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Improving nurses’ work-life balance with team-based rostering

In a pilot with three hospitals, and supported by the Burdett Trust for Nursing, Timewise explored whether a team-based approach to the roster could give nurses greater control of their working patterns. The goal was to improve nurses’ work-life balance, with a view to alleviating the NHS staffing crisis.

Nurses team based rostering

Getting and keeping staff is now the number one challenge for the NHS. And the NHS Long Term Plan recognises that poor work-life balance is a key underlying reason.

From our work across many sectors, Timewise knows that work-life balance is a key element of any ‘great place to work’. But how can hard-pressed ward managers, trying to provide 24-hour patient care with limited resources and at the same time satisfy clinical requirements for particular skills on particular shifts, also facilitate work-life balance for nurses?

Timewise set up a pilot to explore one way of addressing this problem. We worked with 240 nurses in seven wards in three hospitals, to test whether a team-based rostering system could improve nurses’ work-life balance. The aim was to increase nurses’ input into their own working patterns.

“The biggest thing is acknowledging everyone’s preferences and having a mutual respect for the staff work-life balance, and not just a focus on childcare – that’s very positive."

Ward Manager

Why team-based rostering?

Timewise developed the team-based approach to counteract a number of downsides in the current roster process. The first is that flexible working arrangements are rationed to make the shift system work. This creates a two-tier system with ‘special’ arrangements for a few, and flexibility discouraged for everyone else.

More than in any other profession Timewise has worked in, childcare tops the ‘hierarchy of needs’. Nurses with other reasons to want flexibility are expected to be available in whatever pattern is left. The result is a sense of unfairness and resentment.

In the team-based approach we developed, all the needs of all nurses on the ward are considered. Producing a fair rota is a collective responsibility, requiring cooperation across the ward. 

Measuring the impact

Pre and post surveys of participants showed that the proportion of nurses who:

  • felt their work-life preferences were being met went up from 39% to 51%
  • scored highly on amount of input they have into rosters went up from 14% to 26%.
  • felt they had a strong sense of collective responsibility improved from 16% to 36%.

The costs of implementing this approach (training time, and the increased time to put the roster together) need to be set against these benefits.

Key conclusions

Overall, we are cautiously positive about the results of this pilot. Our key conclusions are:

  • The approach has three main benefits: better meeting nurses’ work-life preferences; increasing nurses’ input into rosters; and improving collective responsibility.
  • Distributing responsibility among a lead team also improves the quality of the conversations about work-life balance.
  • There are costs attached – upfront training time and an increased time for a team to put the roster together (compared to the time of a single roster-creator).
  • Ward managers play the key role in making the approach work. Implementation is much smoother where ward managers are willing to step back and delegate responsibility.
  • Lead team members need to be chosen carefully, to ensure they have the right skills.

Policy recommendations

The report makes three key policy recommendations for the NHS:

  1. For NHS Trusts to scale up the team-based approach as part of shared governance initiatives. NHS professionals can request the Timewise ‘how-to’ guide that resulted from the pilot, by emailing info@timewise.co.uk.
  2. For policy makers such as NHS E/I to provide better definition of what flexible working means in a rostered environment, and better guidance on how to build work-life balance for all nurses into the roster.
  3. For NHS Trusts to develop better training and guidance on e-rostering for work-life balance.

Published September 2019

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