The World Health Organization (2020) has reported that, worldwide, there is an estimated shortfall of 6 million registered nurses. Buchan et al (2020) attributed these shortages both to insufficient entrants to the register and to problems retaining the existing workforce.
In 2019, the government committed to increasing the numbers of nurses in the NHS in England by 50 000 by the end of the Parliamentary term—known as the ‘50 000 Nurses Programme’. In March 2022 the Department of Health and Social Care (DHSC) published an update of progress against this programme (DHSC, 2022a). The scope of the programme is registered nurses only and it is split into three broad areas: domestic recruitment, international recruitment, and retention of existing staff. The programme is committed to ensuring that, by 31 March 2024, there are at least an additional 50 000 full-time equivalent (FTE) nurses in place in NHS providers and GP settings, compared with the numbers in September 2019.
The projection for the retention numbers increases from an actual of 1000 FTE retained in September 2019, to an actual retained in March 2020 of 3000, with projected numbers of 9000 in 2023/24. The DHSC report states that retention is the most significant area of uncertainty across the programme, and the area of greatest complexity. The pandemic is cited as a stressor that is thought to impact on staff ‘attachment to nursing’, with thoughts that many may have postponed their plans to leave in order to support the NHS response.
There is also the outcome of the ‘McCloud remedy’, which is a ruling to remove the age discrimination that was judged to have arisen in public service pension schemes (DHSC, 2022b). This allows some staff to retire on more favourable terms than was previously anticipated to be the case. This is an unknown quantity, as it is difficult to predict individual responses to the judgement. It is anticipated that in the short term, and during the remainder of the programme, this could serve to temporarily increase the leaver rate.
In June 2021 the University of Southampton, in collaboration with NIHR Wessex, published an ‘Evidence Brief’ that bought together the key findings from a scoping review of reports and research papers to summarise what is known about factors that influence nurse retention and consider what more needs to be done to develop effective retention strategies (Ball and Ejebu, 2021). The brief focused on factors associated with retention. There was less evidence about how well retention strategies worked.
The factors identified were categorised into eight broad themes:
- Job satisfaction
- Achieving care excellence
- Adequate staffing and resources
- Control/voice
- Pay and reward
- Opportunities to develop
- Work-life balance
- Relationships and support.
Job satisfaction is placed at the centre, with much of the research having examined that many nurses leave due to dissatisfaction. Overall, the review suggested that more nurses could be retained if we are able to create a practice environment wherein there are compassionate and caring leaders, who foster team cohesion, support wellbeing and professional development. This included supporting nurses at different career stages, and recognising the need to adapt what is on offer according to the workforce profile. For instance, mentorship and education packages may be most effective for new starters, whereas flexible pension provision and job redesign could help retain the older workforce. Taking the opportunity to tailor education programmes and continuous professional development (CPD) to enhance skills and career prospects was also mentioned. Many of the factors have interdependencies, with the example given that to achieve care excellence, adequate resources are required. Fair pay and reward was a factor as a tangible sign of how staff felt valued.
Factors influencing nurse retention were cited as ‘multidimensional’ therefore a ‘one-size-fits-all’ approach was felt unlikely to work well. Reflections included that interventions should be tailored according to the workforce profile and needed to take account of differences between the types of nurses (specialty, stage of career, age, or generation) and the context (eg geographical, labour market).
The research by Ball and Ejebu (2021) highlighted the range of factors affecting nurse retention but was less specific regarding the relative importance of each element for different groups of nurses. I found the review of the evidence very useful, with an opportunity for us to understand where our local teams sit in terms of retention and turnover.