Hospital pilot suggests flexible working better for nurse wellbeing

Participants in the scheme were given a greater say in, and choice over shifts, resulting in a large increase in recorded feelings of wellbeing.

“We are committed to supporting and empowering our workforce to ensure we continue to provide the best care we possibly can for patients”

Sue Cox

The findings come from a major two-year project by the flexible working consultancy Timewise and the Institute for Employment Studies, backed by Impact on Urban Health.

The Flex For All project set out to establish how to introduce a sense of flexibility into site-based roles through greater autonomy and choice in working pattern.

Those behind the project said that previously there had been limited coordinated action between employers and industry to redress such workplace inequality.

As a result, three employers were invited to take part in the action-research programme by Timewise. Guy’s and St Thomas’s NHS Foundation Trust, Sir Robert McAlpine and Wickes.

Each were selected because they have large concentrations of site-based workers, and had already made strong commitments to flexible working, health and wellbeing.

Three different methods of data collection were used – employee surveys both before and after the pilots, HR data collection and discussions with those involved.

At Guy’s and St Thomas, they piloted a new rostering process for 15 nurses on the acute admissions ward, in order to give them increased input and control over their shift patterns.

The organisational programme objectives included to challenge traditional attitudes towards shift patterns among managers to accommodate a wider range of working patterns.

Other objectives were to build managers’ skills to implement flexible working and manage teams through the roster and to monitor changes in staff wellbeing, engagement and performance.

According to the report on the project, prior to the pilot, findings revealed a tension between the individual flexible working request system and the expectations and demands of the roster.

Nurses said they wanted more stability, security and control over their working pattern but found the individual flexible working request system limiting or even unfair in a team context.

Pilot activity, therefore, focused on adapting the rostering process for a small group of nurses to give them increased input and control over their shift patterns.

With the senior ward team, Timewise co-designed a trial with a roster group of 15 nurses to increase the number of preferences from five to 10 (five days off and five nights on).

The pilot ran for three months. Check-ins with participants after one month were positive, with people reporting improved work-life balance.

In addition, according to feedback, pilot beneficiaries at the trust explained that having increased control over night shifts improved their sleep.

Beneficiaries also rated their job satisfaction at 5.3 after the pilot, compared with 5.1 for all at baseline (where 1 is completely dissatisfied and 7 is completely satisfied).

Meanwhile, conversations revealed that flexibility enabled some people to work more hours than they otherwise would have been able to, which was particularly significant for lower earners.

For example, in the context of Guy’s and St Thomas’ NHS Foundation Trust, one nurse reported that having greater autonomy motivated her to take on more shifts, said the report.

Sue Cox, associate chief nurse from the trust, said: “Being involved in this pilot programme has supported us in meeting the individual needs of staff to improve their work life balance, all whilst balancing the needs of our patients.”

“At Guy’s and St Thomas’ we are committed to supporting and empowering our workforce to ensure we continue to provide the best care we possibly can for patients,” she added.

Report co-author Astrid Allen, from the Institute for Employment Studies, said: “Our findings suggest that many other employers could benefit from offering similar approaches to their people.”

Nicola Bristow, portfolio manager at Impact on Urban Health, added: “We know that work is not experienced equally, and those working on the frontline face challenges that can impact their health.

“It is an issue of health equity and employers must act to ensure that inclusive practices on flexible work reach those who are already carrying the greatest health burden – people from minoritised communities who are living on low incomes.”

Ms Bristow said the project had shown how being able to work flexibly was a key element of healthier working conditions, bringing greater balance between work and life for better mental and physical health.

“Our hope is that this report acts as a catalyst change in how we think about health at work, and part of a wider movement to make sure that everyone – no matter their role or where they work – can enjoy good health,” she said.