Ben Morrin and Flo Panel-Coates analyse the cause and effect of nurse shortage plaguing the city of London

There are more than 35,000 unfilled nursing and midwifery posts nationwide, half of which are in London, according to the Royal College of Nursing.

Explanations for the shortage have been well rehearsed. Even if some of the contributing factors ease over time, patient need and the drive for safety and quality improvement are continuing to increase maintaining a gap between supply and demand.

The statistics

London has its own particular set of issues to deal with. The reduction in nurse training places has affected the capital acutely, the cost of living is extremely high, and with so many hospital trusts, it is a competitive labour market.

As the recent London life for NHS workers analysis showed, more of our staff are needing to move further away from where they work.

In February 2015, our nursing and midwifery vacancy rate was more than 16 per cent, with a shortfall in all areas, not just those where it has historically been hard to recruit, such as neonatal and theatre nursing. But a year later, our vacancy rate had more than halved to six per cent and is still falling.

University College London Hospitals Foundation Trust now has one of the very lowest nurse vacancy rates of any London trust – achieved in the shortest time – with more than 1,000 posts filled and 750 new nurses and midwives joining in the past 12 months.

The reduction in nurse training places has affected the capital acutely, the cost of living is extremely high, and with so many hospital trusts, it is a competitive labour market

There are 551 more nurses and midwives employed by us now compared to a year ago. Our agency staff bill has fallen by more than £1m and the impact of our overall campaign has achieved a net pay cost saving of more than £3m.

Like many hospital trusts, we have recruited from outside the UK, particularly the Philippines, but we’re delighted that four out of five posts have been filled by UK-trained nurses.

While we had run campaigns to boost nurse recruitment before, these had increased the headcount, but hadn’t really tackled turnover or prompted a trust-wide change in mindset about the ongoing workforce challenges we faced.

Strategising

When we joined UCLH just over a year ago we realised that we needed to rethink our whole approach to retention and recruitment if we were going to turn around the situation. That meant setting up a dedicated taskforce, to develop and prioritise specific strategic goals.

The taskforce was made up of a team of senior nurses and AHPs from across the trust, our union representatives, and staff from HR, communications and education.

We met every Friday lunchtime to review and monitor progress and the group brought vigour and a true sense of teamwork to what had been perceived previously as intractable challenges.

This partnership has been critical to developing a trust-wide focus and enabling the team to gather good quality workforce intelligence; engage with staff to find out what we could do better and how they could help.

Campaigns hadn’t tackled turnover or prompted a trust-wide change in mindset

External market research proved a worthwhile investment. It revealed that we weren’t doing enough to nurture the talents of our existing nursing staff, as a result of which a third of our band five nurses were going elsewhere to secure a promotion. It showed that we had relied on our brand alone to promote itself for far too long.

The findings prompted us to let our nurses, midwives and AHPs redesign our marketing materials with their own quotes and job ads, using ideas from, and starring, our own staff, and to install billboard advertising around our campus and at every new development.

Their ideas were brilliant and we are determined all of our future staff marketing shall be home grown. At the same time we segmented our approach to target specific professional markets and deployed a comprehensive internal and external communications strategy on recruitment and retention issues.

We hold weekly practice and assessment centres for applicants so that recruitment is constant and fitted at times to suit the candidate. These have a well-deserved reputation for being rigorous and tough as we have not wanted the nursing shortfall to compromise our standards.

But we actively encourage those who don’t make it first time around to reapply, providing them with comprehensive feedback and practice materials to help them get through. We have now shrunk our overall time to hire from around 16 to 12.5 weeks.

Expanding horizons

We have set up a careers clinic, run by a dedicated member of staff. This offers advice on how to map out a career path by taking advantage of a ‘learning passport’ to progress a band or by switching to another specialty within the trust without having to repeat the formal assessment.

So far, 85 nurses have used the service to explore learning and development opportunities: 37 have already transferred; a further 45 are registered to transfer when a vacancy arises.

All of them said they were actively looking for jobs elsewhere to progress or change their career so this initiative has helped retain valuable staff.

The clinic has proved so popular that it has now been extended to nursing assistants among whom turnover remains higher than we would like. In a bid to make UCLH a more attractive place to work for those at the lower end of the pay scale, we have become the first NHS provider to guarantee the London Living Wage and jobs for young people who are not in education or employment through the Good Jobs scheme with our innovative partner Citizens UK.

While the government’s decision to place nursing on the shortage occupation list is to be welcomed, we are convinced that resourcing will need our sustained attention

Sometimes it is the small things that can make the difference: a Good Deed Feed enables staff to publicly praise and thank their colleagues for demonstrating our values everyday on our intranet; free food and hot drinks for nursing staff working night shifts, and discounted accommodation for the first months of employment for nurses relocating to London.

We have managed to stabilise turnover rates across the trust, and are now beginning to see these rates come down.

UCLH has been very fortunate in that we have a charitable trust that has helped fund some of our initiatives, and making use of the available creative talent among our staff costs nothing. For every £1 invested at the start of the financial year, we estimate a return of £1.46 by year end.

It’s still not clear what impact the advent of bursaries or the new nursing associate role will have on the supply of trained nurses. And while the government’s decision to place nursing on the shortage occupation list is to be welcomed, we are convinced that resourcing will need our sustained attention.

We can’t afford to slacken the focus on retention and recruitment if we are to provide the high quality, safe care our patients and the public deserve.

Tips for success

  • Bring experts together from nursing, HR, communications and trade unions in one action team
  • Listen to, and harness the talents of, existing staff to design marketing and communications
  • Set stretching targets to gain and focus energy
  • Try innovative and creative ideas for the first time – some will work!