employment. Its attrition rate among over 50s was also at an all-time high and it had 335 nurses eligible for retirement in 2020.
Inadequate staffing levels found at Southend trust
As part of the scheme, the trust was supported to create a new retention model called Stay@Southend, which included establishing an “engagement compendium” for managers to build trust with their staff, assigning each ward a detailed nurse retention dashboard and targets, and training managers to recognise candidates at interview who were more like to stay in the job.
Southend also formed a “flexible retirement and encore career task and finish group” to improve its offer to current and potential older staff. An encore career is when a person takes on a new vocation in later life.
All jobs at the trust are now automatically advertised as “part-time and flexible hours considered”.
As a result, the trust has seen a drop in voluntary turnover and retirement rates since January 2018.
There has also been an 11% increase in retire to return applications, while enquires about encore careers and internal transfers are up 30%.