Many mental health trusts are facing difficulties in recruiting and retaining nurses, particularly in London, where a competitive labour market and the well-advertised problems of mental health services have led to chronic shortages of D and E grades.
1 Government initiatives aimed at recruitment and retention involve the development of the first human resources strategy for the NHS, Working Together, 2 the nursing strategy, Making a Difference, 3 and the National Service Framework for Mental Health. This recognises that local action must be taken to improve recruitment, retention and training of staff if its ambitions are to be achieved.
4 Based on the partial success of a previous local rotation scheme in attracting D and E-grade nurses, and on the development work of Gabrielle Atmorrow at Leeds Teaching Hospitals trust, two west London mental health trusts set about implementing an enhanced nurse rotation programme.
Brent, Kensington & Chelsea and Westminster Mental Health trust and Ealing, Hammersmith & Fulham Mental Health trust set up the joint initiative in February 1999 to attract nurses and support and develop nurses already working in 'hard-to-staff ' areas.
Service users should receive better continuity and quality of care because the trusts will be able to: staff the mental health units and remain in budget; replace bank/agency staff with nurses who will become part of the care team; provide service users and carers with nurses whom they recognise as regular members of the care team and with whom they can form longerterm relationships; invest in junior staff with a view to encouraging them to develop a long-term professional career in healthcare.
A joint trust committee consisting of the directors of nursing, senior managers and HR personnel designed the content of the rotation scheme and consulted local managers and staff in 'hard to staff ' areas. The scheme in its final form, with the support and investment from the education consortium in west London, was launched in January 2000.
Its main component is a staff development programme offering nurses three eight-month staff nurse placements in a variety of service delivery areas - acute adult mental health, older adult assessment, rehabilitation, eating disorders, psychiatric intensive care and community mental health.
The two-year rotation scheme includes a parttime, work-based learning modular degree course provided by the school of health at Middlesex University.
The work-based learning modules focus the nurses on developing their practice in care co-ordination, contemporary interventions in mental healthcare and in small-team management.
Specialist clinical supervision is provided for each nurse by a staff member in each of the service areas.
As there is little evidence to date of the effectiveness of rotation schemes, an evaluation was commissioned from Dr James Buchan at Queen Margaret University College, Edinburgh, and from Employment Research, Brighton.
A recruitment drive attracted 25 nurses on to the scheme, 11 of whom were new to the trusts and would not have considered working at the trusts without the scheme. As a result, 18 service delivery areas have been able to replace agency and bank staff with a regular staff nurse.
The rotation nurses have now completed their first eight-month placement and their first work-based learning module. The first phase of the research has been completed, involving focus groups and questionnaire surveys.
The problems have been in the clarity of the scheme. Although a number of groups were run with managers beforehand, when it came to operating the scheme some of the information was forgotten. This led to a lack of clarity among the nurses about how, precisely, it would operate.
There have also been different levels of experience of rotation schemes in the different service locations. Some clinical areas had run rotation schemes before. Others did not have that experience, and this led to uncertainty about what should be offered and how staff would fit in.
Most problems have been resolved as the scheme has bedded down - although there is work to be done with new clinical areas coming into the scheme.
The scheme, which has secured financing for a second and third group of nurses, has proved to be an attractive local solution to nursing staff shortages for managers, nursing staff, education consortia, workforce planners, clinical effectiveness managers and university partners. It has also been recognised as a positive practice example in developing the mental health workforce in London.
1 Recruitment, Retention and Vacancies Survey. Department of Health, 1999.
2 Working Together: securing a quality workforce for the NHS. Department of Health, 1998.
3 Making a Difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, 1999.
4 The National Service Framework for Mental Health: modern standards and service models. Department of Health, 1999.
5 Mental Health in London: A strategy for action. NHS Executive/Social Inspectorate 2000.