Nurses comprise 50% of the healthcare workforce and therefore care quality depends on maintaining workforce numbers. In collaboration with Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust (RBCH), researchers from Bournemouth University have been looking into ways in which the NHS can retain nursing staff in times of increased care demand, declining resources and uncertainties post-Brexit.
BU Associate Professor Janet Scammell is the Principal investigator of the Burdett Trust for Nursing funded research, looking at how nursing levels can be improved or maintained through the collaborative development and use of an evidence-based nurse retention model, known as TRACS (Transition, Resilience, Authentic Leadership, Commitment, Support).
Janet said: “Nurses are the largest professional group within the healthcare workforce, so a shortfall of nurses will undermine the whole system. Nurses provide 24/7 care, they are always there, and they provide the glue that brings all other healthcare workers together to benefit the patient. Insufficient nurse numbers leads to increased staff stress as they struggle to maintain quality of care.
"For all nurses, the patient is their number one priority but it’s challenging to remain motivated if they cannot give the quality of care they wish to. RBCH is a successful Trust that views their staff as one of their greatest assets and keen to support their staff in these challenging times.
"Working collaboratively, our project looked at the reasons why nurses stay or leave the profession or employer, and then implemented a model that we’ve developed to see if we can support nurses to stay within the profession.”
The TRACS model focuses on key factors known to impact on intention to stay:
- supporting Transition at key career and personal life junctures (such as access to childcare)
- building Resilience to develop positive coping strategies,
- facilitating Authentic nurse leadership throughout the organisation,
- securing Commitment to working practices that support work-life balance
- providing on-going personal and professional Support for staff health and wellbeing.
The two-year study, which concluded in September 2019, initially drew upon Trust baseline data from the NHS staff survey and feedback from nurses. Focusing on nurse retention triggers, the data reflected wider trends across the UK and elsewhere around increasing staff turnover and workload.
A pre-intervention survey then collected data using tools to look at nurses’ perceptions of their practice environment and factors that are known to contribute to burnout. This highlighted a strong commitment to patient care but feeling less valued as they tried to cope within resource limitations, including a perceived lack of staff development opportunities.
Following staff consultations and working closely with nurse management, the project team worked to enhance and improve easy access portal designed specifically for nurses called Support4Nurses This is a one-stop shop for busy nurses to access information and support when they need it, anytime and on any device.
This was introduced in one directorate initially and is now promoted Trust-wide. It is supported by a range of best practice aimed at supporting nurses at trigger points when findings indicated that intent to leave may be a factor: improved staff development including clearer early career pathways as well as clinical lead development; highlighting the benefits of clinical education posts; promotion of the health and wellbeing service; and closed Facebook groups for team-based support.
At a policy level, the TRACS model is informing a new Trust nurse retention strategy. The portal is being integrated into the Trust’s support systems and is available on the internet for others to access in the wider healthcare community. The portal architecture can also be used to design bespoke portals for other organisations and has been presented both locally and nationally where considerable interest has been shown.
Tash Kelly, Ward Sister at RBCH, said: “I think the portal is an idea which can give all nurses up-to-date information, which, in turn, helps them communicate with each other and stay. Staff can access it from home too.
"One of the biggest things is support, and one of the most popular parts of the site is the wellness and support area, which is a surprise, because we thought it might be the career development side, but it’s really good and if nurses feel supported and valued, they will stay.”
She added: “There are all sorts of issues affecting people’s decisions to stay in the profession, not just the removal of the nurse student bursary, but things like Brexit, people being afraid to stay, and the sheer burnout of nursing staff – people are sicker now and in hospital for more complex reasons. You’ve got people who are acutely unwell, and that creates a lot more strain than people realise.”
Hannah Kennedy, a Staff Nurse on the Acute Medical Unit, added: “Our ward is intense but what we have is an excellent team, people onboard stay and are encouraged to stay because of the team spirit, which helps keep retention in that area.”