Although the trust appeared to have a healthy recruitment pipeline for nurses and midwives, retaining them was a challenge. Turnover of nurses and midwives was highest in the intensive care units (ICU) at both the Royal Free Hospital and Barnet Hospital.
The trust began a project to reduce ICU nursing turnover by improving joy at work. A multidisciplinary team headed by the Royal Free’s director of nursing looked at the reasons why turnover and vacancy rates were so high. In focus groups, staff said that offering flexibility and choice around shifts would improve work-life balance and promote roster fairness.
Electronic self-rostering was key to offering staff shift flexibility and choice. This was piloted at the Royal Free’s ICU in January 2018 and then implemented across 32 inpatient areas from September 2018 to May 2019.
It was essential that managers and staff fully understood their roles and responsibilities when self-rostering. Senior nurses, roster managers and the e-roster nursing team discussed with staff the principles, potential benefits and potential barriers.
In the ICU pilot site:
- vacancy rates improved from 33.6% in January 2018 to 27.1% by May 2018
- from May 2018 to March 2019, the average vacancy rate was 32%
- in January 2018 the turnover rate was 29.8 % and steadily reduced to 17.2% by June 2019
- this has been maintained at an average of 20.8% from July 2018 to September 2019
- before self-rostering, on average 4.3% of shifts were requested by ICU staff in a four-week rostered period; by September 2019, an average of 38% of requested duties were made by staff – an increase of 34%.
Supporting and offering staff greater flexibility and choice enables staff to have more control over their rosters, improves work-life balance and promotes roster fairness. This in turn supports staff retention and reduces vacancies.