Part-time roles ‘positively associated’ with retaining nurses

They said age-related and contractual factors seemed to be stronger drivers of NHS hospital clinical staff retention than organisational factors, based on their study published in the journal BMJ Open.

“The NHS faces great challenges in retaining valuable staff amidst high turnover, ageing demographics and growing care demands”

Study authors

As a result, the study authors said that efforts to keep staff in post needed to be tailored to age and profession, rather than applying a ‘one-size fits all’ approach.

In addition, they argued that much better pay was needed to boost staff retention and ensure the sustainability of the NHS amid increasing demand for healthcare and an ageing workforce.

The researchers, from the University of Surrey, set out to explore factors affecting the desire of clinical staff working in acute and mental health care in NHS hospital trusts in England to stay in post.

As a result, they looked at the demographic, contractual, and organisational factors, such as staff engagement and job satisfaction, associated with the retention of clinical staff.

The study involved a total of 448,568 nurses and midwives of all grades, aged 20 to 70, and 70,777 senior doctors, aged 30 to 70, working in NHS hospitals in 2009-13 and in 2014-18.

The researchers drew on staff survey responses and employment records to track their retention up until 2019-20.

They found that nearly a quarter of senior doctors in acute hospitals held a part-time position, rising to almost a third in mental health trusts.

The opposite was true for nurses, however, with 38-41% of those working in acute care and 27-29% of those working in mental health holding a part-time post across both groups.

Around 9% of doctors were employed under a fixed-term contract, while 3% were in temporary locum posts. However, only 2% of nurses and midwives were in fixed-term posts.

Only around half of all clinical staff in the 2009 group were still working at the same trust five years later. This trend was especially noticeable among nursing staff, noted the researchers.

In mental health trusts, only 42% of nurses from the 2014 group worked in the same organisation for five years, compared with 54% in the 2009 group.

“Demographic and contractual factors appear to be stronger predictors of hospital staff retention than organisational characteristics”

Study authors

Female nurses were more likely to stay at the same trust than male nurses. But in mental health trusts, the odds of female nurses and midwives staying in the same organisation fell sharply in the 2014-18 group compared with the 2009-13 group, both after one and five years.

Nurses of Asian ethnicity from the 2009-13 group were almost 75% more likely to stay at the same hospital trust for five years than White nurses.

In contrast, Black nurses in the 2014-18 group were less likely to remain at the same trust, both after one and five years.

International nurses from both timelines, on the other hand, were more likely to stay in the same trust, but only if they worked in acute care.

Part-time work was associated with nurse retention in both mental health and acute care, while working on a fixed-term contract decreased the odds of staying at the same trust for longer periods.

The retention rate of nurses fell after the age of 50, both in terms of moving to other hospitals and leaving the NHS altogether, according to the study, which was funded by the Health Foundation.

In terms of organisational factors, a higher engagement score on the NHS survey was strongly linked with the retention of nursing staff under the age of 51 in both acute and mental health trusts.

Trust line managers who acted on staff feedback was the only other organisational factor strongly associated with retention after one year, but only for older nurses and midwives in acute hospitals.

The authors acknowledged that their data did not include recent potentially highly influential events, including Brexit, the Covid-19 pandemic and industrial action.

Similarly, factors such as Care Quality Commission ratings and local housing costs were not included in the analysis, though the authors noted that they might also influence retention rates.

The authors said their findings “underscore the importance of disaggregating retention challenges and solutions both by occupation and specialisation rather than taking a one-size-fits-all approach.”

Part-time work, for example, seemed to work well for nurses, possibly because it was more flexible and suited those with care duties, suggested the researchers.

They also highlighted that retention was lowest for both younger and older staff, who were more mobile.

“Younger staff have lower opportunity costs to change jobs,” they said. “Older staff retention is linked to retirement.”

The study authors warned: “The NHS faces great challenges in retaining valuable staff amidst high turnover, ageing demographics and growing care demands.”

Based on their findings, they said: “The results highlight the need for strategies, incentives and policies to improve retention rates and ensure the NHS’s future sustainability.

“Demographic and contractual factors appear to be stronger predictors of hospital staff retention than organisational characteristics,” they stated.

They added: “This study also highlights that proximity to the early retirement and state pension ages, as well as the flexibility of appointment and contract duration, are the primary predictors of retention among NHS clinical professionals.”