Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Cliff EvansConsultant Nurse Emergency Medicine
Medway Foundation Trust
governmentevents.co.uk | 0330 0584 285 | [email protected]
Case Study:Recruiting and Retaining
Urgent and Emergency Care Staff
The National Picture
• Oct 2018, estimated 41,000 nursing vacancies across England
• Nursing degree applicants fell by 23% in wake of bursary loss
• 8% of shifts remain uncovered, increasing workplace
• Vacancies vary widely by region:
Nursing vacancy rates 8% in the North - 15% in London
• West Midland Ambulance Service has no paramedic vacancies
• National average 33%
• Staff turnover or retention rates can be equally varied
Why is it hard to recruit?
• NHS staff have “never worked harder” than over the past 5 years “They’ve never had to deal with so much pressure on the front line”.
• Physical assaults on NHS staff increased by nearly 9.7% last year
Our Case Study
September 2015: 65% nursing vacancy rate within ED
• Ineffective leadership – a failure to undertake appraisals
• Only 12% of nurses had received an appraisal
• Years of under investment in staff CPD
• Ineffective working processes
• A blame focused culture
• Poor working conditions - Workforce hopelessness - Burnout
• No students
• Organisation placed in Special Measures 2-years previously
”felt like a punishment rather than help with improvement”
Creating a Sustainable Solution
Our Strategy (Summary)
• Creating a vision of improvement through visible leadership
• Establishing clear lines of communication
• Standardising career development pathways for all nurses
• Reclaiming Emergency Care as a specialism
• Taking complete ownership of the recruitment process
• Developing display boards to visually demonstrate ownership
• Investing in staff through appraisals and CPD
• Sharing resources (collaborations)
NHS Improvement(Improving Staff Retention, 2018)
• Know your local workforce data and construct a strategy based on evidence, including findings from exit interviews
• Support new starters, delivering preceptorship programmes and supervised support from experienced staff
• Offer a range of flexible working options
• Innovative employment practices such as one stop recruitment events
• Effective staff engagement, acknowledge and reward good practice
• Visualise career pathways, promoting roles and opportunities
• https://improvement.nhs.uk/resources/improving-staff-retention/
• https://www.hee.nhs.uk/our-work/workforce-strategy
February 2016 – Progress Begins
Visual Display of Traditional Nursing Workforce
New Roles – New Ways of ‘Doing’
• Having a workforce strategy
• Review of long-term vacancies
• Empowering workforce to undertake new roles
• Existing medical resources could be better utilised
• Benefit to patient groups:
• Minor Injures
• Rapid Assessment, STREAMing and turnaround of acute arrivals
• Ambulant Majors patients
Support Roles
• 60% of care provided by supporting roles (Willis, 2015)
• Knowing your workforce
• Investing in existing individuals
• Associate Practitioners and Nursing Associates
• Historically easier to recruit into support roles
• A staggered approach.
Real Progress
Visual Display of Traditional Nursing Workforce
Can New Staff Groups Improve Care?
The Financial Cost & Cost to PatientsPeriod October
2015October
2016October
2017October
2018
EDNursing Vacancy
Rate 65% 30% 18% 4%
Turnover Rate 24% 12% 8% 7%
Financial CostAgency:
Bank:
Total Cost:
£258,726
£ 19,564
£278,290
£198,959
£ 40,300
£239,260
£115,287
£ 70,264
£185,552
£71.231
£61,883
£133,115
Serious Incidentsinvolving
patient outcomes 7 2 2 1
Period 2016 2017 2018
Total Year Emergency Department
Attendances
105,527
(+6)
114,730
(+9%)
121,531
(+6%)
Nurses completing specialist training
12(Total 12)
12(Total 24)
14(Total 38)
Senior Decision Making
Patients STREAMed to Primary Care
Patients turned around at front door
Per Month
2076 (22%)
70
Per Month
2372 (23%)
126
Per Month
2908 (28%)
274
Rapid Assessment Practitioner(Referred to GP/other)
Per Year0.55%
575
Per Year1.081238
Per Year2.64%3288
Percentage of Total ED Attenders Seen by Emergency Physicians
46% 44% 34%
Key learning
• What are your main recruitment constraints?
• Is your key issue recruiting or retaining staff?
• Why are your staff leaving?
• Forums and communication
• Are you communicating a positive vision?
• Are you family friendly?
• Have you reviewed where, and who delivers care?
• Have you invested in your senior staff?
• Challenge long-term vacancies; patient focused solutions
• Wider workforce understanding of new roles
• Factoring in training and increased rates of uplift.
Budget & Skill Mix(Historic Approach)
• 49 Band 5 Staff Nurses
• Reality 18
Service Improvement ProgrammeNovember 8th 2018
Phase I of new Workforce Strategy commences 8th November
➢ October 1st: Nurse Practitioners compliment Middle Grade rota to cover ‘Majors Lite’ for pre-determined
group of patients
➢ October 16th first Nursing Associates (NAs) commence training
➢ October 30th Support Worker interview day to begin ‘production line’ of new nursing workforce
➢ Phase I: 08/11 new Nursing skill-mix model commences = reduction in Band 7,6,5 roles (as vacancies exist
the result will be realised through a reduction in temporary shift cover)
➢ 12th December NAs formally rostered to new positions
Cost saving MG to NP rota: per shift £237.19 x 80 days service provided = £18,975Full year cost saving accumulating by end of Phase I: = £865.7kFull year investment accumulating by end of Phase II: = (631.6k)Full year cost saving accumulating by end of Phase III: = £ 81.4kTotal accumulated savings (Phase I to the end of Phase III): = £315.6k
Benefits of Workforce Investment
STREAMing
November 2016
STREAMing
November 2017
STREAMing
November 2018