Nurse Job Rotation Scheme
Perceptions of a sample of cohort four rotation nurses
By
Lead Researcher
&
Principal Investigator — Rotation Scheme Research
August 2006
Published by Central and North West London Mental Health NHS Trust, London. (www.nurserotation.com)
Acknowledgements
In particular we want to thank Peter Walsh, Director of Nursing and Luella Dixon, Deputy Director Of Human Resources in CNWL Mental Health NHS Trust, for their initial concept paper on Rotation Schemes, and their support for the development of the projects.
We are grateful to the participants from cohort four of the Nurse Rotation Scheme, and the whole action research community — in particular the two Trusts who have set up the pilot (CNWL and WL Mental Health NHS Trusts); the Workforce and Education Confederation; Middlesex University the education provider; and the local managers who are supporting the scheme. We want also to thank the other researchers involved with the overall rotation scheme and the action research — Professor James Buchan and Jane Ball.
Finally, in the light of the regular organisation changes for both West London Mental Health NHS Trust, and Central and North West London Mental Health NHS Trust, we want to thank all of the new stakeholders who provide us with support.
TABLE OF CONTENTS
SECTION 1 — D/E NURSE JOB ROTATION SCHEME
1.3 The Problems That Have Led To the Action Research Study
1.3.2 Challenging institutionalisation through staff transfer
SECTION 2 — METHODOLOGY
SECTION 3 — FINDINGS AND DISCUSSION FOR THE D/E NURSE ROTATION SCHEME STUDY
3.2 Reasons for joining the rotation scheme
3.2.1 Opportunity to learn more through varied experiences
3.3.1 The rotation was more important
3.3.2 The degree was more important
3.3.2.1 Opportunity to facilitate on going study
3.3.2.2 Gaining qualifications in a low paid job
3.3.2.3 The dynamic of motivation/ placement/ education and satisfaction
3.3.3 Both the degree and the rotation were equally important
3.4.1 Satisfaction and dissatisfaction; negotiating different perspectives
3.4.2 Placements: emerging theme
3.4.3 Rotation nurses who were satisfied with all their placements to date
3.4.3.1 A good and busy learning environment
3.4.3.4 Fear due to lack of ward leader
3.4.3.5 Reflective experience which highlights the intrinsic demands of care services
3.4.4 Rotation nurses who were satisfied with one placements but not another
3.4.5 Misgivings as to how the placements were arranged
3.4.5.1 No community placement
3.4.5.2 Retaining factors that rescue the situation
3.4.5.3 Learning through risk taking
3.4.5.4 Late decisions about placements
3.4.5.5 Recruitment to and retention within the organisation
3.4.5.6 Satisfaction and retention
3.4.5.7 Staying in the placement
3.4.5.8 Overcoming disappointment
3.4.5.9 Lack of orientation and induction
3.4.5.10 Progressive disappointment and lack of choice
3.4.5.11 Successful negotiation
3.4.5.12 More than filling gaps — career planning
3.5.2 Well staffed community placements with support
3.5.3 Rotating rather than resigning
3.5.4 Poor planning by organisers
3.5.6 Nursing capability to accommodate oneself to the needs of clients
3.5.7 Leadership and the main aims of recruitment and retention
3.6.1 Management of the scheme was helpful
3.6.3 The curriculum fits work requirements
3.6.4 Assignments were useful for clients
3.6.5 Rapidly developing capability
3.6.6 Policy to practice transfer time
3.6.7 The power of connecting organisation, workers and clients
3.6.9 A really good experience
3.6.10 It helps me to change things
3.6.13 Common perspectives among partners
3.6.15 The university was great
3.6.18 Making sense of my experiences
3.6.19 Leadership: a brilliant tutor
3.6.21 Reducing the gap between theory and practice
3.6.23 Settling down to learning as a full time worker
3.6.25 National policies transferred to practice
3.6.27 Awareness of organisational and client priorities
3.6.28 Differences between pre and post registration learning
3.6.29 Personal versus Trust perspective — costs
3.6.30 Personal reasons for leaving
3.6.31 Benefits of a good tutor
3.6.32 Comparison of the rotation scheme and initial training
3.7 Quantity and quality of support
3.7.1 Lack of awareness of the different types of supervision
3.7.2 Expectations of supervision
3.7.3 Supervision course for supervisors
3.7.5 Formal education as support in hard to staff areas
3.7.6 They do try to support me
3.7.7 Mentoring others because of high turn over
3.7.9 Someone with whom to discuss college work
3.7.10 Create a two year internship
3.7.11 No staff to allocate as supervisors
3.7.12 The intrinsic nature of hard to staff areas — turnover
3.7.13 Supervisors unaware of expectations
3.7.15 The organisation’s perceptions and attempts to help
3.7.16 Good supervision keeps me going
3.7.17 A lot of ill-defined and poorly organised support
3.7.18 The effect of unled hard to staff areas
3.7.19 24/7 services — poor organisation of supervision
3.7.20 Feeling able to ask for supervision
3.7.21 Line management supervision
3.7.22 Good practice model — supervision system for professional staff
3.7.23 Quantity and quality of supervision
3.7.24 How do you know what to expect?
3.7.25 Time to meet supervisors when working shifts
3.7.26 Experiencing prejudice — what to do about it
3.7.27 Absence of preceptorship
3.7.28 Poor retention because of poor support
3.7.29 F grades’ supervising thirteen people each
3.7.30 Repelling rather than retaining forces
3.7.31 Needs and expectations of supervision
3.7.32 Desperate measures — Informal supervision
3.7.34 Further external supervision
3.7.35 Feeling the stress of the post
3.7.36 Unclear about forms of support and what to ask for
3.8 Things gained from the scheme other than a qualification
3.9 What the Trust can gain from the scheme
3.9.1 Perception from one’s own sphere of understanding
3.9.2 Trust gains — recruitment and retention
3.9.3 Increased standards of care
3.9.4 Dissemination of learning throughout the organisation
3.9.5 Recruitment from outside of London
3.9.6 Understanding policy and the organisations priorities
3.9.7 Better care for patients/clients
3.9.10 Internship and professional capability
3.9.12 Maintaining ‘intellectual capital’
3.9.14 Transferring learning across specialities
3.9.15 Cascading key priorities throughout the organisation
3.9.16 Two or more rotatees on a ward
3.9.17 A lot in two short years
3.9.19 Advanced understanding of ‘care’
3.9.23 Very attractive but might not retain because of the conditions
3.10 What patients/clients and colleagues can gain from the rotation scheme
3.10.1 Eight months of the same professional rather than numerous bank/agency staff
3.10.2 Criticism of the intrinsic deficits of the hard to staff areas
3.10.3 More than the sum of its parts?
3.10.4 Conflicting views — different perspectives over time
3.10.5 Benefits to patients/clients and to colleagues
3.10.6 Benefits provided for patients/clients from the nurse job rotation scheme
3.10.7 Benefits provided for staff from the nurse job rotation scheme- but also for clients
3.10.7.1 No negative attitudes from colleagues
3.10.7.2 Actively shared knowledge
3.10.8 Specific examples that illuminate what staff and patients had gained
3.11 The group of rotatees (professional practitioners)
3.11.1 Sub groups and contact with other cohorts
3.11.4 Classroom time for discussion
3.11.5 Different areas and different skills
3.11.6 Critical mass for local group
3.11.7 We do share and help with settling in and other anxieties
3.11.8 Hearing about other speciality areas
3.11.9 Sharing within the group
3.11.10 Helping each other with study
3.12 Factors that undermine or threaten to undermine the scheme
3.12.3 The scheme is not what it was: leadership and coordination
3.12.4 Unpredictable growth of the pilot scheme: benefits, difficulties and ending
3.12.5 Turnover of key central and local managers/supervisors
3.12.7 Support by reliable education partner
3.12.10 Changing the scheme contract without explicit agreement
3.12.11 Fragmentation of the stakeholder community
3.12.12 Unpredictable length of the pilot scheme
3.12.13 Lack of community placements
3.12.14 Institutionalisation: disrespect of keen adult professionals
3.12.15 Increasing choice of placements
3.12.17 Suffering from success — less placements
3.12.18 Leaders who do not visit
3.12.19 Not having a say in important decisions
3.12.20 Hard to staff areas are intrinsically unattractive
3.12.22 Reason to leave the Trust
3.12.25 Being unable to share with colleagues
3.12.26 Slowly changing environments and team practices
3.12.27 Ignorance about how to promote change in the workplace
3.12.28 Lack of team leadership and team work
3.12.29 Inertia about education about using education to improve practice
3.13.1 Leadership at the end of the pilot scheme
3.13.2 Communication is reducing
3.13.3 A leader who is very committed
3.13.8 Poor reception in placements
3.13.10 Reflect upon the scheme before starting again
3.13.12 Communicate an agreed model of job rotation and its operations
3.14.1 Continuation and the model
3.14.2 The academic part should continue
3.14.4 Worth keeping — the Trust has benefited
3.14.5 Sad that it has stopped
3.14.6 Cost savings through retention
3.14.10 Need to build in rotation
3.14.12 Preparation for promotion
3.14.13 Good lecturers are essential
3.15.1 Managing salary differences in rotation placements
3.15.2 Benefits of more than one rotatee in a placement
3.15.3 Handling ‘difficult staff’
3.15.4 Institutionalisation and closed communities
3.15.5 Positive feedback from colleagues
3.15.6 Unplanned staying and going
3.15.7 Missing out by not rotating
SECTION 4 — CONCLUSIONS
4.2 Aspects of the scheme that were shown to be useful
4.3 Aspects of the scheme that were shown not to be useful
4.5 Evidence of unplanned added value to the scheme or to our understanding of the process
4.6 Aspects of the scheme that the evidence suggests need changing and what is needed to change them
SECTION 5 — RECOMMENDATIONS, STRENGTHS, AND WEAKNESSES OF THIS RESEARCH PROJECT
EXECUTIVE SUMMARY
This is the evaluation of the fourth cohort of the D/E Nurse Job Rotation Scheme, developed by The Central and North West London and The West London Mental Health NHS Trusts.
The Scheme was developed as a pilot scheme to explore ways of recruiting and retaining professional personnel within health care organisations, particularly in hard to staff areas, at a time when many were not only leaving those organisations, but health care per se. This tool was used in those areas that were already using a wide variety of other recruitment tools which, however successful, did not impact upon a regular 30% to 50% vacancy rate.
The scheme sought to offer Junior Nurses incentives in order to attract and recruit them and thus ensure the basic provision of nursing care for the patients/clients of hard to staff areas. The incentives included a professional development scheme involving work based learning to degree level, three rotations, and a continuous service contract. This would support their career development, their transfer to professional practice; increase their employability and their satisfaction with their profession.
It is a part of an Action Research project, also originating and operating within the two organisations (Buchan and Ball (2004); Lucock & Coyne 2003; July 2006; September 2006). These studies will be meta evaluated with the intention of providing a substantial evidence base on the use of job rotation as a service improvement tool for policy development, commissioning, provider and educational leadership.
Conclusions
This study shows that the model of job rotation used here was effective with a small cohort, to attract, recruit and retain them within hard to staff health and social care areas, and to a great extent within the Trusts concerned. This tool specifically set about reducing bank and agency staff to bring about greater continuity of care and it was found to be successful in substantially replacing some of this unreliable staffing solution.
The model was shown to facilitate the extensive development of reflective practice capabilities, and to enable junior nurses to gain the education they needed to make planned changes to their careers. It supported job changes — either within speciality areas or transfer across them. Indeed for the few who did not complete the scheme, there were still potential benefits gains for their careers, the organisation, colleagues and patients/clients. Work based learning was successful in facilitating a successful partnership between academia and the work place and was, to a great extent, a retaining factor because it provided supervision and support that was limited in hard to staff areas.
A variety of unexpected benefits accrued which added value to the use of the model. There were a few problems identified with leadership, education, rotation negotiation, supervision and shared expectations.
Recommendations
It is recommended that this model be used widely for the attraction, recruitment and retention of personnel within the health and social care environment, especially for those parts which might be hard to staff; seeking to improve the quality of care; seeking to avoid institutionalisation and looking to transfer good practice across a learning organisation. Further evaluation is needed to develop the evidence base.
