Return-to-practice initiatives for nurses are proving highly successful, but they still have some way to go to understand those who take them. Thelma Agnew reports

Anybody who needs convincing that returnto-practice initiatives are worth the effort should consider the experience of Burnley General Hospital.

When it established its own return-to-practice course in August 1999, backed by a local recruitment campaign targeted at former nurses, it had 116 whole-time equivalent nursing vacancies.

In under a year, 100 of those vacancies were filled. Now the trust plans to set up a returnto-practice programme for the professions allied to medicine.

The Burnley success story seems to bear out the government's belief that drawing from the pool of nurses who have left the profession, often for family reasons, will go a long way to solving the recruitment crisis.

Last July, the NHS plan claimed more than 4,000 nurses and midwives had returned to work since February 1999, with 'over 2,000 more preparing to do so'.

Good, but not good enough.

'We have to go further and faster, ' exhorted the plan.

'That means extending the national recruitment campaign to other staff groups and intensifying follow-up action, with more - and more accessible - returnto-practice courses, a willingness across the board to offer flexible working practices, and effective support and mentoring of newly returned staff. '

The reality is often far from this ideal, as NHS Confederation policy director for human resources Andrew Foster readily admits.

'Every trust will say it is offering flexible working, but I would agree with Royal College of Nursing criticism that in many cases the practice does not live up to the rhetoric. '

On the other hand, he says, employers have taken on board the need to attract back former staff, and are becoming more adept at doing so.

'They have no choice. You have to say in your trust plan how you will contribute to the government's four-year target of 20,000 more nurses for the NHS.

'A fairly significant number of nurses are coming back.

This is now becoming part of the furniture; we have to have a much more organised way of encouraging nurses back. '

Mr Foster says trust managers are making return to practice an integral part of their normal recruitment and training agenda, rather than seeing this as an add-on project or a drain on resources.

At Burnley, the initial flurry of effort was exceptional.

Local newspapers were used to blitz potential returnees with a 'wish you were here' recruitment campaign.

Preston University, 28 miles from Burnley, was persuaded to supply an accredited ENB course on the hospital's own site, and all returning nurses were offered flexible contracts, support and mentoring while they settled back into the workplace.

Burnley's former return-topractice facilitator Andrea Baldwin, who set up the course, emphasises that support and mentoring must continue for some time.

'Here, they are never left unsupervised. In theatre, returnees are supernumerary for three or four months. '

The attitude of other staff is also crucial; a 45-year-old returnee who finds herself talked down to or ignored by her twentysomething colleagues may soon decide to leave the NHS for good.

RCN director of employment relations Stephen Griffin says employers generally expect return-topractice courses to do too much and underestimate how much on-the-job support this group needs.

'There is a huge issue about confidence for anybody who has been out of nursing for some time. The world of nursing and clinical practice has changed tremendously.

They have to be treated as new recruits and given appropriate support. '

Some former nurses never make it back into the NHS workforce because they can't afford to give up their income for the three months or so it takes to complete a return-topractice course.

Returnees who undertake the Oxford Brookes University course are paid£500 for the 90 hours they spend on clinical placements at local trusts.

Spread over three months, this is a token payment, not a living wage, admits nursing lecturer Jackie Hunt, who has had a couple of returnees drop out for financial reasons.

'I have had people with quite well-paid jobs who wanted to come back to nursing but couldn't afford to. And then there are single mums and people who are recently divorced who really need to come back - but they can't always afford it, either. '

A wide range of local trusts accept returnees on clinical placements, with the community trust popular with returnees nervous about being thrown back into an acute setting.

Wherever they go, it is under the watchful eye of Ms Hunt who calls herself 'a bit of a mother hen'.

The success of a clinical placement depends on matching the person to the right position and on the quality of the mentoring.

Staff in the Oxfordshire trusts have to accept - like those at Burnley General - that they also have something to learn, says Ms Hunt.

'In the teaching hospitals, sometimes the mentors are much younger than the returnees and are not quite sure of the type of person they are dealing with.

'They either leave them alone because they think they know everything, or they do not have the maturity to bring them on. There can be conflict. '

About 60 per cent of the nurses who complete the Oxford Brookes course end up returning to nursing jobs in the NHS.

Ms Hunt says the 'people in the know' at trust level are very keen to accommodate the returnees, but some nurses are still put off by the attitude of individual managers, who are 'not terribly helpful'.

On the other hand, she recognises: 'Managers want to be sympathetic but they have to have a backbone of people who are there all the time. '

The future of return-topractice lies beyond courses - and beyond nursing. At Burnley General, clinical educator Gillian Wilkinson plans to offer return-topractice courses to the professions allied to medicine, although the trust is not yet troubled by severe PAMs vacancies. 'It is a natural extension of the nursing initiative. It is a preventative measure, ' she says.

With applicants to the nursing return-to-practice course now 'dwindling' - Ms Wilkinson suspects the local pool has been pretty much drained - the trust has also put together a 'staff nurse development plan'.

This is designed to give onthe-job support to returnees who have been out of practice for only a few years and need a confidence boost, rather than a full skills overhaul.

The trust is also open to suggestions. Ms Wilkinson recently accepted a nurse's request to work in a supernumerary role until she feels ready to take on a job.

'We are arranging an honorary contract for her, so she can come into the ward and work at her own pace. '

Such flexibility may still be rare, but Ms Wilkinson feels it is the only way to go. 'Return to practice is based around individual needs. It is not a prescriptive thing. '