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Nurse Rotation Scheme at CNWL/WLMHT

Research Report

By

Jane Ball, Employment Research Limited, Hove

James Buchan, Queen Margaret College, Edinburgh

May 2004

Acknowledgements

The research was commissioned by Patrick Coyne (Prinicpal Investigator Rotation Scheme Action Research Project) on behalf of CNWL/WL/NWL Workforce and Education Confederation (formerly BKCW, EHF, and West London Education Consortium). The scheme co-ordinator Patrick Coyne, Adrian Nelson, Peter Walsh, Luella Dixon and Lynne Hunt were instrumental in the setting up and running the job rotation scheme, launching the research, and commenting on the research at every stage. The scheme has benefited from the support of Paula Crouch and her colleagues of the North West London Workforce and Education Consortium.

The following Trusts’ staff (past and present) have played important roles in creating and developing the job rotation scheme:

The scheme has been supported by working parties at: CNWL and WLMHT Trusts; Westminster; Brent; Hammersmith and Fulham. The educational component of the job rotation scheme was devised and delivered by Katherine Rounce and Alan Beadsmoore of the Work-Based Learning Unit at Middlesex University.

Our thanks also go to the 82 nurses and their managers and supervisors who have contributed to the development and evaluation of the nurse job rotation schemes in WLMHT and CNWL to-date. We would especially like to thank scheme participants for taking part in the surveys and focus groups during the research, and for all those who gave up time to be interviewed by the researchers.

The original vision for the scheme came from the Riverside Mental Health Trust Board. The Directorate of Nursing at the then Brent, Kensington & Chelsea and Westminster Trust established the post of scheme co-ordinator. The project and its evaluation has required collaboration between staff at the Trusts, internal and external researchers, and the team of educators.

CONTENTS

Acknowledgements

Executive Summary

1. Introduction

2. Inception

3. Parameters of the scheme

4. Recruitment of participants

5. Expectations at the start of the scheme

6. Views of the scheme

7. Staying or leaving?

8. Conclusions

Appendices

Appendix A: Satisfaction at the start, middle and end of the scheme for 3 cohorts

Appendix B1. Discussion Guide for Managers & Clinical Supervisors

Appendix B2: Stakeholder Discussion Guide

Appendix B3. Scheme leavers questionnaire

Appendix C. Management Structure for the Project

EXECUTIVE SUMMARY

Project overview

This summary presents an overview of the findings from the evaluation of the implementation of the nurse rotation scheme at what was then the Brent, Kensington & Chelsea and Westminster and Ealing, Hammersmith & Fulham NHS Trusts. Since the outset of the evaluation the Trusts underwent a series of reorganisations to form the Central and North West London (CNWL) Mental Health Trust and West London Mental Health Trust (WLMHT).

The scheme combined three eight-month placements with work based learning to graduate level. Its aim was to improve recruitment and retention of nurses working in ‘hard to staff’ clinical areas by helping recently qualified nurses to become proficient practitioners. In addition it was hoped that a culture of life- long learning would be fostered.

Two parallel schemes ran in tandem- one at CNWL and one at WLMHT. All nurse participants were to rotate within their local area and designated specialties. All participants were allocated supervisors and undertook work based learning modules leading to a degree qualification.

In total 65 nurses completed the 2 year scheme between 2000 and 2003; 25 in cohort 1, 23 in cohort 2 and 17 in cohort 3. The evaluation reports on the progress of the three cohorts monitored through three phased questionnaire surveys and focus groups. Feedback was also gathered from interviews with key stakeholders, including managers and supervisors, and the scheme co-ordinators.

Recruitment

Approximately 40% of all nurse participants in the scheme were newly qualified (this varied between cohorts entering the scheme) a further 36% were already working in the two Trusts and 19% had been working elsewhere. Prior to the scheme nearly 60% of the participants (i.e. nearly all those who had not been working in the trusts) had not considered working at the Trust. This suggests the scheme has been successful in widening the recruitment pool.

The majority of participants reported they were reasonably satisfied with the recruitment process across all three cohorts. This said, improvements were suggested including at the outset to increase the amount of written material available, particularly in relation to the education component. Recruitment procedures were improved during the progress of the scheme and the later cohorts were more satisfied with this aspect of the scheme.

Expectations

Educational opportunities, the chance to do a degree and opportunities to rotate around different work locations were the aspects of the scheme which most enthused participants. Promotional opportunities were not viewed as a particular advantage of the scheme as most participants felt they would be promoted within two years regardless. For many participants obtaining a degree was seen as a necessity to achieving an F grade promotion, and some hoped that this would be possible by the end of the scheme. Supervisors were generally positive about the potential impact of the scheme and its impact on recruitment, but were wary that it should not be seen as a panacea to cure all staffing problems.

Leaving the scheme

No exit data was available from the trust for the second and third cohorts. Of the first cohort, most scheme leavers left 6-12 months into the scheme, suggesting that the move to the second placement was a critical juncture. Two main factors contribute to participants leaving the scheme — firstly there were scheme related issues which were primarily associated with the level of choice offered in placement selection and secondly, individual issues such coping with the twin demands of study and work. Several participants clearly did not get placements they wanted and thought they would be able to get, given the information they had received at the start of the scheme.

Staying on

Participants who finished the scheme displayed a high commitment to achieving the educational outcomes and at the end of the scheme almost all of the remaining participants intended to carry on working at the participating Trusts. However, some participants would have liked to have been offered more assistance from their employers/scheme organisers to help plan their future work/careers towards the end of their time on the scheme.

Participants were asked to report how they felt about the scheme on a number of different dimensions, as they progressed through it. For cohorts one and three, views of the scheme generally became more positive as time went on, whereas cohort 2 became less positive, (see the figure below). It should be noted that the findings of participants at the end of the scheme are based only on those who lasted the course. Views of those who left the scheme before the end are obviously not included, but may have been more negative, as they have in effect ‘voted with their feet’.

Three cohorts views at different stages

Views about specific aspects of the scheme can be summarised as follows:

Conclusions

Overall, the scheme can be viewed as successful in attracting nurses to work in ‘hard to staff’ areas. The work-based learning programme is seen as the biggest attraction of the scheme. Attrition has been a problem and poor communication (in particular in relation to the choice of placements) may be responsible for some unmet expectations, which have led to unnecessary wastage. Some aspects of communication were improved during the scheme.

Based on the experience of the first three cohorts experience of the rotation scheme, the factors that are critical to success could be summarised as follows: