5. Expectations at the start of the scheme

5.1 What is the appeal of the scheme to participants?

The first cohort reported that it was the unique combination of rotation and education that gave the scheme its appeal. Participants wanted to be able to rotate to gain clinical skills (and consolidate skills learnt in pre registration training) and liked having the educational component built in as part of job, so signalling commitment to providing study leave etc. The focus groups revealed that this commitment was a key factor making the scheme attractive to both new and existing staff.

When the first cohort were asked in the survey (several months later) which feature of the scheme they felt was most important to them, the majority ranked the educational opportunities as the most important feature, with chance to rotate in close second place. Few participants attached importance to the prospects for promotion to E grade. In discussion, it became clear that opportunity to progress to E grade was not seen as a key driver, as they generally expected this would be achieved within two years regardless of whether they were on the scheme.

Of those already in employment prior to the scheme, some said that they particularly wanted to join the CNWL/WLMHT scheme because they felt the Trusts were committed to making it a success, and they saw the educational funding and provision of study leave as indicators of Trust commitment. At that stage, the overall feeling was that the scheme was well supported in terms of planned supervision, academic tutors, and a commitment of the Trust to be flexible.

When the second cohort were asked which feature of the scheme was most important to them, 75 per cent ranked chance to rotate first whilst 69 per cent ranked the educational opportunities first. Relatively few of the second cohort attached importance to the prospects for promotion to E grade.

The third cohort were more similar to the first in terms of the relative importance of different features in attracting them to the scheme, with 83% ranking the educational opportunities first and 50% ranking the rotational element in first place.

Looking across all the cohorts, the most important characteristic of the scheme for its participants at the outset was the opportunity to do the degree — this was ranked top by 68% of all participants (N=44). After that, the chance to rotate through different clinical areas was next important, with 48% of participants putting this factor first.

5.2 Life after the scheme — expectations and reality

Long-term objectives of participants of the first cohort prior to starting the scheme were varied. Some commented on the need for a degree to get an F grade. Discussion about career progress revealed that some nurses anticipate being able to apply for F grade posts at the end of the scheme, although most thought that they would need at least a year’s work as an E grade before they would be able to get an F grade post.

One of the open-ended questions in the first questionnaire asked participants what they expected to do at the end of the scheme. Many were unsure or said it would depend on how the scheme went. Within the first cohort, about a third indicated that they planned to continue working at CNWL or WLMHT. Clearly for some staff the scheme was a means of testing the Trusts as potential workplaces. For example, one nurse responded: ‘I don’t know — it depends how well I feel the Trust has treated me as an employer and on opportunities elsewhere’. Another said ‘If satisfied, I will remain at the Trust’. Others expressed their future plans in terms of the particular specialty they would like to work in, their educational goals, or grade they hoped to be on, and made no reference to place of work.

About half of the second cohort (seven out of the 12 answering this question) reported they planned to work within their current Trust at the end of the scheme. Similarly, half of the respondents in the third cohort referred to plans to work in the Trusts.

A total of 21 participants from the three cohorts made it through to the end of the scheme and completed the final questionnaire. They were asked whether they planned to continue working at the Trusts. In all but one case respondents indicated that they planned to stay at the Trust, typically for at least a year. Expensive accommodation was the reason given for wanting to move at the end of the scheme.

The reported issue for some, was not their desire to stay with the Trust but the reluctance they perceived on the part of the Trust/HR department to help them plan a future there. Uncertainty about the future toward the end of their time on the scheme was an issue for many:

‘I have not been supported towards maintaining a job/career at the end of the rotation scheme’ C2

‘I am hoping that things will change for the better and that rotation staff will be given some consideration for their efforts in completing the whole programme and being better equipped to serve their employer and sponsor effectively’ C3

‘Unsure of the future, whether you will be able to continue working in the chosen area and be promoted to a higher grade.’ C3

Participants wanted some means of planning their future career, and more support in finding suitable job within the Trusts.

‘There should be some way if you complete your degree you can move on to complete your MA/MSc and better career development for higher grade job’ C1.

5.3 Supervisors views at start of scheme

All the supervisors had been nominated for the role (i.e. they were not volunteers); most were also supervising staff under ‘traditional’ conditions. Initially, the supervisors expected that the scheme would mean more work for them — particularly for those working in the community (the assumption made was that in acute there would be less difference between ‘traditional’ and scheme staff).

They also expressed concern that they had not been involved at an earlier stage in the process of designing and establishing the scheme.

At the outset, the general view of supervisors was that the scheme would prove to be a positive development in the long term, but that there would be costs at the start of the scheme in terms of the time and work needed to launch and support the scheme successfully. They felt it was likely to have a positive effect on the recruitment and retention of staff.

Other positives reported by supervisors were:

• increased knowledge base of staff;
• encourage other staff to participate in education;
• contribution of research projects;
• opportunity for ‘realistic job preview’ in areas — will demystify some of the areas that have a bad reputation;
• provide some basic management training for new nurses.

Perceived negatives reported by supervisors were:

• that community work will not get special duty payments (SDPs), which may be a problem for retaining staff there;
• the potential for clashes of personality with supervisor (acknowledged that this was a potential problem also in traditional system);
• anxiety amongst some supervisors that they are not prepared for the educational component of the scheme;
• danger that those on the scheme would be viewed as ‘favourites’ or an elite;
• potential remoteness of some sites from education provider;
• concern that too many of the cohort may want to stay in one area;
• perception that there was more choice of location at BCKW than at WLMHT.

In terms of the potential impact on service users, supervisors initially felt that there was a need to match clients with participants in some areas. They identified a need to communicate to other staff what the scheme is about and the practicalities of its operation.

On balance they believed that the scheme would have a positive impact on quality of care, but were concerned that it should not be seen as a panacea for all recruitment and retention difficulties — it would be important to continue other efforts to help improve staffing. It was also hoped that the scheme would improve the overall organisational culture at the Trust, making them more attractive places for nurses to work.