Shortage of Nurses in Costas, and our subsequent deliberations...

Over several double-expressos in a particular Trust’s Costas last week, we felt sufficiently hyper to risk discussion on the very complex issue of unfilled vacancies.

[Note: This is not a dating site advert, regardless of the post's image]

We can see clearly from our Trust datasets how vacancies are affecting bank and agency spend, and that not all Trusts feel brave enough to increase their substantive costs (although this is changing, as Trusts do the maths and sniff the wind re: Safe Staffing). And with massive pressure to reduce temporary staffing costs too, we can note down our first conclusion…

1) Trusts are caught between a rock and a hard place (or, the Scylla and the Charybdis, as Greg prefers) on staffing and temporary staffing. Breaking: Providers ordered to take tough new measures to cut deficits

In many Wards, bank use is not at all ad-hoc, it’s pretty much every day. How can this be if establishments are calculated correctly? And it gets worse and more complex.

2) Please think about the NHS as a working environment. OK, now is this likely to stimulate an increase in the number of people entering the nursing profession?  We think no. Train more nurses, says the Nursing Times, but is that the only answer? And how to increase the numbers of those presenting to be trained? https://www.nursingtimes.net/opinion/editors-comment/training-more-nurses-is-only-answer-to-crisis/5082014.article

So we could look to recruit from abroad, which is a strategy many Trusts have used for many years. But is it an effective strategy? Probably if you are thinking operationally, possibly not if planning strategically.

3) Overseas recruitment is more expensive, and turnover rates can be extremely high. Well, this does seem intuitive, but here’s some evidence. https://www.nursingtimes.net/nursing-practice/specialisms/management/exclusive-trusts-hit-by-high-turnover-of-nurses-recruited-from-abroad/5081928.article

So are we in an unhappy place? For sure.

But one possible ameliorating factor – could we try to get more from the trained nursing staff we already have?

[Surely we’d want to do this anyway, regardless of whether the problem of attracting nurses into the NHS has been solved/improved]

• Can we gently encourage our part time staff to increase their hours? A trained “head” is underused if working part time.
• Can we encourage roster planners to improve their planning quality, not overstaff (see my article on this Top 10 reasons why Wards over staff) etc?
• Can we prevent roster/ward managers from decreasing FTE staff hours to better fit shift patterns (i.e. 37.5 down to 34.5 hours) – motivated by concerns about leaking contract hours? This represents an insidious leakage of planned in resource that may not be detected and rebalanced for months.

Taking another look at our Trust datasets, we can see that there are some very strong trends at play. Part timer contract hour values are generally increasing, and part timer headcounts are generally decreasing.

[This can only put more pressure on rostering systems and roster planners to plan shifts fairly and ensure staff achieve a degree of flexible working, and all without (unintentionally) planning in extra cost to boot!]

But who’s driving this, and is it a “good thing”?

• Is it an unconscious Trust strategy, where Ward Managers in isolation are concerned about leaking contract hours and try to reduce this by manipulating staff contracts to better fit shift patterns?
• Is it a conscious Trust strategy, where execs have decided this is a good thing to be encouraged across the Trust?
• Or is it staff-driven – where in harder times staff seek to up their hours, particularly if compensating for a partner’s loss of salary. Will the trend reverse naturally if the economy improves?

At some point, if these trends continue, we do risk evicting nurses who are absolutely only prepared to work part time. That’d be bad thing - we’d rather have access to their skills than not.

There has to be a sweet spot (an inverted U-curve, speaking statistically) mix of part time and full time employees, but will we know when we’ve found it?

Let’s keep an eye of staff turnover for these two cases, or better let’s create a distribution of staff by contract hour bands and then report on turnover for each. In fact, I’m just off to do that now, for our customers…

Regards, Greg.