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• To be aware of the potential benefits of flexible working initiatives such as self-rostering in addressing recruitment and retention issues in the nursing profession
• To understand that self-rostering may enhance nurses’ work-life balance and job satisfaction
• To recognise that the implementation of self-rostering initiatives must be assessed for suitability on an area-by-area basis
Nursing vacancies are high across the UK, with some nurses considering leaving the profession. Evidence suggests that employers, including the NHS, need to be more flexible about working times to support employees’ work-life balance and job satisfaction. Self-rostering is one approach that has the potential to enhance nurses’ work-life balance and job satisfaction, enabling scope for greater autonomy. This could in turn lead to fewer nurses leaving the profession and contribute to making nursing more attractive as a career. This literature review focused on nurses in the NHS and found that self-rostering had a positive effect on their work-life balance and job satisfaction. However, a move to self-rostering can pose challenges and it should be assessed for suitability before implementation. Given the nursing vacancy crisis in the UK and many nurses’ intentions to leave the profession, the potential benefits of self-rostering for nurses cannot be overlooked.
Nursing Management. 29, 6, 27-32. doi: 10.7748/nm.2022.e2048
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Published: 01 December 2022
There are more than 50,000 nursing vacancies across the four UK countries, a number which is estimated to increase (Royal College of Nursing (RCN) 2021). Although there has recently been a record number of applicants to nursing courses in the UK (Universities and Colleges Admissions Service 2021), nurses are also leaving the profession (Ford 2020, Hackett 2021). In addition, there is evidence to suggest that nurses experience burnout (Dall’Ora et al 2020), with the coronavirus disease 2019 (COVID-19) pandemic likely to have increased burnout levels (Galanis et al 2021). Recent literature and systematic reviews have identified increasing numbers of nurses intending to leave the profession, citing reasons such as inflexible working hours, low levels of autonomy, work-related stress, suboptimal job satisfaction, increased unpaid working hours, and a lack of ability to take breaks and time off (Chamanga et al 2020, Marufu et al 2021).
The NHS People Plan 2020-21 (NHS England 2021) discussed the importance of employers being more flexible in their approach to staff, including nurses. This is not new, with similar recommendations made 22 years ago about enabling front-line staff to have more autonomy over their working hours (Department of Health 2000). Other publications have recommended that employers become more flexible (RCN 2015, NHS Employers 2020), with the findings of a systematic review tentatively suggesting that ‘flexible working interventions that increase worker control and choice (such as self-scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes’ (Joyce et al 2010).
Self-rostering, or self-scheduling, is a form of flexible working. In the NHS, team-based self-rostering is defined as ‘a “bottom up” approach to scheduling work, giving staff more control over the pattern of their working week’ (Dartford and Gravesham NHS Trust 2022). Employers set roster and skill-mix parameters in advance, and self-rostering enables staff to choose their times and days of work within these set parameters (Wynendaele et al 2021).
There are alternative types of self-rostering. Team-based rostering, for example is less flexible than total self-rostering (Timewise 2019). Internationally, self-rostering has also been the subject of previous research such as Wynendaele et al’s (2021) wide-ranging systematic review of international literature on the effect of self-rostering from the perspectives of patient, nurse and organisation. Wynendaele et al (2021) found that self-rostering had a positive outcome for nurses in terms of work-life balance, greater satisfaction with working times and increased work-time influence, that is the influence staff had over their working times such as if they could start and finish at times that differed from the standard. However, an organisational outcome was that staff felt that supervisor support was reduced when self-rostering. Wynendaele et al (2021) noted that evidence on how self-rostering affects patient perspectives was not significant enough to draw conclusions and further identified a lack of evidence on the topic generally.
The aim of the literature review was to contribute to the existing evidence on self-rostering by focusing specifically on self-rostering for nurses in the NHS in the UK. It aimed to determine if self-rostering initiatives may have the potential to enhance work-life balance and job satisfaction. To the best of the authors’ knowledge, no previous review has focused on self-rostering, work-life balance and job satisfaction in UK nursing. This is an important topic given the high level of nursing vacancies and reports of burnout among UK nurses.
The population, intervention, comparison and outcome (PICO) framework (Boland et al 2017) was used to develop the review question: Does enabling nurses to self-roster their hours and days of work increase job satisfaction and work-life balance?
A scoping search provided an initial understanding of the literature. The next stage was to define the inclusion and exclusion criteria (Table 1). Although there are several comment and opinion articles on the topic (Fudge 2001, Barrett and Holme 2018, Elliott 2020a, 2020b, Rawson 2020), it was decided that the articles included in the review should be limited to primary research and other studies. There was no restriction on study design or the type of study.
A comprehensive literature search was conducted in the first months of 2021. Four databases were searched: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, ProQuest and Scopus. Keywords included: ‘nurse’, ‘nursing’, ‘nurses’, ‘self-staffing’, ‘self-roster’, ‘self-rostering’, ‘self-scheduling’, ‘morale’, ‘work-life balance’, ‘fatigue’ and ‘job satisfaction’, using truncation and Boolean operators to ensure the search was focused and appropriate: ‘self-staffing’ OR ‘self-roste*’ OR ‘self-scheduling’ AND ‘burnout’ OR ‘morale’ OR ‘work-life balance’ OR ‘fatigue’ OR ‘job satisfaction’.
The initial search returned 132 results. After duplicates were removed, the titles and abstracts of 73 records were screened resulting in 63 being excluded. The full texts of ten articles were then screened for inclusion and four were excluded. Due to a low number of results, secondary searching in the form of hand searching was undertaken to identify sources the search might have missed. This resulted in an additional two ‘grey literature’ (information that has not been formally published in journals, for example) sources being included but removed on screening.
Six studies were therefore included for analysis and synthesis and were read in full before data extraction was undertaken to ensure they were appropriate and applicable to the review aim and question.
Data were extracted from the included studies using a data extraction form devised by the authors. Following this, a bespoke quality assessment tool was developed to assess the quality of the studies and comprised three questions: Does the study have a clear aim and/or objective? Is the study method appropriate to address the aim and/or objective? Does the study indicate its strengths and limitations? (Table 2).
The principles of narrative synthesis were used to analyse the findings extracted from the included studies (Popay et al 2006). Narrative synthesis involves applying an iterative four-level framework:
1. A theory of change was identified, which centred on self-rostering being hypothesised as an initiative that could improve work-life balance and job satisfaction.
2. The data extracted from the studies was applied to develop a preliminary synthesis.
3. The relationships in the data were explored by identifying overarching candidate themes from the included studies.
4. The robustness of the synthesis was assessed by refining to generate two overarching themes: self-rostering and improved work-life balance, and self-rostering and improved job satisfaction.
The characteristics of the six studies are outlined in Table 3 at rcni.com/work-place-balance. Three of the studies involved a trial of self-rostering (Richmond and Greenhill 2003, Wortley and Grierson-Hill 2003, NHS England and NHS Improvement 2019), with one focusing on team-based rostering (Timewise 2019). Silvestro and Silvestro (2000) and Silvestro and Silvestro (2008) discussed self-rostering among other rostering practices in the UK.
Timewise (2019) identified that nurses’ work-life balance increased after implementation of a team-based rostering initiative. In this project, work-life balance was measured by nurses’ input into rosters. Increases in nurses’ level of input into rosters were reported after the initiative (14% at implementation versus 26% at completion), while midpoint scores went up from 21% to 40%. However, one third of respondents felt they still had insufficient input into their rosters (Timewise 2019).
Silvestro and Silvestro (2000, 2008) identified that staff were able to coordinate their lives more effectively when they were able to self-roster, with an ability to fit home life in with work schedules. The ability to have much greater control over aspects such as childcare arrangements and being better able to plan life outside work was identified by Wortley and Grierson-Hill (2003). They found that 82% of respondents reported enhanced work-life balance six months after implementation of a self-rostering initiative compared to 38% before the initiative.
Participants in the survey by Richmond and Greenhill (2003) also reported benefits, for example that they had fewer periods with eight to ten consecutive days of work.
Silvestro and Silvestro (2000) identified that high levels of staff empowerment and motivation resulted from the ability to self-roster. Staff also showed greater incentive and commitment when they were able to self-roster. NHS England and NHS Improvement (2019) suggested that self-rostering reduced staff attrition, due to the provision of better choice and flexibility, enabling greater job satisfaction. In the intensive care unit pilot site, NHS England and NHS Improvement (2019) reported that vacancy rates decreased from 33.6% to 27.1% and the turnover rate reduced from 29.8% to 17.2%.
Timewise (2019) conducted its project in the light of research showing that many nurses were unhappy with their rotas and many intended to leave their workplace. With self-rostering, feelings of collective responsibility were greatly enhanced, leading to greater job satisfaction. Wortley and Grierson-Hill (2003) and Richmond and Greenhill (2003) found evidence of a greater perception of autonomy and responsibility, with staff wanting self-rostering to continue.
This review synthesised the findings of six studies to determine if self-rostering initiatives may have the potential to improve work-life balance and job satisfaction for UK nurses in the NHS. Silvestro and Silvestro (2000) stated that self-rostering is only appropriate for areas that have small staff numbers, arguing that larger numbers may make self-rostering unmanageable. Therefore, they stated that studies focusing on self-rostering trials with larger numbers of staff are required to improve the evidence base. They continued by stating that self-rostering is often advocated naively and is implemented for the benefit of staff rather than patients and the organisation, suggesting that staff often have little consideration for the effect and challenges of self-rostering beyond their own experience. This statement by Silvestro and Silvestro (2000) may be challenged given the concerns about nursing vacancies, not to mention the effect of shift work on nurses’ physical, mental and social health (Dall’Ora et al 2016, 2020). Self-rostering cannot in itself eliminate the need for shift work, but having more autonomy and influence over working patterns may reduce the negative effect for nurses of working continuously for extended stretches (Richmond and Greenhill 2003).
The ability to have an element of choice in rostering could improve nurses’ job satisfaction and work-life balance, which may in turn enhance their mental health and well-being, as well as their physical and social health. This is in line with the findings of Wynendaele et al’s (2021) systematic review that work-life balance and job satisfaction appeared to increase after the implementation of self-rostering. However, an important issue relating to work-life balance is that self-rostering may not reduce the working times of nurses. For example, nurses may be able to choose the days they work or even the type of shifts, such as day or night shifts, but depending on the area of work, they may have little if any control over start and finish times. Start and finish times can be further influenced by staffing issues and the acuity of patients. For example, the shift end time may be 8pm but due to staffing issues or patient acuity, nurses may leave much later than this, sometimes working unpaid overtime. This issue merits further investigation in the context of research on self-rostering given that the NHS Pay Review Body (2019) identified that the service is reliant on the goodwill of staff, often leading to unpaid overtime, which in turn affects work-life balance.
Silvestro and Silvestro (2000) argued that all staff need to appreciate the complexity of rostering. Silvestro and Silvestro (2008) alluded to the fact that there is a serious need to reconsider and rethink rostering systems in the UK. They suggested that suboptimal rostering can result in dysfunctional behaviour by staff, such as taking sick leave when shift requests are rejected. Although they do not suggest that self-rostering will solve this issue, self-rostering certainly could be considered as a possible approach to tackling the phenomenon. Roster design has a direct effect not only on the nurses working those rosters, but also on overall organisational performance, affecting areas such as retention and recruitment (Silvestro and Silvestro 2008). This may indicate that improvements in job satisfaction and work-life balance gained by self-rostering could in turn have a positive effect on retention, recruitment and staff attrition levels, and even possibly attract more people into the nursing profession.
Although this review has not addressed the question of retention and recruitment directly, NHS England and NHS Improvement (2019) reported improved results in relation to vacancy rates following the implementation of self-rostering. In addition, Silvestro and Silvestro (2000), despite their reservations, noted that self-rostering fostered enhanced motivation and commitment to employers. This was also the case in the other studies, all of which reported a greater feeling of satisfaction, autonomy, work-life balance and responsibility among nurses (Richmond and Greenhill 2003, Wortley and Grierson-Hill 2003, NHS England and NHS Improvement 2019, Timewise 2019). These findings are supported by the wider literature, where for example, Hung (2002) reported that self-rostering reduces staff turnover, leading to cost savings. Hung (2002) further indicated that self-rostering empowers staff, by granting them accountability, participation, creativity and autonomy. Other commentators also reported these benefits (Fudge 2001). In addition, Barrett and Holme (2018) and Koning (2014) stated that leaders and managers have a duty and obligation to support such initiatives and changes to roster practices for the benefit of staff, to ensure organisational performance and the overall functioning of healthcare provision.
Nonetheless, supporting self-rostering can be a challenging suggestion for many managers. Wortley and Grierson-Hill (2003) found that some managers declined the opportunity to allow staff to self-roster because of a fear of losing control. The researchers identified that to be effective, self-rostering required management support, enthusiasm and positivity. Conversely, managers did implement self-rostering trials in the project by Richmond and Greenhill (2003), which is arguably a more proactive leadership style. It is important to note that the implementation of self-rostering should not be considered in attempt to be ‘fashionable’, but it should have a clear aim or purpose (Silvestro and Silvestro 2000, Richmond and Greenhill 2003).
The Nursing and Midwifery Council (NMC) promotes registrants’ autonomy (NMC 2018a, 2018b), yet some aspects of nurses’ working conditions such as rigid working patterns prevent autonomy. This review identified that granting staff the ability to self-roster and have some level of autonomy over their working times and days, may enable them to achieve an enhanced work-life balance and increased job satisfaction. West et al (2020) identified that autonomy is one of three vital elements that nurses should possess if they are to thrive and flourish in the workplace, the other two being belonging and contribution, all of which could be enhanced by self-rostering. All of these elements combined are vital to achieve the aim of safe and effective working conditions, not to mention their positive effect on the crisis in nursing vacancies.
This literature review was led by a novice researcher for an undergraduate dissertation. The screening and data extraction for the review was undertaken by the lead author (BW), but would usually be undertaken by more than one person. However, the work of the lead author was checked by the second author (DA). The review could have explored more databases.
One strength of the review was that it appears to be the first of its kind with a sole focus on UK-based studies. The review also included grey literature, which added to the weight of evidence, particularly since there is a dearth of peer-reviewed studies on the topic of self-rostering in the UK. Grey literature can also reduce the likelihood of publication bias in a review. However, the inclusion of grey literature can also be limited in terms of quality because it comprises non-peer-reviewed evidence. Nevertheless, all the studies included in the review were subject to a quality assessment and the authors felt that, on balance, the grey literature added useful evidence.
Limitations were identified in the included studies. For example, a significant limitation of the studies which featured quantitative analyses was that none included comparator groups in their designs. This limitation meant that the review findings should be interpreted with caution in terms of directly attributing any effects on work-life balance and job satisfaction to self-rostering initiatives.
This review identified a lack of studies on the topic of self-rostering in the UK, with no peer-reviewed studies published since 2013. However, the findings of the peer-reviewed articles and more recently published grey literature indicated that the effect of self-rostering on nurses’ job satisfaction and work-life balance warrants further study.
As noted, the quantitative studies included in the review had limitations. The authors concur with Wynendaele et al (2021) that future quantitative research should consider longitudinal approaches using comparator groups. In addition, any future research should consider focusing on self-rostering approaches for groups of nurses outside primary and secondary care, for example in social care. Future researchers might also consider outcomes such as morale, empowerment and commitment in relation to self-rostering, as well as focusing on elements such as the size of the area in which the intervention is being implemented. If pilot studies of self-rostering in larger areas proved that it could be effective, it might then be the case that scaling up would be appropriate, with whole hospitals trialling self-rostering.
In terms of policy, self-rostering and other forms of flexible working are already embedded in high-level policy, recommendations and UK law. Policymakers should be open-minded and consider all possibilities in a bid to enhance nurses’ work-life balance and job satisfaction. This could subsequently have a positive effect on recruitment and retention at an organisational level, and also on employers’ duty of care for the health and well-being of staff.
This review explored the use of self-rostering as an intervention to enhance UK nurses’ job satisfaction and work-life balance. The findings demonstrated that self-rostering is associated with a positive effect on nurses’ work-life balance and job satisfaction. This review also found that self-rostering can pose practical challenges and it is important that self-rostering initiatives are assessed for suitability, since it is not an intervention that will be appropriate for all areas. The challenges posed by the implementation of self-rostering should not overshadow the potential benefits and positive effects for nurses, especially given the rate of nursing vacancies across the UK and the reasons behind many nurses’ intention to leave the profession.
• Employers should be more flexible regarding nurses’ working times and patterns, which could in turn lead to enhanced work-life balance, and a potential for reduced attrition rates and increased recruitment
• Self-rostering is one form of flexible working, which can be implemented with the willing support of staff and managers
• Self-rostering needs to be assessed for suitability, taking into account that it will not be appropriate in all areas
01 December 2022 / Vol 29 issue 6
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