Published: 21/02/2002, Volume II2, No. 5792 Page 28 29
The arguments for flexibility are especially relevant to nurses as the NHS struggles to meet its target of 20,000 extra staff by 2004.Wastage for qualified nurses is high, averaging 12.9 per cent in the UK nationally, with rates above 20 per cent in the London area, and turnover is expected to rise as nurses grow older.
The Royal College of Nursing estimates that 110,000 nurses will have to be recruited to meet government targets, and only about half of these posts can be filled by newly qualified entrants. The deficit will have to be made up with an estimated 18,000 overseas recruits and, more significantly, 29,000 UK returnees, most of whom are expected to work part-time. Part-time working is vital to the success of the NHS plan's target to expand the number of nurses.
Yet part-time working in nursing is less common than in other female-dominated service sector industries. It accounts for only a third of employed nurses, compared with around 70 per cent in most services. Given the significance of this group, we decided to carry out a study of part-time nursing in three London trusts - acute, community and mental health in 1999-2000.
We distributed questionnaires to a proportionate sample of 110 line managers and 875 permanently employed qualified nurses, both full and part-time, across participating trusts.We also carried out faceto-face interviews with senior managers. This was designed to identify the benefits, disadvantages and costs associated with part-time working, and to compare terms and conditions of employment, deployment, opportunities for training, development and career progression of part-time nurses with those of their full-time colleagues. The survey identified strategies used by managers in the management of part-time nurses within the trusts.
Eliciting a 46 per cent (n=51) response rate from line managers and a 44 per cent (n=385) response rate from nurses (124 of whom were employed part-time), this survey is one of very few to examine part-time working from both a staff and management perspective.
All the senior managers interviewed said that offering the option to work part-time was an important part of their recruitment-and-retention strategy. There was less uniform endorsement from line managers, but 62 per cent cited retention and 50 per cent recruitment as an advantage of parttime working.Most part-time workers had reduced hours within their current post or on return from maternity leave, and only about a quarter had been directly recruited to a part-time job. So part-time working in this case seems more important as a retention rather than a recruitment device.
Most of those working part-time (59 per cent) did so to accommodate caring responsibilities, but a significant number (16 per cent) cited quality of life. The average age of part-time workers was 35, and 80 per cent had been registered for over 10 years.
The proportion of part-time nurses in the acute and mental health trust was surprisingly small, at 13 per cent and 21 per cent respectively. Numbers in the community trust were nearer the national average at 30 per cent, but still low compared with the average service industry. All three trusts depended heavily on bank and agency staff to deal with staff shortages.
The relatively low level of employed part-time staff needs further exploration. The line managers surveyed were asked about the main advantages and disadvantages of managing the employment of part-time nurses. Recruitment and retention was the most frequently cited advantage - 42 per cent believed that part-time workers were less stressed, and 30 per cent that it reduced absenteeism. About a third thought they could be used to cover peaks in service demand or jobs not requiring full-time staff.
Managers also saw disadvantages to part-time working. Forty per cent cited difficulties with giving and receiving information, and about a quarter with team communication. Problems with continuity of service (28 per cent) and completing tasks (26 per cent), and the reluctance of part-time workers to work unsocial shifts owing to their caring commitments (25 per cent), were also mentioned.What are the consequences for the way part-time workers are deployed and managed?
Part-time workers' reports on their working activities suggest that managers tend to use them less extensively than full-time staff. Part-time staff are less likely to carry out higher-grade work than full-timers (29 per cent as opposed to 41 per cent) and fewer part-timers (45 per cent) than full-timers (59 per cent) were very or quite satisfied with their involvement in decision-making. Table 1 shows statistically significant differences in the frequency with which full and part-time workers said they undertook a range of tasks involving responsibility.
Table 2 demonstrates that part-time workers also have less opportunity to contribute to more advanced activities such as research and management meetings. These findings show that part-time nurses are as well qualified as - and on average only two years younger than - their full-time colleagues, but their experience and skills are being underused.Also, they have fewer chances to develop new skills and acquire the management experience necessary for promotion.Only 48 per cent of parttime staff were satisfied with their opportunities to gain qualifications, against 63 per cent of full-timers.
It is not surprising that far fewer part-time staff are to be found in the higher-graded posts (table 3).
Part-time workers are largely concentrated in the lower grades, and while 12 per cent of full-time staff surveyed had risen to H grade, only 5 per cent of part-time staff had done so.Two per cent of fulltime workers are I grade, but no part-time ones surveyed had succeeded in progressing to this level.
Our study offers clear evidence that underuse of part-time workers leaves them at risk of skills erosion and impairs their chances of career progression.
However, not all part-time workers were disadvantaged and some have successfully reached higher-graded posts.Also, despite the drawbacks, part-time staff were as satisfied with their jobs as full-time ones.The value of a better work/life balance appears to compensate for fewer opportunities for career advancement and skills development.Most part-time workers surveyed were committed to the profession and to their careers, and planned to stay in nursing for the foreseeable future.
Over half claimed that they would be back in fulltime employment within three years, and hoped to be working for the same trust.
We found little evidence of the strategic use of part-time workers to cover staff shortages or peaks in service demand. Instead, most managers rely on overtime (thus increasing the pressure on full-time staff) and the use of expensive agency and bank staff.Therefore the NHS is failing to reap the full benefits of part-time working.
Why should this be? We found that senior managers are highly committed to flexible-working policies, but the line managers, who have to put these policies into operation, perceive substantial difficulties with part-time working. Some of the problems may stem from the Florence Nightingale culture of nursing that equates long hours with commitment.
Anyone who wishes to reduce hours may be accused of seeing nursing as 'just a job' rather than a vocation.But there are more tangible issues to do with a system of work organisation designed around full-time input into a continuous shift system.
Reorganising work to integrate staff with different work patterns, and adapting systems of communication and training to meet their needs, requires strategic planning, resources and time.
While most trusts provide guidance on the rights of part-time workers and options available to them, they have done little to support managers with practical advice and additional resources to make these policies work in practice.These issues need further exploration to verify the extent of the problem and to provide solutions.Variations in the findings between and within trusts suggest no single solution, but throw up examples of good practice. Identifying these and putting them into practice is the next logical step.
Key points
A study of part-time nurses in three London trusts found that they were concentrated in lower grades and less likely to be involved in management than full-time nurses.
While senior managers in the trusts were fully committed to flexible working, managers lower in the organisation felt that part-time working presented problems for continuity of care, and that part-time nurses were unwilling to work unsocial hours.
A more strategic approach is needed to ensure that part-time nurses are employed most effectively at a time of acute nursing shortages.
Professor Christine Edwards is head of the school of human resource management, Susan McLaren is professor of nursing, Dr Olive Robinson is industrial fellow, and Dr Margaret Whittock is senior researcher, faculty of health and social care sciences, Kingston University.
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