2. Inception
A concept paper by Luella Dixon (Assistant Director of Human Resources Department) and Peter Walsh (Director of Nursing) of the then ‘Riverside Mental Health Trust’ put forward the idea of D/E grade staff internal rotation in January 1999. Prior to this the Trust had had some experience of rotating staff (albeit on a smaller scale) within one locality. Although the scheme petered out, the experience had been useful in that it showed the idea to be highly popular with potential and actual nurse employees for ‘hard to staff’ areas,, and highlighted some of the problems in keeping staff rotating. By April 1999 the Trust put forward a proposal seeking consortium funding for a rotation scheme that coupled the movement of staff through three eight month long placements with post-registration training to graduate level.
The key drivers for the scheme were to:
- Improve recruitment — difficulties link to both the geographical area and specialty
- Improve retention — particularly of new recruits
- Rejuvenate staff development
- Improve care standards within ‘hard to staff’ service areas.
The ‘hard to staff’ areas selected were operating as much as 50% below establishment. The aim was to enhance service delivery priorities (such as care co-ordination, clinical and risk assessment, shift management, clinical governance) in these areas and generate local knowledge for practice via National Service Framework related project. Additionally the hope was that the rotation of staff would facilitate the transfer of knowledge and skills across boundaries.
At the outset the scheme was viewed by the organisations primarily as a recruitment tool. The potential to impact on retention was identified later. It was believed that a job rotation scheme on its own, without links to appropriate continuing education, would be less likely to succeed. The educational component could provide support to newly qualified nurses working in areas with staffing difficulties, whilst having a creditable qualification at the end of two years was seen as a potentially important motivator to attract and keep nurses in the Trusts. Hence the idea of a work based learning programme that took diploma-qualified nurses to graduate level was developed.
Some stakeholders also believed at the outset that the scheme would have a positive effect on the quality of the services offered in both the short and long-term. In the short-term, areas that had been identified as ‘hard to staff’ would benefit by not only having more staff, but having staff who bring with them new ideas and have the support of the work-based learning modules. In the longer term, it was hoped that the reputation of the Trusts would be enhanced by the scheme, making the Trusts more attractive to nurses and widening the applicant pool in general, not just for the rotation scheme posts, thus improving both the quantity and quality of recruits.
Two of the problems identified with the previous scheme, was lack of co-ordination, and insufficient set up funding. To avoid similar problems, a key part of new rotation scheme was to ensure that there were adequate resources and a scheme co-ordinator. The long-term vision and commitment by key individuals and organisations to the establishment and evaluation of this model of recruitment and retention is believed to have been critical to it. Additionally the absence of a formal programme of evaluation and research of previous job rotation schemes was addressed by including research activities as a key result area of the Co-ordinator’s post.