#IGNursing17 Natalie Shamash Careers Clinic Project Lead University College London Hospitals NHS Foundation Trust Lorraine Szeremeta Deputy Chief Nurse University College London Hospitals NHS Foundation Trust
Improving Recruitment and Staff Retention UCLH Transfer Scheme Lorraine Szeremeta - Deputy Chief Nurse, UCLH Foundation Trust, Natalie Shamash Careers Clinic Project Lead, UCLH Foundation Trust
The National Picture 2014 nursing vacancies at its highest for 15 years Number of reports highlighting concerns regarding nursing numbers and patient outcomes NHS headcount increased by 4.9% between August 2012 & November 2015 returning to level last seen in 2010. Now FTE higher than 2010 Overall UK Nursing workforce rose by 3% between March 2012 and March 2016 Opportunities for nurses generally outside of the NHS New Generation of Nurses different expectations
Why is nurse retention important? Nurses leaving a trust can lead to a loss of institutional knowledge and adversely affect the quality of patient care and access Recruiting nurses to replace leavers can be difficult and expensive: Shortages of nurses in some geographies and for some specialties (e.g. geriatrics) Training new nurses takes at least three years and is expensive Supply from outside the European Economic Area (EEA) has declined over the last decade. Brexit may create greater barriers for new recruits from the EEA. The variation in leaver rates from NHS trusts across the NHS, implies that there is scope for some improvement. Leaver rates also vary significantly within trusts. Source NHSI
What proportion of nurses are leaving NHS providers? Why have leaver rates increased since 2011/12? Improved labour market conditions Greater competition for nurses post Francis report Changing composition of the workforce Increased demands and pressure of the job
Where are they going? Half of the nurses leaving an NHS provider move to work in another part of the NHS, while the other half leave the NHS The NHS leaver rate versus the NMC leaver rate suggests that most nurses leaving the NHS are either taking a short term career break or are going into other nursing roles. Around 20% of nurses in the UK work outside of the NHS. 13% work in the private sector and around 6% work outside the NHS in charity or the voluntary sector, local government and other public sector. 3.9% is likely to be a lower estimate of the leaver rate from UK nursing; some nurses choose to stay on the NMC register while not working as a nurse 0.9% are retiring from the NMC register 6
Nursing in London Good Transport Variety Cultures Location Pay Experience Opportunities Range of Colleagues London Chance Develop Patient Access Wide Range
UCLH Overview Major London teaching hospital; provides general acute hospital services and nationally recognised cancer specialist provider Combined population locally of 1.626 million. High level of poverty in local population (78,600 children) Employs approx. 8,000 staff of which approx. 3,000 are nursing staff Recruit around 1,200 new staff across sites each year Major research activities in partnership with University College London Clinically led model long standing tripartite management (nursing, medical and general management) reporting to Medical Director Generally not difficult to attract nursing staff to the organisation. 8
What was the problem at UCLH? 16% overall nursing vacancies in 2014 - London average 17% Actively recruiting vs. losing a high percentage of existing workforce. In 2014, 648 registered nurses were recruited, however 443 left the trust Exit questionnaires/independent market research highlighted nurses were leaving: Unaware of all in-house opportunities available for career prospects Frustration in repeating pre-employment checks when applying internally Feeling unsupported to apply for lateral roles internally High cost of living in central London 9
Requirement for a long term retention strategy Retention strategy established to stem the flow of nursing workforce; improve job satisfaction, morale, career pathways, confidence 2 unique nurse-led initiatives to support opportunities and prospects available at UCLH were proposed, piloted and introduced: Careers Clinic for nurses offering professional career advice Transfer Scheme fast tracked process for nurses interested in a sideways move, reducing the complexity and time to fill vacancies 10
What did we do? In 2015 a Steering group representing nursing and workforce teams established to design and implement improvements Pilot process for nurses transferring sideways to a specialty of choice to be facilitated by project lead Challenge/Barriers the Trusts size and multiple sites meant difficulties in convincing managers so project was piloted in one clinical board initially. 11
Process flow Week 1 Week 6 Nurse attends careers clinic to discuss career pathway and vacancies Nurse registers interest to transfer and submits application form authorised by line manager Vacancy exists in area of interest recruiting manager interested to meet Transfer agreed. Existing & prospective manager confirm transfer date Nurse retained through structured support with new career pathway Encouraged to work bank shift/shadowing opportunity in area of interest ahead of transferring Nurses must meet the eligibility criteria to be considered for a transfer 12
Measures Measures to assess the impact: Monthly leavers data for nurses Exit interviews from both the trust survey and careers clinic interview Number of contacts to careers clinic Reasons for transfers Number of requests for, and successful transfers 13
Evaluation Initially Band 6 nurses were out of scope for pilot but following interest received, the pilot was opened up to this staff group. Interestingly band 6s were requesting a reduction in band to gain experience in different areas Initiatives permanently adopted for nursing staff Nurses feel enabled to forecast their own career path and benefit from a wide range of in-house opportunities Although nurses are leaving one specialty and moving to another they are remaining as trust employees Financial savings average recruitment cost of a band 5 nurse is between 1-9k 130 transfers to date 14
Other staff groups During the pilot, requests were received from other staff groups interested in transferring Process trialled for Nursing Assistants where turnover was high To date, 15 successful transfers for Nursing Assistants 15
Vision for the future To apply the model to Allied Health Professionals Partnership with other NHS organisations across the local health economy as a joint initiative to retain the workforce Trial inter trust transfer rotations What can we do together to model this nationally? 16
Natalie.Shamash@uclh.nhs.uk 17