The retention of registered nurses is a critical issue with the loss of nurses from the workforce is having a significant impact on healthcare.
I have been involved in a two-year collaborative project between Bournemouth University and the Royal Bournemouth and Christchurch Hospitals (RBCH) Foundation Trust, supported by the Burdett Nursing Trust, to research this issue with a particular focus on older people’s’ medicine where retention is even more difficult.
I have been nursing for over 40 years so thought I knew what the outcomes would be: that nurses would highlight staff shortages, increased pressure on the services, disillusionment with the quality of care they can provide alongside stress, burnout and reduced job satisfaction.
However, as the project progressed it has become clear that the factors influencing nurses’ decisions to leave or stay are complex – personal and organisational – and that no single solution to this issue was apparent. The solutions are multifactorial.
The project looked to make a positive impact by taking a nurse-led, evidence-based approach incorporating key components known to have a positive impact on the retention of registered nurses.
The model we developed is called TRACS:
- Transition: focusing on support for nurses at pivotal career points;
- Resilience: overcoming emotional, physical and psychological adversity within the workplace to remain optimistic about the future;
- Authentic leadership: empowering leadership styles for engaged leaders;
- Commitment: feeling valued within and by the organisation;
- Support: supporting healthy working lives.
As we delved further, we found that the trust had a number of innovative developments but many nurses were unaware of these and uptake was low. This included supporting nurse retention through career guidance, training, continuing professional development, health and wellbeing services and supplementary services provided by human resources and occupational health departments.
This project aimed to provide an element of personalised response to signpost individuals to support and services that were, as far as possible, tailored to their own needs. Certainly not what I had envisaged at the outset.
To make this happen we developed an interactive web portal, support4nurses, to locate all the relevant internal and external information and act as a ‘one stop shop’ for nurses to use when facing various situations likely to affect their work and possibly their intention to stay in nursing.
Designed around the TRACS concepts the portal support4nurses brings together a range of trust-based and external information for nurses, accessible via any internet-enabled device. While designed for RBCH, its structure can be reconfigured to support other healthcare organisations.
“We must continually listen to nurses working ‘at the coalface’ and learn from what they tell us”
Now over halfway through the project, I have a different take on nurse retention, which challenges my initial assumptions. The solutions are complex, requiring personalised approaches that support nurses at different stages of their career, who are facing a wide range of personal and job-related stress.
We must continually listen to nurses working ’at the coalface’ and learn from what they tell us. During the project research phase the nurses we have encountered have been inspirational, honest, sometimes frustrated and angry, reflective, open-minded and above all, patient-focused.
The TRACS approach provides a framework to develop and bring together a number of evidence-based interventions, which have been shown to impact positively on nurses decisions to stay.
By introducing the support4nurses web portal specifically for nurses helps to both value them as a crucial group in delivering high-quality healthcare and support them to work with their employing organisation to seek solutions for individual issues related to staying in their job.
The flexibility and scope of the portal reflects the fact that retention is reported as highest when multiple interventions are used.
The TRACS model for nurse retention will stimulate new interventions, resulting in further improvements to retention rates and refinement to a sophisticated and personalised tool that can be helpful to other healthcare organisations facing similar challenges. The model is being evaluated and the results will be published later this year.
Sue Higgins is Burdett nurse retention project lead, Royal Bournemouth and Christchurch Hospitals Foundation Trust