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Staff retention is a huge challenge for healthcare organisations, so if you’re thinking of leaving, can strategies such as flexible working, internal transfers and so-called stay conversations make you feel more inclined to stay?
Nursing has a problem with retention across the UK. But the scale of the issue is not uniform – it varies between organisations.
Nursing Standard. 39, 6, 64-65. doi: 10.7748/ns.39.6.64.s20
Published: 05 June 2024
Analysis by health think tank Nuffield Trust found notable differences between different employers in the number of nurses leaving. Importantly, those variations were not only in nurses moving on from the profession entirely; they included those leaving one healthcare employer to move to a job with another.
Of course there will often be circumstances where no inducement can keep you. But in many cases, there are ways in which managers can increase the likelihood of a ward, department or organisation retaining its valued nursing staff.
University Hospitals of Derby and Burton NHS Foundation Trust has introduced a range of measures to improve nursing retention.
An internal transfer scheme supports staff to stay in the organisation, but to take on new roles; a ‘working for longer’ project has given nurses more information about retire-and-return and pension options; and conferences helped to give managers more information about reasonable adjustments, including for symptoms of menopause.
The trust had an average nursing turnover of 8.46% for the year ending January 2024. This compares to rates of 9.63% and 12.23% in the two organisations that merged to form it in 2018.
A decision to stay in an organisation or to leave is highly individual, explains NHS Employers assistant director for development and employment Jennifer Gardner. ‘There are so many different elements that can contribute to retention,’ she stresses.
The key to holding on to staff, says Ms Gardner, is for a manager to know what those factors are for each member of the team. If it only becomes clear that nurses are unhappy when their behavior changes, or that they are resigning only when a letter is submitted, there is a problem – and it is likely that retention rates will be poor.
In 2022, NHS England published a nursing and midwifery retention self-assessment tool. It is designed to help organisations assess performance against the seven elements of the NHS People Promise.
The information gathered can then be used to identify areas for action and to implement local retention improvement plans.
This tool is intended to be used by chief nurses and human resources professionals, as well as managers in specific directorates and departments. But line managers also have a practical, hands-on role to play in supporting conversations that encourage retention, not least through regular conversations with staff.
‘Stay conversations’ offer an opportunity to find out what will help keep an individual in their role or in the organisation. ‘Essentially it is about understanding what people enjoy about the workplace, what they find frustrating, and how they could be more satisfied in their role – looking at areas of development and the working environment,’ says Ms Gardner.
They can be particularly helpful for new starters, who may be at increased risk of leaving. ‘Some organisations are doing three, six, nine conversations – so a conversation at three months, one at six, one at nine to ask: “How are things for you?”’
The NHS Long Term Workforce Plan recommends stay conversations should be standard practice: ‘Every staff member should be given the opportunity for regular conversations to discuss their well-being and what will keep them in work, including discussions about pension flexibilities, flexible working options, and health and well-being.’
There is no one set format for a stay conversation. With that said, NHS Employers suggests focusing on two areas – finding out what might be pushing someone to leave; and identifying what might pull them back from leaving.
It offers the following examples of potential questions:
» What gives you the greatest enjoyment in your work?
» What do you find most frustrating in your work
» How involved do you feel about changes at work?
» What could be done to improve working conditions/relationships in your team?
» How can we help you achieve your goals?
» If there was one immediate change that could be made in your working life, what would it be?
Source: NHS Employers (2023) Retention Discussions: From Reaction to Prevention
The important thing is to take action. Not everything that affects someone’s job satisfaction will be something on which a manager can act: pay being the most obvious example. In such cases, it is important to be honest about what is and is not possible (and offer different support to improve a financial situation – signposting to advice services, for example).
Where something can be actioned, a clear time frame should be given.
‘It’s about following through conversations and actions,’ says Ms Gardner. ‘Because that builds up trust and someone feeling valued. If they’re in an environment where they feel safe and trusted and valued, they’re going to want to stay.’
Find out more about the impact on retention of supportive managers, development opportunities and career chats rcni.com/stay-or-resign
