7. Staying or leaving?
7.1 Attrition levels
Given that the scheme was borne out of a desire to improve recruitment and retention, a key measure for judging its success must be attrition and the extent to which the scheme has been able to keep staff in the Trusts. One year after the start of Cohort 1, 9 of the original 25 participants had left the scheme. This bald figure disguises variation — there are several different levels of departure. Six staff have left the scheme and the Trusts, whilst three have discontinued the scheme but are still working at the Trust. All these staff stayed at least 6 months, with discontinuations happening 6 to 12 months into the scheme (the move to the second placement appears to have been a critical point).
| Table 7.1 Mapping changing composition of the first cohort | |
|---|---|
| 25 participants at start | |
| 12 WLMHT | 13 CNWL |
6 Newly qualified 1 Working elsewhere 3 Recent Trust recruits 1 from career break 1 unknown (non responder) |
2 Newly qualified 2 Working elsewhere 8 Recent Trust recruits 1 unknown (non responder)
|
| 16 participants on scheme January 2001 | |
| 5 WLMHT | 11 CNWL |
1 Newly qualified 1 Working elsewhere 1 Recent Trust recruits 1 from career break 1 unknown |
1 Newly qualified 2 Working elsewhere 8 Recent Trust recruits
|
| 13 participants at end of the scheme Feb 2002 | |
Employment Research 2003
The purpose of Table 7.1 is to give some indication of the composition of the first cohort in terms of their previous employment situation, and show how this changed since the start of the scheme. Of the 8 newly qualified nurses recruited to the first cohort, 2 remained. At this stage CNWL had had greater success in keeping nurses on the scheme than WLMHT. Of the first eight participants that left cohort 1, three are known to have left for personal reasons.
Thirteen participants from the first were still on the scheme at the end of the two years. The second cohort went from 23 recruits to fifteen participants starting the scheme, nine at the time of the first survey, and seven at the end.
7.2 Reasons for leaving or staying
The scheme is made up of twelve key elements — 3 of the main being the education, clinical experience and rotation to placements. A point made by one interviewee was that this means that for an individual to be satisfied overall with the scheme, requires them to not only be satisfied with each of the elements separately, but also to be satisfied with their abilities to combine work with study, whilst maintaining a reasonable quality of life.
In the final survey, participants remaining on the scheme were asked their views as to the reasons that some people had left the scheme, before being asked why they had stayed until the end. The responses were coded into themes, and the number of times each was cited is shown in Table 7.2 and 7.3.
| Table 7.2 Why do you think colleagues left? | |||||
|---|---|---|---|---|---|
| Theme | Cohorts | Examples of comments | |||
| 1 | 2 | 3 | All | ||
| Placement choices | 5 | 3 | 3 | 11 | ‘Some did not want to rotate’ C1 ‘Lack of flexibility in rotation placement arrangements; Lack of variety of placement specialties’ C2 |
| Combining work/study; number of study days | 1 | 4 | 4 | 9 | ‘Lack of proper study time if you are working in very busy understaffed areas’ C1 |
| Promotion/better job elsewhere | 1 | 2 | 2 | 5 | ‘Understand someone got an F grade on second placement so had to drop out of the scheme’ C3 |
| Having to rotate | 1 | 2 | 3 | ||
| Poor coordination/ organisation | 2 | 1 | 3 | ‘The beginning of the scheme was a little confusing both for the ward staff and colleagues doing the course’ C1 ‘Organisation by the Trust very poor…There should be an identified link person’ C3 |
|
| Personal reasons | 1 | 1 | 2 | ||
| Lack support from personnel department | 1 | 1 | 2 | Lack of support given by WLMHT personnel department’ C2 | |
| Lack of clear future at end of scheme | 1 | 1 | 2 | ‘At the end of the course, where do you go?’ C1 ‘Not supported towards maintaining a job/career at the end of the rotation scheme’ C3 |
|
| Misinformed at start | 1 | 1 | 2 | ||
| Lack of support in clinical area | 1 | 1 | 2 | ||
| Commitment needed | 2 | 2 | ‘The rotation has needed a great deal of commitment and focus, which I felt some colleagues may not have foreseen’ C1 | ||
| Course content/structure | 1 | 1 | 2 | ||
| Costs of living in London | 1 | 1 | |||
Some of the reasons given for leaving the scheme (and in some cases the Trust) could be said to relate primarily to the individual — wanting different things from the education or finding that they were unprepared for the level of commitment and time required. The main ‘scheme’ based reason for leaving was dissatisfaction with the amount of choice over placements. Comments like the one below from a participant in Cohort 1 were typical.
‘I have been fortunate to get the placements I wanted but some of my colleagues were not therefore this may have put them off’ C1.
For the first cohort, poor communication at the recruitment stage about placements and during the scheme was blamed for much of the dissatisfaction about placements. Some felt that the parameters and limitations of the scheme had not been spelt out early on, and as a result their expectations regarding the placements were not met.
After placement choice, the second most frequently cited reason participants gave as to why colleagues may have left the scheme, was difficulty in combining studying and working, especially as the areas worked in were generally those with lower staffing levels/higher workloads. For example a participant in cohort 3 speculated that those that had left had done so because they:
‘Could not cope with the assignments and full-time job at same time’ C3,S3
The responses to the question asking respondents at the end of their scheme why they have stayed (table 7.3), shows that the factors that were most important in attracting them to the scheme in the first place have continued to be important in motivating them to continue.
| Table 7.3 Why did you stay? | |||||
|---|---|---|---|---|---|
| Theme | Cohort | Example of comment | |||
| 1 | 2 | 3 | All | ||
| Education/getting degree | 3 | 4 | 5 | 12 | ‘To achieve the degree’ C2 ‘I stayed on the programme to complete the educational component’ C3 |
| Professional development/learning experience | 2 | 1 | 1 | 4 | ‘The rotation has developed me greatly both professionally and personally, thereby motivating me’ C1 |
| Rotation though different areas | 1 | 2 | 3 | ‘Wanted to experience fully the benefit of different clinical areas’ C3 | |
| Personal commitment to see things through to end/Positive outlook /Enjoyed the challenge | 3 | 3 | 6 | ‘I was determined to stay and complete the course, though it means hard work’ C3 ‘Wanted to complete what I had started’ C2 |
|
| Don’t know | 1 | 1 | |||
| Hoped to get job in chosen specialty at end | 1 | 1 | |||
The most frequently cited reason given by more than half of all respondents for staying on the scheme, was to complete the educational component and get the degree.
For example, in response to ‘Why have you stayed’ some answered:
‘To finish my degree and gain more experience’ C1
‘Because it has been my desire to improve my professional educational background. I was determined to stay and complete the course’ C3
‘I enjoyed the two years I spent on this scheme. I have achieved the main objective which will be a stepping stone for me to carry on with my professional development’ C3.
Looking across the comments in Table 7.2 and 7.3 the message that comes across is that whilst the education and varied experience are key motivators, the factor discriminating ‘stayers’ from ‘leavers’ (in the eyes of many of the ‘stayers’) is personal determination.