Nurse Job Rotation Scheme
Perceptions of a job rotation scheme by a sample of supervisors
By
, Lead Researcher
&
, Principal Investigator — Job rotation scheme Research
September 2006
Published by Central and North West London Mental Health NHS Trust, London. (www.nurserotation.com)
Acknowledgements
In particular we want to thank Peter Walsh, Director of Nursing and Luella Dixon, Deputy Director Of Human Resources in CNWL Mental Health NHS Trust, for their initial concept paper on Rotation Schemes, and their support for the development of the projects.
We are grateful to all of the participants in this study, and the whole action research community — in particular the two Trusts who have set up the pilot (CNWL and WL Mental Health NHS Trusts); the Workforce and Education Confederation; Middlesex University the education provider; and the local managers who are supporting the scheme. We want also to thank the other researchers involved with the overall job rotation scheme and the action research — Professor James Buchan and Jane Ball.
Finally, in the light of the regular organisation changes for both West London Mental Health NHS Trust, and Central and North West London Mental Health NHS Trust, we want to thank all of the new stakeholders who provide us with support.
TABLE OF CONTENTS
SECTION ONE — D/E NURSE JOB ROTATION SCHEME
1.3 The Problems That Have Led To the Action Research Study
1.3.2 Challenging institutionalisation through staff transfer
SECTION TWO — METHODOLOGY
SECTION THREE — FINDINGS AND DISCUSSION FOR THE SUPERVISORS OF THE NURSE JOB ROTATION SCHEME STUDY
3.2 Supervisors training for supervision and their supervision of the job rotation scheme nurses
3.2.2 Attendance at the three day supervisors’ course and preparation for supervision
3.2.2.4 Difference between line management supervision and clinical supervision
3.2.2.5 Confidence, focus and structure
3.2.2.8 Who should attend the supervisors’ course
3.2.2.9 Preparation for supervision
3.2.2.10 Supervision and formal teaching qualifications
3.2.2.11 Preparation for supervision
3.2.3 The effectiveness of supervision and related issues
3.2.3.1 Confusion about need for supervisors course
3.2.3.3 Effectiveness of supervisors
3.2.3.4 Influence of supervisors
3.2.3.6 The connection between work based learning and supervision
3.2.3.7 Supervision is an ongoing nightmare
3.2.3.9 Content of supervision — CPA
3.2.3.10 Management supervision
3.2.3.11 Content of supervision — worries
3.2.3.12 Peer supervision at university
3.2.3.13 Content of supervision — reflective
3.2.3.14 Supporting course work
3.2.3.15 Experienced at facilitating learning
3.2.3.17 Clear rotatee expectations are helpful
3.2.3.18 Supervisors’ experience of supervision
3.2.3.19 Trust audit of supervision
3.2.3.20 Time as a scarce management resource
3.2.3.21 Improving quality of supervision generally
3.3 Advantages and disadvantages of the job rotation scheme for colleagues at work
3.3.1 Benefited — recruitment and retention to hard to staff areas
3.3.2 Patients/Clients benefits
3.3.5 Good at simply staffing the wards
3.3.6 Improved skill mix and knowledge base
3.3.9 Staff in continuing care services
3.3.11 It’s been fantastic — six rotatees
3.3.12 Temptation to persuade rotatees to stay
3.3.13 Type of nurse — committed
3.3.14 I have never seen any disadvantages
3.3.19 Makes a big difference on elderly ward
3.3.20 By comparison — more motivated
3.3.21 Comparison with staff seeking long term posts
3.3.22 Bringing assessment tools to the service
3.3.23 Benefits to patients/clients
3.3.24 Changed the format of the care plan — more specific
3.3.25 Filling gaps with very good nurses
3.3.26 It’s good to have someone who is questioning energetically
3.3.27 Four rotatees would have been wonderful
3.3.28 Team workers: much more than bank/agency
3.3.29 Team working — attitudes and capabilities
3.3.30 They’re experienced and know the system
3.3.31 Budgetary fears in notoriously hard to staff service
3.3.32 No, we are not benefiting
3.3.33 To contribute or to bide time
3.3.35 Reluctance of rotatees to join a service
3.3.37 Refusal to rotate — crisis
3.3.38 Supervisors who want nurses to stay
3.3.40 I’ve lost rotatees — I’ve done quite badly
3.3.41 Other wards do quite well out of it
3.3.42 It’s a big disappointment when good rotatees rotate
3.3.45 A job rotatee who becomes a supervisor
3.3.46 Passing on knowledge from my community placement
3.3.47 Work based learning syllabus — CPA useful
3.3.48 Syllabus and major organisational priorities
3.4 What patients/clients can gain from the job rotation scheme
3.4.1 Good feedback from clients and carers
3.4.2 Nurse to patient matching
3.4.3 Potential downside — envy
3.4.4 Top notch assessment and care planning
3.4.5 Get to know regular staff
3.4.6 Agents of change: government policy
3.4.8 A good all rounder — characteristics
3.4.9 Basic and advanced benefits
3.4.10 Education about administration and management — important
3.4.12 No benefits — except more thorough CPA
3.4.13 Costs and benefits compared to bank and agency
3.4.14 Dissatisfaction through wishful thinking?
3.4.15 Patients miss them when they rotate
3.4.16 Induction to the NHS from private sector
3.5 What the Trust can gain from the rotation scheme
3.5.2 Cheap way of recruiting and filling gaps
3.5.3 Exploitation or facilitation?
3.5.4 A nurse for two years and much more
3.5.5 More than filling gaps — developing the profession
3.5.6 Reassurance that someone will know the patients
3.5.8 Retaining staff — but a lot do not stay
3.5.9 Clinical governance — they are giving a lot to the organisation
3.5.11 Whole group feedback to the organisation
3.5.12 Using literature reviews to improve standards and audits
3.5.13 Use the rotatees research within the organisation
3.6 Usefulness or otherwise of the scheme for the rotation nurses
3.6.1 Helps their decision making
3.6.2 Work based learning brings it alive
3.6.4 Relevant versus irrelevant education
3.6.5 ‘Joined up’ plan for their development
3.6.6 You need to be vocational to work here
3.6.7 Perspectives in hard to staff areas — realistic and unrealistic
3.6.8 Developed and ‘picked up’ skills
3.6.9 Not asking for enough help from ward staff
3.6.11 Insufficient variety in placements versus staffing hard to staff areas
3.6.12 Amazing that community teams are not signed up
3.6.13 Maintaining motivation — I never had the opportunity
3.6.14 Beneficial partnership with the university
3.6.15 Some rotatees believed their abilities were not sufficiently exploited
3.6.16 No interest — ‘up and went’
3.6.17 Really enjoyed the scheme and felt wanted
3.6.18 Some were ready for promotion but did not want to leave the degree
3.6.20 A conflict of perspectives — ‘what is the point’
3.6.22 The opportunity to rotate from an area they do not like
3.6.25 Useful for experienced nurses too
3.6.26 Better communication between services
3.6.27 Neighbourhood rotation schemes
3.6.28 Salary differences between placements
3.6.29 Reduced salaries in the community — drop out
3.6.30 Matching nurses to case loads
3.6.33 Gaining all the time — policies and practice
3.6.34 Useful assignment on supervision
3.6.35 More and less attractive hard to staff areas
3.6.36 Developing a nursing ethos — fairness
3.6.37 Most happily accept placements
3.6.38 A safe job at the end of the scheme
3.6.40 Leadership — prejudice is a major project management issue
3.6.41 Blatant Ignorance leading to dissatisfaction
3.6.42 Learning from the pilot schemes
3.6.43 Lack of awareness of the transferability of skills and capabilities
3.6.44 Study leave and a paid for course
3.6.45 CPA is not interesting to me
3.6.47 Advantages of a degree — employability
3.6.48 Opinions based on traditional courses
3.6.49 Confusing and conflicting opinions
3.6.50 Induction to the NHS from the private sector: CPA
3.6.51 Work based learning is most important — I already had a degree
3.6.52 Difficult to learn as there was little information in the service
3.6.53 Reason for leaving — lack of support materials
3.7 Factors that undermine or threaten to undermine the scheme
3.7.2 Right kind of experience and knowledge
3.7.3 Communication with leaders
3.7.5 Advantages and disadvantages of pilot schemes
3.7.6 Timely knowledge about placements
3.7.7 Sustained operational management
3.7.9 Advantages and disadvantages of being flexible
3.7.10 Guaranteed promotion at the end of six months if competencies are met
3.7.11 Lack of awareness of transferability of skills
3.7.13 Trust wide competency statements
3.7.14 Cross trust and cross borough working
3.7.15 Copy of the course content — syllabus
3.7.16 Different perspectives: keeping meetings to a minimum due to a lack of time
3.8.1 Most comments and complaints
3.8.3 Planning problems due to year by year funding decisions
3.8.4 Sustained educational leadership
3.8.5 Lack of contact with organisation’s leaders
3.8.6 Information about the educational side
3.8.8 Confusion — ‘students’ and ‘registered professionals’
3.8.9 We could have asked the rotatees
3.8.10 Organisational tweaking
3.8.11 Negotiating their own next placement
3.8.12 Self managing team elements
3.8.15 The effects of withdrawing leadership
3.8.16 Being involved in the recruitment of the scheme
3.8.17 Different perspectives — appointability
3.8.18 Pre placement induction
3.8.20 Leadership: sustained commitment from the top to the bottom
3.9 Changes that could or should be made to the scheme
3.9.3 Specific supervision course
3.9.4 Well organised and reliable supervision
3.9.5 A benefit of an evaluation study — a chance to reflect
3.9.6 Leading central and local operations
3.9.7 Biggest change — open up the scheme
3.9.8 Access to university personnel
3.9.9 Greater funding for the rotation scheme
3.9.10 Greater variety of placements
3.9.11 A study area on the ward
3.9.14 Be responsive to ideas for improvement
3.9.15 Placements and long term career decisions
3.9.16 Hard to staff areas becoming well staffed
3.9.18 Sustained leadership for greater organisational benefits
3.9.19 A rotation post in all services
3.10.1 We all need to get together
3.10.3 Still useful even if here were no staff shortages
3.10.4 ‘Feast and famine’ of nurse recruitment
3.10.7 An internship for professional nurses
3.10.8 Overseas rotatees who have competed an adaptation course
3.10.9 A rotation scheme within a speciality
3.10.10 The usefulness and flexibility of the model
3.10.11 The broad responsibility of nursing
3.10.12 Defending an ‘unattractive’ speciality
3.10.13 Time to reflect — four years on
3.10.14 Research study — impact on careers
3.10.15 Not wasting the learning from work based learning projects
3.10.17 Envy was common: jealousy was rare
SECTION FOUR — CONCLUSIONS
4.2 Aspects of the nurse job rotation scheme that were shown to be useful
a) Recruitment and retention of nurses for patients and clients
d) Better than bank and agency
f) Common understandings and priorities
h) Able to use capabilities with patients/clients
4.3 Aspects of the nurse job rotation scheme that were shown not to be useful
4.5.1 Evidence of added value from the job rotation scheme itself
4.6 Aspects of the scheme that the evidence suggests need changing and what is needed to change them
SECTION FIVE — RECOMMENDATIONS, STRENGTHS AND LIMITATIONS OF THIS RESEARCH PROJECT
c) University to support recruitment and retention
f) Study on benefits of supervision
j) Supervisors and education syllabus
l) Rotation and concerns of patients/clients
r) Speedy transfer of theory to practice
s) Neighbourhood job rotation schemes
SECTION SEVEN — APPENDICES 1 AND 2
EXECUTIVE SUMMARY
This is the evaluation of the a) Rotatees’ supervisors supervision course, their supervision and the supervisors’ perspectives concerning the D/E Nurse Job Rotation Scheme, developed by The Central and North West London and The West London Mental Health NHS Trusts.
The Scheme was developed as a pilot scheme to explore ways of recruiting and retaining professional personnel within health care organisations, particularly in hard to staff areas, at a time when many were not only leaving those organisations, but health care per se. This tool was used in those areas that were already using a wide variety of other recruitment tools which, however successful, did not impact upon a regular 30% to 50% vacancy rate.
Local managers and supervisors suggested that a job rotation scheme could improve recruitment to hard to staff areas. The scheme that was developed sought to offer Junior Nurses incentives in order to attract and recruit them and thus ensure the basic provision of nursing care for the patients/clients of hard to staff areas. The incentives included a professional development scheme involving work based learning to degree level, three rotations, and a continuous service contract. This would support their career development, their transfer to professional practice; increase their employability and their satisfaction with their profession.
It is a part of an Action Research project, also originating and operating within the two organisations (Buchan and Ball (2004); Lucock & Coyne 2003; July 2006; August 2006). These studies will be meta evaluated with the intention of providing a substantial evidence base on the use of job rotation as a service improvement tool for policy development, commissioning, provider and educational leadership.
Conclusions
This study shows that the supervisors liked the model of job rotation used here to attract, recruit and retain nurses within hard to staff health and social care areas, and to a great extent within the Trusts concerned. They were pleased that this tool reduced the need for bank and agency staff, assisted with budget management and brought about greater continuity of care.
The supervisors affirmed that the model facilitated the provision of care and reflective practice capabilities, and enabled junior nurses to gain the education they needed to make planned changes to their careers. They argued that it supported job changes and that work based learning was successful in facilitating a successful partnership between academia and the workplace. They also argued that a retaining factor was the provision by the university of supervision and support that was limited in hard to staff areas.
A variety of unexpected benefits accrued which added value to the use of the model. There were a few problems identified with the clarification of the meaning of supervision and its provision, leadership, communication, rotation negotiation, and shared expectations.
Recommendations
It is recommended that this model be used widely for the attraction, recruitment and retention of personnel within the health and social care environment, especially for those parts which might be hard to staff and have budgetary problems. Supervisors recommended that it could be useful in improving the quality of care, avoidance of institutionalisation and in transferring good practice across a learning organisation. More supervision training and more consistent supervision was recommended. Further evaluation is needed to develop the evidence base.
