Leading change

The Chief Nurse at Barking, Havering and Redbridge University NHS Hospitals Trust (BHRUT) led on the development and implementation of an ‘Intern Programme’ across the organisation, re-designing the model of support offered to new staff members at the organisation to address unwarranted variation. This programme has led to improved outcomes, experiences and use of resources across the Trust.

Where to look

Mind the Gap – exploring the needs of early career nurses and midwives in the workplace (2015) summarises a project titled Every Student Counts, which was commissioned in Birmingham & Solihull due to local employers’ growing concerns about the recruitment and retention of nurses and midwives locally. The report revealed generational concepts that required consideration to truly support individuals as they begin their professional careers. This included the way values, expectations, perceptions and motivations have evolved in the current workforce. The evidence demonstrated that traditional approaches to staff support would not be as appropriate for newly qualified or younger staff coming into the nursing workforce. Indeed, the report reflected that this could impact on staff experience.

Within BHRUT, the Chief Nurse identified a similar pattern to that described in the evidence base: several nursing staff were leaving the Trust within the first year of employment. The Trust’s approach to preceptorship and new staff support remained set within traditional models and therefore required adaptation and redesign, to address the unwarranted variation in staff leaving the organisation.

What to change

The Chief Nurse identified a need to refresh and update the offer of support for new staff entering the Trust. Newly qualified nurses and midwives in today’s workforce have different needs to their preceding generations and the Chief Nurse recognised that the nursing team must gain a better understanding of what was needed to enhance staff well-being and support their experience in the Trust.

Based on this evidence, the Chief Nurse and senior nursing team identified the need for a new model of pastoral support to be adopted across the Trust, to reduce the unwarranted variation seen in retention rates.

How to change

A new pastoral support team were introduced at the Trust, including a Senior Intern Lead and two nursing roles. This team provide pastoral care and support to new members of the nursing team. The team are not there to replace the support and guidance given by ward staff providing formal or informal mentorship, but to enhance their support, ensuring this is maximised so that it is effective across the Trust.

The Senior Intern Lead identified all newly qualified and newly recruited staff within the Trust, which totalled over 190 nurses. The wider intern team then offered individual meetings for these staff to add to the support system already provided by ward sisters, senior sisters and Matrons. The intern team found variation in the needs of individuals across the organisation. By building a supportive relationship with the new nurses and midwives, this has helped staff to proactively identify areas for development and support in a safe environment to tailor the support to the needs of the individual.

The nursing team have ensured that the intern team is cohesively embedded within existing support structures. They attend wards, clearly describe the offer of the intern team and discuss how the teams can work together to support new starters on the ward. Useful resources and links are circulated to all senior nursing and midwifery nurses involved with the programme, to further support integration and closer working relationships. The intern team also provide a feedback mechanism to senior management at the Trust, so to continue to develop support systems. For example, a new member of staff suggested a ‘new starter badge’ scheme, where each new member of staff is now offered a yellow name badge rather than the Trust standard white one. This enables teams to recognise staff who may need additional support in practice. The team have also enhanced the provision of support when staff are moving across wards, specialities and services, which is maximising staff experiences as well as productivity.

Adding value

Better outcomes – A review of retention data following a 6-month implementation period of the programme has highlighted a significant reduction in newly recruited or newly qualified nurses and midwives leaving the organisation within 12 months of recruitment. Only 20 members of staff from the 202 new starters left BHRUT within the first 12 months. This demonstrates a marked decrease from the 16 leavers (in their first year) per month reported prior to the start of the Senior Intern Project. Of the 20 new starters who left the Trust in their first 12 months, 1 leaver has already returned and 1 is continuing to work bank shifts in BHRUT.

Better experience – An initial 6-month survey has evaluated the impact of the programme and identified areas for further development. The results demonstrated that 91% of new staff are happy working at BHRUT with a 97% satisfaction rate of the support provided by the intern team. Some direct quotes from staff are:

I’m very impressed with the intern team. They assured me that I have someone to talk to if I have any challenges.

The intern team were really supportive in assisting with changing of wards.

I know how to get in touch with the team when I need them.

Yes I am very happy. I feel everyone works with PRIDE and it is a supportive place to work.

Although patients haven’t been directly involved in the evaluation of the programme and the intern team, anecdotal feedback suggests staff are happy and remain in posts they enjoy working in which is positively affecting patient experience too.

Better use of resources – Although a formal assessment hasn’t yet been undertaken to demonstrate the impact of this project on resources, the reduction in numbers of staff leaving the organisation within their first twelve months has had a positive impact on service delivery as well as staff experience across the organisation. A further review at 12 months and 18 months of implementation are planned.

Challenges and lessons learnt for implementation

Initially, there was some hesitation from the ward staff regarding the re-design of the support offer. However, by providing education and support to these staff, there was soon a shared recognition of the benefit of the support being offered and how this would help the staff on an individual level and the Trust more widely.

Time and resources need to be dedicated to ensuring new staff are fully integrated into their new team as a part of their induction. This can be difficult to overcome if left unaddressed.

The intern programme is set to continue, with a focus on areas such as protected meeting times, the Trust’s induction programme, managing competing demands, maximising training opportunities and promoting effective staff well-being.

Find out more

For more information contact:

• Beverley Sawer, Senior Intern Team Leader BHRUT, beverly.sawer@bhrhospitals.nhs.uk
• Gary Etheridge, Director of Nursing, Safeguarding and Harm Free Care, BHRUT, gary.etheridge@bhrhospitals.nhs.uk