Retention of experienced staff in the NHS

In 2005, the Nurse Directors Association (NDA) and the Royal College of Nursing (RCN) held workshops for senior nursing staff who had experienced redundancy. The aim was to learn from the experiences of staff that had been displaced and look at ways of supporting existing HR staff retention polices. NHS Employers funded a project to look at the key themes emerging from the work and to widen the project to other staff groups.

• Background
• Key findings
• Issues for specific staff groups
• Tips for HR and line managers
• Other useful resources

Background

At the beginning of 2005, the Nurse Directors Association (NDA) and the Royal College of Nursing (RCN) agreed to collaborate on how to draw attention to the high turnover of board level nursing staff, learn from the experiences of staff that had been displaced, and look at ways of supporting existing HR staff retention policies. Directors of nursing and senior nurses who had experienced redundancy were invited to a workshop at the RCN in June 2005 to discuss their experiences. These issues were discussed further by a group of senior nurses at a workshop at the NDA annual conference in September 2005.

The themes that emerged from these meetings include:

• The signs that a serious workplace problem existed were often missed
• The impact of displacement
• Their needs before, during and after the organisational change period

NHS Employers agreed to fund a project to analyse the key themes emerging from the work already undertaken and to take the work beyond nursing. The views of senior HR staff were particularly important, because of their experience in staff retention and their expertise in managing organisational change. This second phase took place in December 2005 and March 2006, involving discussions with HR directors, senior managers, nurses, allied health professionals and doctors.

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Key findings

The following issues were highlighted by the group from their own experiences of being involuntarily removed from their substantive post, and may form a useful checklist for HR teams to identify what staff may be experiencing:

Issues for individuals

• Feelings of defensiveness and anger
• Loss of confidence and credibility
• Concern about the loss of earnings
• Impact on the team, particularly if their leader did not get a senior job
• Reduced credibility of the leader if they did not get the 'top job' though no fault of their own
• Managing staff who are distressed about losing their leader
• Survivor syndrome - those with jobs feel guilty
• At a senior level the process is often very public
• There is a need for a level playing field within HR procedures which supports all executives regardless of their profession, some groups felt that there was not the same support network for them as existed for other professional groups

Potential impact on the organisation

Senior skills, experience and expertise may be lost, along with corporate knowledge, history and networks. There are several issues around the use of fixed term contracts and secondements. For example, staff may feel less likely to take a fixed term contract as they may be concerned they will be forgotten during the change process.

Seconded staff may be anxious about not being there to contribute to debates on reconfiguration of staffing structure, or about how colleagues will manage the workload whilst they are on secondment.

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Issues for specific staff groups

Other issues emerged from the project that were specific to certain staff groups and may need further consideration:

HR directors

Staff in this group felt that retaining senior HR staff in the NHS can be challenging as they are able to move into the social care sector easily or, less often, move to the private sector. The development of a national pool for staff seeking employment requires exploration. The same employment procedures must be applied to all staff groups as there is the perception that some staff groups will be employed on their past experience and abilities whereas others will have to go through assessment centre processes.

The use of interim management providers could offer opportunities for displaced staff to carry out useful and productive work. External providers may be able to offer work in non-NHS settings. Staff who have been displaced could take up an interim position in another organisation, either within or outside the NHS, for example a fixed contract of six months to cover an HR director post during maternity leave. This will add to the individual's portfolio and bring to the NHS new skills and knowledge gained elsewhere.

The CPLNHS human resource framework makes a commitment to improving equality and diversity, however a number of participants raised concerns that this may be more difficult to achieve across all organisational changes. NHS Employers has produced good practice guidance to give an overview of the issues that NHS organisations should be addressing to maintain and enhance their ability to deliver the equality and diversity agenda, and to ensure that all staff are supported through times of organisational change. The document, called Equity in implementing organisational change, includes relevant legislation and guidance on its implementation, recommended actions for NHS organisations and information around carrying out an equality impact assessment.

Doctors

During the course of the study it became clear that doctors were concerned about the retention of experienced medical staff, particularly in light of CPLNHS. It was felt that there was a lack of support for medical directors during reorganisations and mergers, and many of these directors may no longer be clinically up-to-date.

Allied health professionals (AHPs)

Although the number of AHPs who participated in the study was very small there was concern about the impact of CPLNHS on senior AHP roles within the mergers. Their issues were similar to those outlined above, but there were also concerns about secondments, as changes in organisational structures in the secondee's absence may mean a lack of suitable posts available when returning from secondment.

Consideration needs to be given to the leadership of AHP groups within the new structures to retain senior AHP management skills.

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Tips for HR and line managers

Individuals may be looking for some of the following support mechanisms that emerged from the project, from either HR teams managing the process or from their professional organisations:

• Individually tailor support to help staff deal with the emotional impact and improve skills to 'read the signs' leading to workforce displacement
• Learn some personal survival skills
• Communicate up-to-date information and provide open, honest feedback
• Help with managing the stress and anxiety caused by overseeing the redistribution of workloads
• Help staff with recognition of their own behaviours
• Think about management of existing relationships
• Accommodate 'time-out' for preparation for moving to new or different roles
• Plan for effective conclusion of work/ issues of unfinished business
• Never assume what people want
• Management of sick leave needs to be proactive to help staff retain a sense of control
• Establish links with clearing houses which include access to non-NHS employers
• Recognise stress signals in individuals and groups
• Consider whether your team has the skills to support senior staff and, if not, consider the use of out-placement support
• Maintain your professionalism and do not collude with disgruntled staff
• Remember that managing exits is as important as managing entries into organisations
• Acknowledge behaviours such as aggression, worry or stress
• Undertaking capacity analysis early in the HR process may provide reassurance to staff 'at risk' and stop them from leaving early or unnecessarily or help them to find similar or better jobs elsewhere.

You may wish to consider setting up support mechanisms for staff, for example:

• A named 'support person' available and accessible for support
• A menu of support options, for example
  • help with writing CVs
  • one to one coaching
  • interview skills
  • self promotion and image building
  • confidence building
• Skills analysis
• Diagnostic coaching
• Stress busting and relaxation methods
• Support groups
• Financial advice
• Counselling - both personal and career
• Training and development, for example 'coping with change' seminars
• Establishment of effective contacts, ensuring that they are available for help via a number of methods, for example
  • Face to face
  • Email
  • Meetings
  • Occupational health access
  • Action learning sets (these may be internal or may be an external preference)
• Continuing education establishments may be able to provide support for staff in terms of retraining, so that displaced staff can re-enter roles within the NHS

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Other useful resources

Stress campaign

Recognising that employers need more information and support to tackle stress in their organisations, NHS Employers is taking forward a major programme of work in this area in 2006. You can find out more about workplace stress and what NHS Employers is doing to tackle it.

You can also access advice, tools and resources for employers at NHS Employers' stress campaign website.

Bullying and harassment

Guidance for employers on how to manage bullying and harassment, along with a model policy template, can be downloaded on our website.

Commissioning a Patient-Led NHS (CPLNHS)

NHS Employers has been involved in the CPLNHS process since the Department of Health's document Commissioning a Patient-Led NHS was published in July 2005. Our role is to support NHS employers through the HR implications of CPLNHS by representing NHS views at a national level and by providing guidance to help with decision making during this organisational change.

Taking Healthcare to the Patient: Transforming NHS Ambulance Services (TNHSAS)

In June 2005 the Department of Health (DH) published a review of ambulance services in England. The role of NHS Employers is to support the ambulance service through the HR implications of TNHSAS by representing their views at a national level and by providing guidance.

This study was undertaken by Sheila Marriott on behalf of NHS Employers, the Nurse Directors Association and the Royal College of Nursing.

Staff resources

A web tool is being developed to help to provide support for staff who believe that they are, or could be, at risk of involuntary job loss. This will be published on the websites of key stakeholder organisations including the RCN and NDA.