1. Introduction
The report summarises the key findings to emerge from the evaluation of the implementation of the nurse rotation scheme at what was then Brent, Kensington & Chelsea and Westminster and Ealing Hammersmith & Fulham Trusts. The Trusts have since undergone a number of mergers, de-mergers and reorganisations and are now Central and North West London Mental Health Trust (CNWL), and West London Mental Health Trust (WLMHT)1. Whilst this type of reorganisation is commonplace in the NHS, the problems such discontinuity causes to leading and managing the change for setting and sustaining new schemes should not be underestimated.
1.1 The Scheme
The CNWL & WLMHT scheme combines nurse job rotation (three eight month placements) with work-based learning to graduate level provided by the Work Based Learning Unit of Middlesex University. At the outset of the scheme, the primary aim was to assist service users by recruiting and retaining nurses to ‘hard to staff’ clinical areas by helping recently qualified nurses become proficient practitioners. In so doing, it was expected that there would be an improvement recruitment and retention, and promote the development of a life-long learning culture. This scheme was established in addition to other recruitment and retention initiatives that were also being undertaken at the same time in these ‘hard to staff’ areas.
| Components of the Scheme | ||||||||
|---|---|---|---|---|---|---|---|---|
| Clinical work | ||||||||
| Start | → | 1st Placement | → | 2nd Placement | → | 3rd Placement | → | End |
| (8 months) | (8 months) | (8 months) | ||||||
| Education | ||||||||
| module 1 → module 2 | → | module 3 → module 4 | → | module 5 → module 6 | ||||
The scheme has built on learning from previous rotation schemes in this area and others (eg. Leeds). The first cohort of 25 participants (13 at CNWL and 12 at WLMHT) began on the rotation scheme in February 2000. A second cohort of 23 nurses started the scheme in autumn 2000, and a third cohort of 17 nurses began in summer 2001. All three cohorts have now completed the 2-year scheme.
1.2 Research methods
There are two main strands to the evaluation research:
- Monitoring the progress of the three cohorts of nurse participants, through focus groups (eight in total) and surveys at key points. Each participant was sent a questionnaire to gauge their views shortly after starting the scheme, once they had moved to their second placement and then again as they approached the end of the scheme. The three questionnaires had several ‘core’ sections that stayed the same in each survey plus questions designed to ask about issues pertinent to that particular stage. The same three questionnaires were used for each cohort.
- Views of the stakeholders from organisations associated with the scheme on the principle and reality of the scheme (from interviews).
The tools used in research (questionnaires and discussion guides) are presented in the Appendix. Ethical approval was sought and obtained from Riverside Ethics Committee.
Questionnaires were initially sent to participants’ work addresses, but later in the project they were distributed by the course tutor on study days. Regardless of the method of distribution, free-post envelopes were supplied so that the completed forms could be returned directly to Employment Research. Table 1 outlines the number of questionnaires distributed at each stage and the number returned.
A major challenge for the project has been tracking participants and keeping up to date records of the participants and their current places of work. The table shows that the number of questionnaires sent to the first cohort was less at each stage, reflecting the numbers who had left the scheme. Data on the numbers of leavers/stayers were not available for the third cohort.
| Table 1. Number of survey respondents | |||
|---|---|---|---|
| Cohort | Survey | Number questionnaires sent | Number returned |
| Cohort 1 | first | 24 | 23 |
| second | 16 | 14 | |
| third | 14 | 8 | |
| Cohort 2 | first | 15 | 13 |
| second | 9 | 0 | |
| third | 7 | 5 | |
| Cohort 3 | first | 15 | 12 |
| second | 15 | 12 | |
| third | 15 | 8 | |
| All cohorts | first | 48 | |
| second | 26 | ||
| third | 21 | ||
Employment Research 2003
1.3 Report Structure
The report describes the views of participants and stakeholders as identified through the surveys, focus groups and interviews from just before the start of the first cohort in January 2000, until the end of the third cohort. Because of the nature of the research, this report focuses on the views and experiences of participants and staff whilst they are involved in the scheme. The evaluation would be more comprehensive if it also included Trust personnel data on the number and type of applicants to the scheme and on those who have left the scheme (numbers and reasons for leaving).
A ‘leavers questionnaire’ was designed by the researchers to be administered by the Trusts, but keeping track of individual participants progress through the scheme and getting feedback from them before they left has been a major challenge for the Trusts. At the time of writing the report the researchers were not in receipt of any data on leavers.
With this in mind, it is recommended that the report is not read in isolation, but that Trust personnel data (pre and post scheme) for each cohort are reviewed alongside it. More detail on the early and middle stages of the scheme are provided in the interim reports (Ball & Buchan in 2001; Patrick Coyne 2002).
The report is structured to look at the different stages and elements of the scheme:
- Inception
- Parameters of the scheme
- Recruitment of participants
- Expectations
- Views of the different elements of the scheme
- Staying or leaving?
- Conclusions
1 Whilst the new organisation names are used throughout the report, at the time of most of the research the organisations were in the previous form