Improving retention at all stages of nurses' careers: United Lincolnshire Hospitals NHS Trust

Overview

United Lincolnshire Hospitals NHS Trust (ULHT) developed a detailed retention action plan which outlined the steps the trust could take to reduce nurse turnover rates. Target areas for interventions were identified based on the findings from extensive staff engagement, with the trust focusing activity across all stages of a nurse’s career.

Key benefits and outcomes

• Created a retention action plan which included a number of initiatives focused on four key areas of nurses’ careers: supporting new starters, staff mid-career needs, supporting over 50s and those that were leaving the trust.
• Many wards have adopted the use of self-rostering and data from staff surveys shows that there has been an increase in staff satisfaction on the wards, a reduction in time spent on finalising the roster and feedback suggests that it has reduced sickness absence.
• All staff members that have had ‘itchy feet’ conversations, have stayed with the trust.
• Changes to the leavers process has resulted in an increase in completion rates of exit surveys, from 12 per cent to a response rate of 38 per cent.

What the organisation faced

Increasing nurse turnover rates were an issue in 2018. A report commissioned in May 2018 highlighted to the trust that a ‘one size fits all’ approach would not work and that they needed to look at retention initiatives targeted at staff groups with differing motivations and needs. At the time of the report 20.9 per cent of the trust workforce were aged 55 or over and within five years this was expected to increase to 36.8 per cent.

Key differentiations for the trust’s workforce and their needs were outlined as follows:

• Baby boomers (+50 years) - look for a workplace that compliments their attitude to team working, and value leadership and mentoring positions for continued workplace learning.
• Generation X (35-50 years) – generally seen as adaptable and great at collaboration, they want to learn more skills to stay competitive and highly value work/life balance.
• Millennials (18-34 years) – important to have a workplace that aligns with their values and flexibility to sustain a good work/life balance, with ongoing feedback to help them progress.

What the organisation did

The trust set up a retention project team in July 2018 and developed a framework that helped bring focus to the retention initiatives, based on the above identified groups within the workforce. The team put together a retention action plan and its overall aim was to reduce nursing turnover at the trust by one per cent over a 12-month period.

In order to achieve this, they focused on drivers which broadly covered three themes:

1. Enhance the quality of data around nurse turnover to understand the reasons behind staff leaving and staying.
2. Develop a formal and consistent approach to flexible working including the option to retire and return.
3. Enhance awareness of the development opportunities and career pathways available for staff.

Since the inception of the project, there have been a number of initiatives that have been undertaken by the project team and supported by other teams both within the HR and organisational development (OD) directorate, as well as the nursing clinical education team. As a starting point, the team set out to better understand staff experience by organising world café events across two hospital sites to engage staff and find out more about what would make them want to stay with the organisation. They were able to gain views from more than 100 participants via one-to-one interviews, focus group discussions and online surveys. Based on the findings of the staff engagement exercise, the project team launched their interventions from November 2018. These included specific outcomes targeted at staff within each of the following career stages.

Pillar 1: Supporting new starters

• Rotational posts were identified for a set of roles within various wards and newly qualified nurses were put on a rotation programme.
• A legacy nurse initiative was introduced to support newly qualified nurses with information sharing and buddying. The team created a mentorship programme through which newly qualified nurses can opt to be mentored by more experienced nurses.
• Insight days were introduced to enable staff to spend time on a different ward and see what it is like before making a move. A directory of insight days is available to staff with detailed information on the available posts.

Pillar 2: Staff mid-career needs

• A campaign was launched in April 2018 to showcase the career pathways of staff within the trust. The team produced video case studies to showcase the careers of a variety of nursing staff at all levels. 
• An improved and more consistent approach to flexible working has been implemented. The team shared videos from executive board members talking about their views on flexible working and how the trust supports its staff, published flexible working case studies of staff ambassadors to showcase the various ways colleagues can agree an arrangement, and created a dedicated intranet site about flexible working with details of policies and new resources to enhance awareness of flexible working internally.
• The team rebranded the benefits of working with ULHT by launching a new brochure titled ‘Hi, I’m Ben’ which highlighted all of the benefits of working for the trust. This included information on annual leave, pension, accommodation, car parking, discounts and salary sacrifice, health and wellbeing and reward and recognition. The brochure is now available on both the trust’s intranet and external website and is also used in recruitment events. 
• Self-rostering is being promoted as way of supporting flexibly working and enabling staff to achieve a better work/life balance for staff. It has become part of the flexible working policy and a toolkit has been added to the intranet with a guide for how teams can adopt it. A self-rostering pilot launched on three wards gained positive feedback.
• A new internal transfer policy has been introduced, which encourages staff to move to other roles within the hospital rather than leave the trust.

Pillar 3: Supporting over 50s

• A retire and return scheme was introduced that identifies retiring staff and the roles that they can come back to, which could either be in the same ward or a different area. The process was designed and implemented in April 2019 and sits within the nursing clinical education team.
• A communications campaign was launched to showcase and celebrate the careers of nurses who had retired and chosen to return to work at the trust.

Pillar 4: Leaving the trust

• When members of staff choose to leave the trust, it is imperative to gain as much information and feedback from them on their reasons for leaving and what the trust could have done to retain them. In some cases, this has even helped retain employees at the very last opportunity.
• ‘Itchy feet’ conversations take place with those staff who are thinking of leaving the trust or want to try something different before they resign. These are one to one conversations with a senior member of staff who may be able to address any challenges they are facing, propose solutions, and thereby change their decision to leave.
• Changes were made to the exit interview process as previously ULHT saw very little feedback from staff choosing to leave the organisation. Only 12 per cent of staff returned their paper survey and of those, 40 per cent of staff did not share a reason for leaving the trust. These paper surveys were usually posted to the individual’s home address after they had left the trust. To improve the chances of the survey being returned, a shorter online survey was introduced, with line managers now holding the responsibility to signpost to the survey and offer a conversation as soon as the letter of resignation is received.

The focus on retention is ongoing, much has been planned and delivered and the team will continue its focus in this area.
 

Results and benefits

The project team’s measures of success for the various initiatives are highlighted below:

1. Changes to the leavers process has resulted in an increase in completion rates of the exit survey, with a response rate of 38 per cent, which is a great improvement on the previous rate of 12 per cent. Of the responses received, 84 per cent of leavers have stated their reason for leaving, which is an improvement of 24 per cent.
2. The retire and return initiative involves the clinical education team making one-on-one contact with every single member of staff who has registered for the pre-retirement course offered by the trust, to discuss the option of retire and return. In the first quarter of implementing the retire and return scheme, 18 people who reported resignation due to retirement either returned to ULHT as bank staff or took up substantive posts.
3. 16 wards and outpatient clinics across three hospital sites have adopted self-rostering following the pilot. Initial surveys showed an increase in staff satisfaction on the wards, reduction in time spent by the ward sister and/or charge nurse on finalising the roster and feedback suggest that it also reduces sickness absence.
4. In the first six months of launching the ‘itchy feet’ conversations, there have been 26 staff members accessing the clinics and requesting conversations with senior leaders. The conversations prove to be a success as all 26 staff have stayed with the trust.

Other initiatives are in the early stages. The project team are periodically tracking them to assess the impact. Staff survey data and turnover data over the course of the year has indicated the initiatives are having a positive impact on improving staff experience and better retaining nursing staff.

Overcoming obstacles

The project team worked with multiple teams from across the trust to implement the various initiatives. As such, it was necessary to establish common goals and shared objectives to prevent conflicting priorities across different teams from causing tension.
 

Takeaway tips

1. Consider tailoring retention initiatives to different groups of staff based on differing motivations and needs.
2. Establish a retention project team to focus on retention and put together an action plan with clearly defined aims, roles, and responsibilities.
3. Engage with staff to find out what they would like to see implemented and once achieved, provide feedback on successes.

Contact details

For more information about the work in this case study, contact Saumya Hebbar, organisational development lead at United Lincolnshire Hospitals NHS Trust.