April @BloggersNurse Challenge: the Retention of Healthcare Staff

Last week I said I’d look at the topic of retention and said that would be interesting once this lockdown phase of the COVID-19 story passes. However, before we get to my thoughts on this you need to understand the context.

So rather than give a history lesson this article by Poly Toynbee in the Guardian on the 25th April does a much better job than I would ever do. See https://www.theguardian.com/commentisfree/2020/apr/24/year-nurse-tories-10-years-bad-care-nhs-crisis

As Poly says

…retention isn’t difficult, there is nothing insoluble about it. Pay them decently, give them as clear a career path ahead as doctors enjoy, and see what happens.

So getting beyond the politics of a pay rise, cancelling healthcare workers student debt, improving healthcare workers working conditions and terms of employment and providing a career path that includes recognition of health care workers in the care home and social care sectors… what does the professional literature suggest.

In a systematic literature review published last year Brook et al (2019) looked at the issue of retaining early career nurses. Early career nurses are important because it is in the transition from student to registered nurse that that the losses to the profession are at their highest.

So what did they say about retaining staff in the first year of practice. Firstly, employers have to offer a transition to practice programme. The form that the programme takes, be it preceptorship, mentoring programmes, residency programmes, internships, externships,orientation to practice programmes or clinical ladder programmes is not as important as having one in place. That is because of the message that it sends out; that the organisation by doing this is indicating the importance attached to their newly-qualified staff and this alone is enough to positively influence recruitment
and retention; especially if the organisation is perceived to be investing in the workforce to a greater extent than competitors.

Interventions with the highest benefit appear to be an internship/residency programme
or an orientation/transition to practice programme that incorporates formal teaching, a preceptorship element and possibly the addition of a mentorship element. They suggest that programmes need to last 27–52 weeks in duration. These findings align with
support that is already offered in USA, Canada and Australia. In the UK preceptorship and mentorship are embedded in our culture so we may be starting from a good position.

Unfortunately most of the studies done looking at this topic have been done in high income economies. The quality of their findings have also been affected by inconsistent and incomplete description of the interventions, missing detail of some components of the intervention and variations in methods of evaluation across the studies Brook et al (2019) reviewed indicating that many of the studies on this topic so far were not conducted using rigorous research methods of evaluation. The quality of this review, like many others has been  limited by the quality of the study reports that are available.

What is of interest is not the interventions but a need to refine and review already established transition programmes. If the programmes focussed more on the elements of teaching, preceptorship and mentorship and considered how these added to the new staff nurses experiences then more successful programmes might result. However, variation in the quality of mentors, preceptors and teaching are bound to affect the outcome of support programmes; so Brook et al (2019) suggest reviewing these before you start out.

The full review is available and published as follows

Brook, J., Aitken, L., Webb R., MacLaren, J., Salmon, D. (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review, International Journal of Nursing Studies, Volume 91, Pages 47-59,
ISSN 0020-7489.
https://doi.org/10.1016/j.ijnurstu.2018.11.003

Unfortunately it does not appear to be open access.

So to the UK response to Coronavirus. Effectively all 4 nations in the UK have just sent all their students out into practice prior to completing their education at a time of crisis. It is not likely that the usual transition programmes that most hospitals and employer they are being sent to are running, or will be in place for them, or even considered, until this lockdown ends and something like ‘normal’ service is resumed.

What happens this month and over the next few months may well shape the outcome of hundreds of new students attitudes towards their profession. Are they going to transition well into their new roles with more limited support? Will the NHS and other employers consider offering better support to those who have commenced ‘early’ to help them out in the current situation? Will the Government follow through on the plans it says it has to better support and reward front-line health and social care staff? Will the COVID-19 situation encourage people to join health and social care professions or will it put them off?

I really don’t have the answers to the above questions. We will just have to wait and see… but I am worried already and angry at how depleted the nursing workforce has become and how badly the successive Conservative governments have treated Nursing and  other AHP professionals.

If nothing else, its time to change or my profession will become less attractive and the recruitment and retention problems existing at the moment will only worsen.

(You can follow me on Twitter @uwsraymondduffy)

 

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