Flexible shift patterns in a community district nursing team

Overview

Midlands Partnership University NHS Foundation Trust (MPFT) piloted a scheme of flexible working, by extending shift patterns in its community nursing teams. Following the success of the scheme, not only has the scheme been rolled out to other teams in the trust (clinical and non-clinical), but also been shared with several community teams across the country to support their flexible working approach. 

Key benefits

• There was a positive impact on the retention and attraction of the workforce.
• The scheme has been adopted by several community nursing teams across the country and can be offered to all staffing groups not just nursing teams.
• There were no additional costs incurred by changing shift patterns.
• Staff gained better work-life balance, there was a reduction in staff working unpaid hours and they were more willing to pick up extra overtime and bank shifts if needed. 
• There was greater continuity in care for patients who were able to see the same member of the team over a longer period.
• Improved efficiency and capacity.

What the organisation faced

MPFT had a number of obstacles to overcome. 

Historical shift patterns

In the community nursing teams shift patterns varied by team and locality but were fixed with little flexibility. Often shifts were 8.45am to 5pm or similar, seven days a week. 

Flexible working

This was available on request to staff who had caring responsibilities, or needed to work differently due to illness or disability but this was often a temporary agreement and was not always available to all.

Poor retention

Exit interviews showed experienced nursing staff were leaving the service to work in other services that supported working shifts over fewer days as standard.

Missed recruitment opportunities

Experienced staff indicated they wanted to move to community nursing but increasingly asking to work full-time hours over less than five days. Some were used to working long days in other organisations and were not prepared to give up their days off. 

Changing demand

MPFT faced challenges in matching available workforce to the changing demand for timed visits. Teams were unable to meet their timed medication demand because of the volume of demand and rigid shift times. For example, staff were not able to provide medication to patients before breakfast or with their evening meal.

Capacity challenges

Capacity in the team was reduced by staff requiring temporary reductions in hours to address caring responsibilities, there were high levels of sickness and requests for special leave.

What the organisation did

The team reviewed current evidence and guidance including the Queen's Nursing Institute guidance on Workforce Standards for the District Nursing Service and NHS England's flexible working guidance. 

The team spoke to other community and hospital based providers to see what worked for them. They also conducted a literature search on the impact of 12-, 10- and eight-hour shifts and found that 12-hour shifts could have negative impact on staff wellbeing and in turn patient care; and were also associated with increased workplace errors. They found no evidence of a negative impact from shifts that were 10 hours or less, on medication or workplace errors, reports of burnout or increased fatigue from staff.

MPFT carried out pulse checks (surveys, group discussions, interview feedback and face-to- face one-to-one discussions) among its staff and found out that while some staff were happy with their existing shift patterns, a large majority of them were interested in doing longer shift patterns over a shortened number of days. 

The trust used NHS Employers' flexible working toolkits to support the change. MPFT also engaged multiple stakeholders such as HR and rostering colleagues, partner organisations and patients to understand how viable the scheme was and what the likely impact of the scheme would be. 

The piloted scheme ran for eight weeks, it consisted of: 

• Two community nursing teams, one city based team with stable staffing and another team that covered a larger geographical area and city and rural localities, with more unstable staffing and high levels of sickness in order to understand the variables.
• 9.5-hour shifts were introduced at either 7am to 5pm or 8am to 6pm, with full-time staff allowed a shift per week where they could finish 30 minutes earlier. 
• Voluntary participation so that anyone who preferred the usual 8.45am to 5pm shift pattern was allowed to maintain their hours. 

Results and benefits

On evaluation of the scheme, they found that there was no increase in complaints, incidents or risk to patients because of the change in shift patterns. Patients experienced better continuity of care having the same member of the team see them over a longer period. 

A staff survey found that there was no change in the number of patients being seen by the team each week regardless of the shift patterns. Staff were also more willing to pick up bank shifts and overtime during surges in demand, as they felt they had adequate rest days within the week. Staff expressed overwhelmingly positive feedback to the change in shift patterns. 

• Workload was perceived to be 35 per cent more manageable.
• Staff reported working less unpaid overtime.
• The flexibility supported their management of personal caring commitments, as well as supporting staff to manage their own health and wellbeing.
• Their work life balance saw significant improvement.

Gemma talks about her experience on the piloted scheme and the changes it has made in her work and life. The shift pattern is now a permanent fixture offered to community nursing staffing groups including admin and leadership teams. 

Take away tips

• Make sure you involve HR and rostering colleagues from day one, this will help streamline the process and help to plan off duties. 
• Follow a plan, do, study, act (PDSA) cycle. Continuously evaluate the changes, through staff feedback and review of relevant data. Monitor patient feedback, incidents and activity data identify and address any issues.
• Celebrate successes.
• Be open minded and willing to adapt and try new approaches.
• Make the changes optional, listen to the needs of staff as they will change over time so today’s solution may not work in a couple of months. 
• Use resources available such as NHS Employers' flexible working toolkits to support the scheme for change to work more flexibly.