As of October 2018, there are approximately 41,000 vacancies across the nursing workforce in England. Against this very challenging backdrop, we are starting to see an improving picture in how trusts are able to retain their valued staff. For the last twelve months, we have worked in partnership with NHS Employers to deliver a direct support programme for retention.
As a result, staff turnover levels within some of our cohort trusts are the lowest they have been for four years after a prolonged period in which staff turnover has been steadily rising across the NHS. We outline the progress made on this programme and some of the emerging themes that all trusts can explore when trying to improve retention.
Retention: where are we?
- the most recent data we have for the nursing cohort 1 trusts (March 2018) indicates average nursing turnover was 15.2%. This compares to a peak in June 2016 of 16.8%
- turnover in clinical staff in cohort 1 mental health trusts is now 13.9%, compared to a peak just before we started our retention programme of 15.5% in March 2017
- this isn’t easy work and reflects a lot of hard work from our cohort 1 trusts, and it continues to be a tough climate
- however, the message from the NHS trusts we are working with is clear: a locally owned solution for retention, which staff are empowered to develop and champion themselves, and which understands and addresses the multiple factors affecting leavers, is an effective way to start tackling turnover, morale and engagement
- based on the impact we are seeing with our cohort trusts in this programme, we are expanding our activity throughout our second year, so we can work directly with more trusts, as well as continue to offer national guidance and resources to any NHS organisation
- we recognise this is only part of the workforce picture. As part of the NHS long-term plan, we are working collaboratively with all NHS bodies to explore solutions to the broader workforce challenges, including current vacancies and supply routes into nursing
‘We know that nurses stay with us when they can provide good quality care for their patients, when they can relate to our trust’s values, be recognised and supported in their roles, and when they are able to balance their work and home life, whilst continuing to learn and remain healthy. Our retention model takes in all these factors and also places a premium on good engagement at all levels, from board to ward, so that every member of staff feels like they belong.
We have really enjoyed being part of the NHS Improvement retention programme — it has given us opportunity to learn from retention approaches taken by other trusts and it has helped us to showcase Southend Hospital as a great place to work.’
Sue Bridge, Head of Human Resources, Southend University Hospital NHS Foundation Trust
The retention programme so far
- 110 NHS trusts (that were experiencing higher staff turnover rates) so far have received direct support from us (nearly 50% of all trusts), in partnership with NHS Employers
- 500 NHS delegates have attended one of our retention masterclasses where we share best practice across England
- staff turnover rates are going down, where our cohorts are engaging fully with the programme
- 71% of our nursing and mental health cohort 1 trusts (25 out of 35 trusts) are seeing an improvement in their staff turnover rates since starting the programme
- trusts in cohort 1 of our programme are seeing larger reductions in their turnover so far
- nursing cohort 1 trusts have improved their staff nursing turnover rates by 1.0 percentage point on average (average turnover has fallen from 16.2% in June 2017 when we started the programme to 15.2% in March 2018) — compared with trusts not receiving direct support, where the improvement was on average 0.4%
- Mental health cohort 1 trusts have improved their clinical staff turnover rates by 1.1 percentage points on average (13.9% turnover in March 2018 vs. 15.0% in June 2017) — compared with trusts not receiving direct support, where the improvement was on average 0.7%
Emerging themes — what do we know about tackling retention?
There is no silver bullet, but there are actions all trusts can take, which starts by understanding your own workforce and leaver data and what it is telling them.
We have seen that successful staff retention programmes include many of these elements, which you can tailor to your local situation:
- knowing your workforce data inside out and building a plan based on the insights this data offers you, including those gleaned from consistently doing exit interviews and holding staff focus groups
- supporting new starters and the newly qualified, expanding preceptorship programmes and offering pastoral support from more experienced staff
- offering a range of flexible working options for all staff to support their work-life balance and life needs (i.e. caring or childcare)
- mapping out career pathways so that staff can visualise early, how to progress their career in the trust, as well as promoting roles and opportunities through career clinics and online support
- effective staff engagement, including finding ways to acknowledge and reward values-driven behaviours
- supporting staff health and wellbeing
- employing innovative employment practices and trying new things, such as fast track/one stop recruitment events, ‘itchy feet’ conversations as a preventative measure, and new models of ‘retire and return'
Based on the promising results we are seeing in our first cohorts, we are expanding our programme to accelerate the collective rate of improvement based on the early gains we have seen in the first 12 months.
We will be contacting trusts to take part in cohort 4 of the programme.
We are also hoping to take in additional specialised areas of support over the coming months where the need is greatest, including a review of high secure hospitals, alongside our core programme with trusts.