Improving recruitment and retention

Project overview

The national economic situation, COVID-19 recovery and NHS pay negotiations have had an impact on hospice recruitment and retention across the whole country. Peace Hospice Care experienced some extra challenges:

• A significant proportion of the clinical workforce are aged over 50, which means more staff are nearing retirement age and there are fewer younger people to take over roles.
• There are several hospices and palliative care providers in the local area, which gives jobseekers a lot of choice. It is not uncommon for people to accept a role, then pull out because they got a better offer.
• The proximity of the hospice to London means that people don’t have to go very far to get London weighting on their salary.
• If staff are coming from the NHS, they are required to give three months’ notice (however outgoing hospice staff only need to give one month). This means that even if a post is filled quickly, there will be a staffing gap.
• The hospice was in the process of merging with Rennie Grove Hospice, which created some uncertainty for prospective employees.

The hospice needed to act before staff shortages had too much of a negative impact on safe staffing levels, morale and wellbeing.

Outcomes

Peace Hospice developed new roles to help solve the staffing problems. These included:

• Nurse associates
• Nurse consultants
• Clinical Fellowship
• Head of Pharmacy
• Assistant Allied Health Practitioners.

They set up a Palliative Care Response Team, led by a virtual ward sister and including paramedics, to work with the local Macmillan community nurses.

Key facilitators

The hospice has a good relationship with the West Hertfordshire Hospital Trust, who have a good international recruitment programme. Peace has now gained a Home Office licence to employ international candidates. This really opened up the recruitment pool.

Peace worked with two agencies to fill staffing gaps. They trained a group of nurses to work in the hospice, knowing they were likely to return over time. This helped make sure the quality of care was always high, but also gave the hospice a level of flexibility over staffing patterns.

The merger with Rennie Grove Hospice, along with the development of several new posts, has helped create a clear career development path for staff. It is now possible to join the team as a Healthcare Assistant and progress to Director! 

The hospice carries out weekly monitoring for safe staffing levels. If staffing goes below 80%, this now triggers an automatic reaction (this might be recruitment, employing temporary agency staff, etc). This helps ensure the staffing situation does not escalate.

Challenges

Working with the local Acute Hospital Trust, the hospice developed a system of rotational posts for nurses. This was very successful – so much so that, when they finished their rotation in the hospice, nurses wanted to stay! Unfortunately, this meant that the hospital decided to stop promoting the programme.

While it is positive that a number of new staff have joined the hospice, this has resulted in a loss of ‘organisational memory’. Processes have not always been cascaded.